If anyone doesn’t know why the public is fed-up with our government, all they need to do is look at yesterday’s RFI on third party payment, which can best be summarized as “politics as usual” and big insurance dictating its own agenda. The former CMS Administrator – who is now the nation’s leading lobbyist for the insurance industry – appears to be getting the Agency to prioritize her new employer’s desires over the needs of the nation’s most vulnerable patients. To put even more pressure on the Obama Administration, Aetna just threatened to pull out of even more health insurance exchanges if it doesn’t get its way, despite record profits overall that continue to exceed even Wall Street’s expectations. Meanwhile, large insurers are portraying dialysis in a negative light for donating to charities that help patients pay for their insurance coverage – which unfortunately is the story line that many news outlets appear to be going with.
When will we start to focus on what really matters – the impact of our policies on patient access to care, and in particular some of the sickest and most vulnerable members of our society. Right now CMS seems to be extremely concerned with who is making more money – the insurers or the health care providers. Did the Administration forget that the Affordable Care Act was enacted to prohibit insurance company discrimination based on pre-existing conditions? Why aren’t we talking about health insurers efforts to convince CMS to roll back the pre-existing conditions ban, so that it can then dump some of its sickest patients of their plans who are supposed to protected by the ACA? What about the devastating impact when a patient with more robust private insurance is forced to switch over to less generous federal coverage with higher out-of-pocket costs? Did CMS forget that Medicare requires 20% coinsurance payments from patients, offers no out of pocket maximum protection, often offers less generous benefits (such as limited financial assistance for diabetic testing supplies) and is often accepted by far fewer health professionals? So now instead of trying to figure out how to protect “patient choice,” CMS is considering whether to eliminate the ability of patients to receive any outside help in paying for their care.
How are we supposed to explain to the 28,000+ dialysis patient members whom we serve, many of whom frequently have to set-up their own “Go Fund Me” pages to help pay for their medical expenses, that there are those in our government who think they should not be able to receive any help with paying for their insurance premiums to access a plan that is best for them and their families? That only those who have the resources (as you may not be able to continue working once you get sick) should be allowed to keep their private coverage. Dialysis Patient Citizens currently has a complaint pending before the Office of Civil Rights against Blue Cross Idaho for implementing similar discriminatory policies to dump low-income individuals because of their disease.