May 09, 2016, 03:00 pm

A new "pre-existing condition" for those living with chronic and life-threatening illnesses

By Dana A. Kuhn

When Congress passed the Affordable Care Act (ACA) in 2010, it took the historic step of preventing health insurers from discriminating against patients with pre-existing conditions. Unfortunately, guidance from the U.S. Centers for Medicare and Medicaid Services (CMS) is now risking those gains and keeping essential treatments and services out of reach for vulnerable patients who need them the most. In so doing, CMS has inadvertently turned not being able to afford your health insurance premium into the new ‘pre-existing condition.’ This is contrary to the intent of the ACA.

For many individuals living with chronic and life-threatening illnesses such as cancer, arthritis, HIV, hemophilia and autoimmune diseases, the costs of simply maintaining their health insurance can be prohibitive due to marketplace plan variations. Charitable non-profit premium assistance programs have stepped in to help thousands of these families pay their monthly insurance premiums and provide them with a temporary safety net that can often mean the difference between life and death.

Yet, when CMS issued federal guidance on third-party insurance payments for the new Exchange plans offered under the ACA in 2014, it failed to include non-profit charities on the list of acceptable arrangements for patients covered by qualified health plans, which it previously included in a February 7, 2014 Frequently Asked Questions (FAQ). Exemptions have been extended to Ryan White HIV/AIDS Programs, Indian Tribes, and other state and federal programs – but not nonprofit charities. The CMS guidance is in direct contradiction to the standard currently followed by Medicare.

As a result of the CMS failure to include nonprofit charities as an acceptable third party premium payment arrangement, health plans across 38 states are now denying coverage to patients by rejecting the assistance they receive from third-party charities. More insurers are likely to follow suit.

When patients cannot afford health insurance and are unable to access health care, the impact extends beyond their health. When health care becomes prohibitively expensive, many patients declare bankruptcy. Others enroll in expensive government programs or turn to hospitals for their primary care needs, which drives up uncompensated care costs for all taxpayers. In this era of health care cost containment, non-profit patient assistance programs help to maintain the health and financial stability of patients, but they do so with charitable donations rather than through government or taxpayer funds.

Patient Services Inc. (PSI) and other leading national patient advocacy organizations this week launched the Marketplace Access Project (MAP), a patient advocacy movement dedicated to protecting non-profit premium assistance for those living with chronic and life-threatening illnesses. No patient should have to choose between paying for insurance and paying their rent or providing food for their families.

Fortunately, there is a common-sense, bipartisan legislative solution that will correct the harmful CMS guidance and help ensure that patients have access to the treatments and services they need. The Access to Marketplace Insurance Act (H.R. 3742), introduced by Rep. Kevin Cramer (R-ND), would allow non-profit charity organizations to continue providing premium assistance under the Affordable Care Act.

We urge Congress to let charities be charitable and pass the Access to Marketplace Insurance Act.

Dana A. Kuhn, Ph.D., is the founder and president of Patient Services Incorporated (PSI), a non-profit charitable organization that helps patients find health insurance and then provides or subsidizes the cost of health insurance premiums/co-payments for persons suffering from specialized expensive chronic illnesses.