Op-Ed: Serious ACA Wrinkle Jeopardizes Help for Chronic Patients

Advocacy News
Note: The following is an op-ed written by Charlene Cowell, executive Director of HFA member organization Hemophilia of North Carolina. This article was originally published by the Raleigh News & Observer. To learn more about this issue affecting third party premium assistance, visit our Advocacy page.

Despite a significant uptick in the number of insured North Carolinians as a result of the Affordable Care Act, federal guidance might have inadvertently created a new “pre-existing condition” that is jeopardizing this coverage for many of our state’s most vulnerable patients.
North Carolinians living with chronic and life-threatening illnesses, such as bleeding disorders, cancer and autoimmune diseases, often face extreme financial pressures to obtain the health insurance they need to manage their conditions. For many of these patients, baseline monthly insurance premium payments are enough to break the bank.
That is why nonprofit premium assistance programs are so critical. These programs help patients with chronic conditions cover the costs of their monthly premium payments so they don’t have to choose between paying for insurance and paying rent.
But federal guidance issued by the U.S. Centers for Medicare and Medicaid on acceptable third-party payments for patients covered under the ACA is making it possible for health insurers to reject patients who receive premium assistance from nonprofit charities.
North Carolina is one of 38 states with health plans that are denying coverage to patients based on this CMS rule. Now-threatened premium assistance programs serve as lifelines to many patients, particularly those with debilitating and expensive medical conditions. The programs must be protected.
As executive director of a nonprofit organization dedicated to improving the quality of life of persons affected by bleeding disorders, I work with patients every day who are in financial distress due to their medical expenses. I frequently refer patients to nonprofit premium assistance programs, and I can attest to the indispensable services they provide.
And the support they offer extends far beyond financial assistance. Patients often tell me how their lives have been changed by premium assistance programs – not just because of the relief that comes with knowing they can pay their bills but because of the unwavering counseling and legal support that they have received. That can make all the difference for patients confronting serious medical conditions.
When patients cannot afford their medications, it is not only their health that suffers. Prohibitively expensive medication has forced many patients to declare bankruptcy. Others enroll in government programs or visit hospitals for their primary care needs, which drives up costs for North Carolina taxpayers.
Fortunately, the Access to Marketplace Insurance Act (H.R. 3742) is bipartisan legislation that would protect the ability of nonprofit charities to continue to provide premium assistance under existing CMS guidelines.
Nonprofit premium assistance programs are invaluable resources for North Carolinians living with chronic diseases. North Carolina’s congressional delegation should cosponsor H.R. 3742 to make sure those who receive charitable premium assistance have access to the vital treatments and services they need.
Let North Carolina charities be charitable.