5 findings from a federal judge on kidney patients’ right to use charitable premium assistance

1.17.17

A federal judge last week halted a controversial rule that would have let insurance companies deny coverage to lower-income kidney dialysis patients.

U.S. District Judge Amos Mazzant, in Sherman, Texas, put a temporary restraining order on the Centers for Medicare and Medicaid rule, which otherwise would have taken effect last week.

The rule would allow insurance companies to reject premium payments from dialysis patients who rely on charitable premium assistance – financial aid from nonprofit organizations – to pay their bills, essentially allowing insurers to avoid covering patients with a chronic condition they don’t want to cover because of the expense.

The Chronic Disease Coalition is pleased that the judge sees through insurance companies’ lobbying and is siding with patients. However, the hold on the rule is only temporary – there is still work to be done to ensure our rights are protected and that sick, lower-income patients are able to access the best health plan for themselves and their families.

Here are five important findings from Judge Mazzant’s ruling last week:

    1. Charitable premium assistance provides a lifeline to patients with end-stage renal disease (ESRD), or kidney failure, who are more likely to be low-income because they often can’t work full-time due to their health condition.
    Dialysis treatment is expensive and must be performed multiple times per week, for hours each time, to effectively clean the blood.
    “This limits ESRD patients’ means to work full time, and patients cannot afford treatment without insurance,” court records state. “Given the expense and vulnerability of ESRD patients, charitable organizations provide premium assistance to eligible ESRD patients. These charities, such as the American Kidney Fund (“AKF”), often provide assistance to patients based on financial need, regardless of which insurer — whether private or public — the ESRD patient has selected.”
    2. Patients need the right to choose the best health plan for their individual situation.
    Many ESRD patients, even if eligible for Medicare, choose to purchase private, commercial insurance because Medicare does not provide coverage for spouses and dependents, the court found, among other key differences.
    3. Insurance companies have been given excessive influence over CMS’ decision-making.
    When CMS issued a request for information earlier this year, it received 829 responses, a majority of which came from patients, patient advocacy organizations, charities and dialysis providers who supported patients’ right to use premium assistance and explained the rules in place to prevent steering patients to one plan or another. In addition, there were 15 responses from insurance companies that were critical of premium assistance.
    Even so, the government rule is weighted heavily toward insurers rather than the hundreds of comments received from charities, consumers and concerned activists.
    4. Allowing insurance companies to reject patients who receive help from charities to pay their premiums would force many patients onto Medicare, and it would leave others without any option to pay for the dialysis treatments they need to survive.
    “As to ESRD patients, the Rule will cause them to shift to public insurance options, and many patients would be better served by private insurance options,” court documents state. “Not all ESRD patients qualify for Medicare and Medicare does not cover families. Therefore, some ESRD patients and their family members would lose insurance coverage altogether if forced to change to public insurance.”
    5. The temporary restraining order does not undo the harmful CMS rule.
    The incoming Trump administration could help to ensure kidney patients have the same choice every other American has over their health plan.

Regardless of what happens with this controversial federal rule, many big insurance companies are already rejecting coverage for lower-income kidney patients who rely on premium assistance to pay their bills. To do this, they are going around the federal government at the state level to deny coverage to lower-income kidney patients.

Working together we can urge government leaders to see through insurance companies’ tactics and protect the rights of low-income kidney patients along with all American consumers.

Read more:

  • 6 reasons people oppose a government rule that will take away kidney dialysis patients’ choice
  • Take action to stop health insurers from denying coverage to kidney dialysis patients
  • Feds take a stand for insurers over vulnerable patients
  • Chronic Disease Coalition calls on federal government to overturn rule enabling insurers to discriminate