The following is a statement from the Chronic Disease Coalition executive director Scott Bruun in response to an interim final rule issued by the Centers for Medicare and Medicaid Services, regarding dialysis companies providing premium assistance for individual marketplace plans either directly, or through a third party.
On Monday, December 12, the Centers for Medicare & Medicaid Services (CMS) issued an administrative rule that will have a major and harmful impact on kidney patients, especially those who are low-income and likely the most vulnerable.
The rule contends it will provide, among other things, “greater transparency” around charitable assistance programs and to “ensure that patients get the information they need to make coverage decisions that are right for them.” The Chronic Disease Coalition applauds every effort to provide for transparency and patient education about insurance options. A patient’s full understanding of treatment, costs and insurance coverage options are key factors in successful disease management and quality of life.
However, we are deeply troubled that CMS has failed to acknowledge or address the very real issues currently affecting patient protection and treatment, much less the additional problems this new rule could create.
An issue of major concern and demonstrable patient harm includes the documented efforts by insurance companies in numerous states to reject charitable premium assistance. With profit as their motive, many insurers are attempting to screen out patients with chronic conditions by restricting their options for paying their bills.
By selectively disallowing charities to assist financially vulnerable disease patients, many insurance carriers are effectively discriminating against those patients based on disease. This, in turn, may prohibit patient choice and limit treatment options by steering those patients into government insurance programs. These issues clearly violate the spirit, if not letter, of the Affordable Care Act. And the consequences fall on patients – not on health-care suppliers or on insurance carriers.
For the past few years, CMS has provided protection for some groups of people, such as those living with HIV/AIDS, by requiring insurers to accept premium assistance from certain programs, but the agency has failed to extend those protections to people with end-stage renal disease or other chronic illnesses.
The Chronic Disease Coalition is hopeful that the CMS will reevaluate and amend its recent ruling in light of the very real patient harm issues left unaddressed. We are also hopeful that Congress will immediately take up efforts to protect patients from discrimination by passing HR 3742, the Access to Marketplace Insurance Act, which would require insurance companies to accept premium assistance from qualified, third-party nonprofit organizations.
Patients have a right to choose the right health plan for themselves and their families. It’s not a choice that should be dictated by the profit motives of insurance companies.
Read more about this issue here: https://chronicdiseasecoalition.com/patient-advocacy-groups-send-joint-letter-to-cms-defending-charitable-premium-assistance-programs/.