Picking up the pace on Rx pricing reform
In uncertain health care environment, Congress should swiftly protect patients most in need
As Congress considers the future of ObamaCare, it should also take steps to correct another misguided federal policy that created a new 'preexisting condition' and inadvertently prevented some of the most vulnerable Americans from accessing the health coverage they needed.
For Americans battling rare and catastrophic conditions, such as cancer, HIV/AIDS, and hemophilia, treatment costs can reach upwards of $500,000 per year. In order to account for these pricey medications, health insurers often charge patients living with devastating diseases higher monthly premium rates than healthy individuals. As a result, the chronically ill find themselves making difficult choices such as choosing between paying rent and taking their medications.
Fortunately, non-profits, civic groups, and churches have been providing a temporary safety net for these patients for decades by helping them cover the cost of their insurance premiums and copayments. Without this charitable aid, hundreds of thousands of Americans would not be able to access their life-saving and life-sustaining treatments.
Not only do these charitable patient assistance programs save lives, they do so at no expense to the American taxpayer.
Yet, under the Obama administration, the U.S. Centers for Medicare and Medicaid Services (CMS) introduced a policy allowing health insurers offering plans under the Affordable Care Act to deny non-profit charities from providing premium and copay assistance to patients. CMS authorized Ryan White HIV/AIDS Programs, Indian Tribes, and other state and federal programs to provide financial assistance - but not charitable organizations. Perhaps even more puzzling, this CMS guidance is in direct contradiction to the standard currently followed by Medicare.
Instead of creating a more hospitable health care environment for patients with devastating diseases, CMS is threatening access to critical treatments and services for those who need them most. Currently, health insurers in 41 states are citing this rule to deny coverage to those who benefit from charitable patient assistance, effectively pushing health care out of reach for many of the most medically vulnerable.
This is why I am reintroducing the Access to Marketplace Insurance Act, a common-sense, bipartisan solution to correct CMS' harmful guidance and help ensure that patients have access to the care that is right for them.
The Access to Marketplace Insurance Act, which was co-sponsored by 146 of my colleagues last Congress, would remove the handcuffs from private charities, allowing them to assist insured patients who need help paying for their insurance without fear of breaking the law. It would help Americans living with chronic conditions who, through no fault of their own, need expensive treatments to survive. I also led a letter earlier this year that garnered support from 183 bipartisan House Members urging HHS Secretary Tom Price to protect the ability of charitable assistance programs to provide premium and cost sharing assistance to patients.
Regardless of the changes ahead for the U.S. health care system, Americans with expensive diseases need help now to mitigate the effects of prohibitive insurance costs. I urge all of my colleagues in Congress to join me in ensuring that charities can continue to be charitable by co-sponsoring the Access to Marketplace Insurance Act. Many lives depend on it.
Congressman Kevin Cramer represents North Dakota's at large district and is a member of the Energy and Commerce Committee.