THE BLOG
10/04/2016 12:22 pm ET Updated Oct 05, 2017

INSURANCE JUSTICE FOR KIDNEY FAILURE PATIENTS

Imagine that you were lucky enough to get health care through the Affordable Care Act (ACA), that you were paying your $300, $400, or $500 a year monthly payment. While the cost might stretch your budget, you wouldn't mind. You had peace of mind knowing that you'd be covered if anything went wrong.

You might have been among the millions who breathed a sigh of relief because you knew than an insurer could not deny you health care because of a pre-existing medical condition. You felt secure that you could access health care without fear that your health status would be a barrier for you. You might rest easy unless you had kidney failure. Then, you might find that health insurers have a loophole to exclude those kidney failure patients whose health conditions make it difficult for them to pay their premiums, and whose fine print in their insurance policies preclude them from taking help to pay their premiums.

Some of the people who can't afford to pay premiums need, and can find, a little help, are forbidden to get it by the fine print in their policies that say they must use their own funds, and accept no outside help. Meanwhile, the American Kidney Fund helps more than 70,000 patients a year with their premiums because dialysis on Medicaid is more onerous than dialysis on private care. Further, if you've been paying private health premiums for decades, shouldn't you have the benefits of private health care?

Those who are affected by these policies are disproportionately black and brown. African Americans represent 13 percent of the US population, but 32 percent of those with kidney failure. The rate of kidney failure among Latinos has increased by an astounding 70 percent since 2000, and Latinos are 1.5 times as likely as whites to be diagnosed with kidney failure. While insurers may say they don't intentionally discriminate, the adverse outcomes are undeniable.

We've been down this road before. Aetna recently announced that it would become the latest insurer to pull of the ACA exchanges because they apparently weren't making enough of a profit on the plans they offered. Meanwhile, the company as a whole raked in nearly $7 billion in profits last year - far above what even the most optimistic Wall Street analysts projected. And its CEO took home almost $28 million in take-home pay last year alone.

The Centers for Medicare & Medicaid Services (CMS) should not limit the ability of charitable groups to provide financial assistance for low-income patients who wish to enroll in private coverage. Indeed, CMS should applaud it! After all, if someone has paid private insurance premiums for years and now needs help to keep paying them, CMS should appreciate organizations like the American Kidney Fund, who are willing to stand in the gap for patients who are having challenges paying their premiums. To oppose this help goes against the ACA promise all Americans - regardless of income or health status - can freely access the health exchanges to select a private insurance plan so long as they have not already enrolled in Medicare or Medicaid. This rejection of charitable assistance to patients seeking private health insurance is yet another tool insurers have been employing in their efforts to push away sick patients, and it's unfathomable that it might soon be supported by CMS policy.
If insurance companies are able to collect their premiums, they should not care where they come from. To prevent patients from accepting assistance from premium support programs limits their possibilities for health care, especially with kidney failure treatment, and also pushes already needy patients further into poverty. Instead of restricting premium assistance, insurers should be grateful for it. Certainly, patients are enhanced when they are assisted by those charitable organizations that would expand their options for quality care.

If insurers can arbitrarily reject charitable assistance payments for patients - lining their pockets while limiting patients' options for care - then what's next? Should cancer patients with costly but lifesaving therapies anticipate the same? Will insurers find new and novel ways to eliminate patients from their rosters who suffer from ALS, diabetes, cancer, or heart disease? In the long run, we may all be impacted when insurance companies have the option to cherry-pick those they cover.

Six short years removed from passage of the ACA, it's shameful that our nation's sickest patients continue to face obstacles in obtaining the care they so desperately need. It's even more outrageous that policies adopted by private insurers could soon be supported by federal regulations.

Before the care of a single patient is further disrupted, and before health insurers add another dollar in profit to their balance sheets because they are able to discriminate against the sick, our nation's policymakers to take a hard look at the direction we're headed and remember the patients for whom protective healthcare policies were created in the first place. If charitable organizations are willing to support kidney failure patients by helping them pay insurance premiums, insurance companies should applaud, not repel, this assistance.