Dive Brief:
- Hospitals in New York, Florida and Wisconsin looking at ways to help individuals and families pay for ACA policies purchased through the marketplaces, in part to be sure that hospitals get paid when those consumers seek care. (Charities such as the United Way are also exploring this possibility.)
- This prospect has health plans alarmed, however, as they argue that premium assistance programs will expand the number of costly sicker patients who have coverage. Health plans are asking the federal government to restrict this practice.
- To date, however, the federal government has not banned premium payment for ACA policies by third parties. And in the meantime, programs continue to blossom; for example, Wisconsin's United Way of Dane County is using $2 million donated by a local hospital system to help more than 650 near-poverty-level policyholders to pay premiums.
Dive Insight:
Looked at one way, subsidizing the premiums of those who can't afford ACA policies just makes sense, at least for consumers, hospitals, doctors and the communities that bear the costs of ill health when patients aren't cared for properly.
Insurers, however, say that paying such premiums is unfair to them, as it will allegedly attract patients who are far more costly than the norm. (Readers, if you have data that backs up their claim, please feel free to share it.)
Hospital industry leaders, for their part, think insurers are full of hot air. As many hospitals see it, a few people will show up at hospitals who have a premium lapse—which, until it hits 90 days cannot be cause for termination—but they note that paying the back premiums simply restores the patient's relationship to the insurer to its existing state.
To avoid this conflict, hospitals are laying out criteria for premium payment that, in addition to being tied to consumer income, will pay premiums for an entire year rather than when consumer premium payments lapse. This is unlikely to silence health plans' objections entirely, but it could calm things down.
Want to read more? You may enjoy this story on HHS' position on the subsidization of premiums by charitable third parties.