by: PSI, Mandy Herbert & Jim Romano

Published: Lifelines for Health Spring 2018

Patient Services Incorporated (PSI) is leading the effort to pass H.R. 3976, The Access to Marketplace Insurance Act, and protect the valued safety net of patient assistance. This legislation is in response to a regulation issued in 2014, during the implementation of the Affordable Care Act (ACA), that allowed Marketplace insurance companies to deny charitable third-party premium and cost-sharing assistance. The rule essentially provided a permission slip to health insurance providers to prohibit assistance by charities looking to help patients in need in order to shift sicker patients off their plans.

Since 2014, the impact of this regulation has been considerable, with approximately 90 insurance plans in 43 states having implemented the prohibition. This rule allows insurers to evade the reforms of the ACA removing the pre-existing condition exclusions and provides an open route to discriminate against
patients with higher healthcare costs simply because they receive assistance. Taking these discriminatory practices, a step further, health insurance providers have also attempted to expand this prohibition into other markets including the Medicare Supplemental Insurance Market.

In response to this misguided policy, PSI created the Marketplace Access Program (MAP) coalition to bring together leading patient advocacy groups and patient assistance organizations dedicated to protecting charitable assistance for individuals suffering from chronic and life-threatening illnesses. The focal point for our coalition’s work is H.R. 3976, federal legislation that would require insurers to accept assistance from non-profits, places of worship, and local civic organizations. PSI has worked closely with H.R. 3976’s sponsor, Congressman Kevin Cramer (R- ND), to develop this legislation and stop this harmful policy from continuing.

We have made great progress on the bill, garnering over 130 cosponsors since introduction in October.

PSI would welcome any assistance from readers who would like to get involved. If interested, please contact PSI at jromano@uneedpsi.org or (804) 521-7908 for more information.