By Matt Hadro
Washington D.C., Aug 15, 2016 / 23:08 pm
Sponsors of a proposed bill in the U.S. Congress say that churches are not able to help pay people's insurance premiums in 38 states, but is that really the case?
"There's nothing actually that prevents the church now," JoAnn Volk, project director at Georgetown University's Center on Health Insurance Reforms, told CNA. "If you wanted to just help someone pay their bills, there's nothing that prevents that."
A proposed bill in Congress – H.R. 3742, the Access to Marketplace Insurance Act – states that non-profits can offer premium assistance to people with health plans on the state exchanges set up under the Affordable Care Act.
"People with chronic, rare, and acute diseases have the right to get the help from third party organizations, and insurers have no sound reason to deny these payments," Rep. Randy Hultgren (R-Ill.), one of 94 co-sponsors of the bill, stated.
The reason for the bill, according to Hultgren, is that under the health care law "the Centers for Medicaid and Medicare Services released an interim final rule which gave authority to insurers to deny non-profit charities from providing premium assistance."
However, insurers were not specifically instructed to deny or discourage all charities from helping pay medical bills, Volk explained.
Rather, for health plans on the state exchanges, the administration "discouraged" insurers from accepting third-party payments by patient advocacy groups which focused on people with specific health conditions.
These are groups like the Muscular Sclerosis Society and the National Hemophilia Foundation, which provide financial assistance for patients with chronic conditions to pay their monthly premiums, she said.
The reasoning behind this rule was because helping only those with serious medical conditions enroll in the insurance marketplaces could skew enrollment toward high-risk patients, where fewer healthy enrollees would be subsidizing more enrollees with chronic health conditions, Volk explained.
In 2013, the CMS published a Q & A about this topic. "[The Department of Health and Human Services] has significant concerns" about third-party payments, it said, "because it could skew the insurance risk pool and create an unlevel field in the Marketplaces."
Basically, the statement was to "discourage insurers taking payments from charitable organizations that target their assistance based on health diagnosis," Volk explained.
Then in February of 2014, CMS followed up with a clarification. Charities and churches were allowed to offer premium assistance, as long as they did so based on income need and not health condition – "based on financial status and do not consider enrollees' health status," as CMS stated.
In April of 2014, the Catholic Health Association and American Hospital Association wrote then-Secretary of Health and Human Services Kathleen Sebelius and asked her for a statement confirming that the administration was "not discouraging hospital-affiliated or other charitable foundations from subsidizing premiums" on the exchanges, or helping with "cost-sharing expenses for needy enrollees."
In her response, Sebelius reaffirmed CMS' statement that charities were allowed to help with premium payments as long the assistance was income- and not condition-based.
However, although any stories of church assistance being refused by insurance companies are "anecdotal right now," insurers are sending letters stating that they are not accepting third-party payments by non-profit organizations, Dana Kuhn, founder and president of the patient advocacy group Patient Services, Inc. told CNA.
60 plans in 38 states "are returning checks from non-profit organizations, once they find out they're a non-profit organization that is paying a premium on behalf of a person with a chronic condition," he said.
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The fact that the prohibitions stand for "third parties," without specifying that income-based assistance by charities and churches will be accepted, is troubling, he said.
For instance, a March, 2014 letter from BlueCross BlueShield of Louisiana stated that they were "not accepting premium payments from any third parties who are not related (by blood or marriage) to the subscriber."
UnitedHealthcare of North Carolina told members in a coverage packet that they could not "accept any direct or indirect contribution or reimbursement by or on behalf of any third party." The only exempt parties were, again, those exempted by CMS. Churches and charities were not specifically mentioned.
A November, 2014 letter From BlueCrossBlueShield South Carolina stated that CMS "has encouraged insurance companies offering plans through the Federally Facilitated Marketplace to reject premium payments made by third parties on behalf of members in certain circumstances."
Regardless of churches and other charities, patient advocacy groups"like Patient Services, Inc. that help people with specific chronic conditions say their payments should be accepted anyhow. They are now pushing for the passage of the bill in Congress to have insurers accept their premium payments.
Medical costs for people with chronic health conditions can be high, and despite the health care law capping out-of-pocket medical expenses, some situations still may require financial assistance.
According to the National Hemophilia Foundation, someone suffering from severe hemophilia could incur up to $300,000 a year in treatment costs. Someone waiting for a kidney transplant – currently more than 100,000 Americans – will need expensive weekly treatments just to survive, according to the American Kidney Association.
Unable to pay for a health plan they need, people might resort to skipping treatments, enrolling in Medicare or Medicaid, or using emergency rooms for health care, the Marketplace Access Project claims.
Rejection of third-party payments by patient advocacy groups for those with chronic health conditions "is really a backdoor way of a pre-existing condition, which the ACA was supposed to absolve," Kuhn maintained.
"The people who need the help have a health condition," he said.
So the bill, introduced by Rep. Kevin Cramer (R-N.D.) last November, allows these charities and other third parties to continue making these payments. The list of 98 co-sponsors is bipartisan: more than 30 Democrats have co-sponsored the bill.
A valid concern – and a reason behind the regulation, Kuhn admitted – is that certain groups "in conjunction with" pharmaceutical companies and other providers "were putting people on the marketplace plans because the reimbursement is better," although the patients qualified for Medicaid and Medicare.
He said that Patient Services, Inc. ensures that patients qualify for Medicare and Medicaid first before exploring plans on the exchanges.
"We've got to figure out a way to fix this so that charitable non-profits aren't penalized because of other maybe charitable organizations that were created at the bequest of a provider, to just be able to sidestep this," he concluded.
