Health insurers are preventing chronically ill patients from accessing life-saving treatments, which is why Congress must ensure charities remain a safety net.
As the future of healthcare in America remains uncertain, health plans in 41 states are currently denying coverage to patients with chronic conditions because they receive life-saving support from non-profits.
Safety net holes
In 2010, Congress passed the Affordable Care Act (ACA); while this was historic in ending the long-standing practice of health insurers dropping patients with pre-existing conditions, there remained holes in the safety net.
The Centers for Medicare & Medicaid Services (CMS) issued a rule in 2014 where patients couldn’t seek third-party assistance to health plans in the ACA exchanges. Unlike with the Ryan White HIV/AIDS Program and Indian tribes, “CMS failed to include non-profits as an exemption,” cites the Marketplace Access Project, a patient advocacy movement dedicated to protecting non-profit assistance for individuals with chronic illnesses.
Agents of change
One such non-profit, Patient Services Inc. (PSI), is stepping up to petition both CMS and Congress to expand these exemptions and repair the safety net for our most vulnerable patients.
“When we engaged CMS, their attitude was ‘it’s only a couple of plans being denied, it wasn’t our intent, we’re not going to change it,” says James Romano, Director of Government Relations at PSI. When Romano engaged Capitol Hill, he saw more enthusiastic responses. “After August’s congressional recess, Representative Kevin Cramer will introduce a bipartisan bill to codify the rule in the ACA to protect non-profits’ ability to provide premium and cost-sharing assistance.”
However, nothing will change unless patient communities and the public press their legislators to act. Not only do these charities save lives, they save taxpayer dollars.
Find your representatives at house.gov/representatives/find and encourage them to co-sponsor Representative Cramer’s Access to Marketplace Insurance Act in September.