Congress wants HHS to roll back rule that bars charities from helping patients pay premiums

A bipartisan group of lawmakers is asking the Department of Health and Services to reverse a rule governing third-party payment of premiums for ACA marketplace plans.

A group of lawmakers is asking federal health officials to reverse a policy that they say discriminates against chronically ill patients, but which was meant to stop the practice of steering those patients to higher-reimbursement plans.

The policy in question is part of a federal rule enacted during the Obama administration, which excluded nonprofit charities, places of worship and local civic organizations from a list of approved “third-party payers” of premiums for qualified health plans under the Affordable Care Act. Before the rule, many dialysis patients received financial assistance from these third parties to help pay their health plan premiums and out-of-pocket costs.

Last year, the Centers for Medicare & Medicaid Services said there was a widespread practice among dialysis providers of directing Medicare- or Medicaid-eligible dialysis patients into ACA marketplace plans by connecting them to industry-backed charities that can help pay their premiums. Such private plans offer higher reimbursement rates, making the practice lucrative for providers.

Now, though, Congress is pushing back. In a letter (PDF) sent to Health and Human Service Secretary Tom Price this week, a bipartisan group of 184 lawmakers argue that the rule “encourages qualified health plans to discriminate against people with rare and chronic diseases” as it allows ACA marketplace insurers to reject them if they are receiving charitable assistance from certain groups.

“This practice essentially allows insurers to ‘steer’ patients to the government or to other plans to avoid providing coverage,” they wrote, noting that nonprofit patient assistance programs offer a bridge to care for many of the sickest patients.

The lawmakers ask HHS to issue a new rule that allows patients to receive premium- and cost-sharing assistance from nonprofit charities, places of worship and local civic organizations. However, they also urge the agency the ensure that patients are the ones in charge of picking the health plan that works best for their needs.