Congress must ensure charities remain safety net for patients

As Congress gets ready to reform the Affordable Care Act (ACA), the health insurance industry has set its sights on an unlikely target: nonprofit charities that provide premium and co-pay assistance to patients in need.

Precisely because these charities step in and help chronically and terminally ill patients stay on and use their private insurance, health insurers want those patients off their rolls. Congress must act to ensure that charities remain a vital safety net for these patients.

Even today, both private insurance and Medicare leave many Americans behind, making it virtually impossible for the chronically ill to maintain the health coverage they need. While the private insurance market covers those with preexisting conditions, there is no assurance these patients can afford that insurance or their medications.

For example, chronically and terminally ill patients often are prescribed medications that are not on the lower-tiered plans, mostly because less-expensive generic alternatives do not exist. Thus, these patients must pay the higher premiums of gold and platinum plans in order to secure this coverage.

But that still does not suffice, as these higher-tiered plans have large deductible and coinsurance requirements that force these patients to pay substantial out-of-pocket costs on top of their premiums. All told, these patients can pay as much as 30 percent of their gross incomes on their medical care.

The financial reality for Medicare-insured patients is equally bleak. Medicare Part D beneficiaries face the “donut hole” — a certain expense threshold beneficiaries reach that requires them to pay 50 percent of their prescription drug costs. This, too, forces patients to make terrible choices between food and shelter or lifesaving medicines as they are often on fixed incomes.

Congress, however, can fix this problem. First, it could seek reasonable solutions to make the coverage gap less burdensome. However, the incoming Congress is unlikely to support additional federal spending given its desire to pare back the ACA. A more realistic approach would be for Congress to pass legislation to empower charitable organizations to support these patients through premium and co-pay assistance, a path that would not cost taxpayers a cent.

{mosads}Almost 30 years ago, I founded the first charity of its kind to help patients in need pay for their insurance premiums and their medication. Today, nine charities provide $1 billion in annual assistance to over half a million Americans.

Without this charitable support, many of these patients would lose their homes, skip or not take appropriate drugs, have less food on their tables, or be forced down the path of bankruptcy. Indeed, many couples have involuntarily divorced so that sick children could qualify for Medicaid.

Why is Congress needed? Because insurance companies are targeting these charities at both the federal and state levels, seeking to ban this charitable assistance and force patients into federal programs where taxpayers must foot the bill.

For insurance companies, it is all about their profits. Nonprofit, charitable support of these patients enables them to stay on their employer-provided or ACA-obtained private insurance and afford the actual medications their doctors prescribe.

Insurers don’t want that. They want to force these patients toward insolvency so that they are forced onto federal support programs.

Of course, insurers do not acknowledge their profit motive. They claim that, because pharmaceutical companies are the primary donors to these charities, the charities are somehow propping up higher prices for medicines than would otherwise be the case.

But this makes no sense. While charities provide $1 billion in annual assistance, the total American pharmaceutical market is $400 billion. With support for just a quarter of a percent of this spending, there is no way these charities are doing anything other than supporting patients.

Just as food retailers give to food banks, drug companies give funds to charities to help patients afford needed treatments. In addition, in the case of my organization, many patients we assist have rare diseases where there is only a single drug for their treatment. There are simply no other lower-cost products available that would reduce insurer costs. Preventing patient assistance for these populations can be a death sentence when they have no other options.

It is not economically or politically feasible for the government to cover all costs associated with financially vulnerable patients’ out-of-pocket expenses.

However, the legislative approach is already gaining traction. With over 140 co-sponsors and broad bipartisan support, the Access to Marketplace Insurance Act (H.R. 3742) would let patient assistance charities be just that — charitable.

If enacted, this bill would simply add nonprofit charity assistance to the list of existing, acceptable third-party premium assistance programs, reversing the insurers’ recent efforts.

We should recognize that outlawing denial of coverage for preexisting conditions is a necessary consumer protection — a provision of the ACA that President-Elect Donald Trump agrees should remain intact. Being unable to afford your insurance and medication is just another invidious form of a preexisting condition.

The time is now to shine a light on those who have fallen through the cracks of our healthcare system and support them. Most importantly, the time is now to stop insurers from removing a vital safety net for the most desperate patients.

Dana Kuhn, Ph.D., is the founder and president of Patient Services, Inc., a nonprofit charitable organization that helps patients find health insurance and then provide or subsidize the cost of health insurance premiums/co-payments for persons suffering from specialized expensive chronic illnesses.

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