Judge to con­sider whether to al­low third-party pre­mium pay­ments

Modern Healthcare - - THE WEEKEND AHEAD - —Joe Carl­son

A federal court hear­ing in Ba­ton Rouge, La., on Mon­day could shed light on whether hos­pi­tals, drug­mak­ers and federal pro­grams can make third-party pre­mium pay­ments to cover people on the Oba­macare in­sur­ance ex­changes.

Lawyers for Blue Cross and Blue Shield of Louisiana will ar­gue to a federal judge that the in­surer should be al­lowed to en­force its pol­icy of not ac­cept­ing federal grants or other third­party pay­ments to buy plans for low­in­come people with HIV or AIDS.

The in­surer’s de­ci­sion to refuse pay­ments from the federal Ryan White pro­gram prompted a federal clas­s­ac­tion suit against Louisiana Blues, al­leg­ing dis­crim­i­na­tion against HIV and AIDS pa­tients. Judge Brian Jack­son will hear oral ar­gu­ments on whether to is­sue a pre­lim­i­nary in­junc­tion block­ing the in­surer’s pol­icy.

The con­tro­versy is not limited to Louisiana or Ryan White pay­ments. In­sur­ers na­tion­ally are wary of ef­forts by third par­ties to ex­pand cov­er­age by pay­ing pre­mi­ums for low-in­come people and those with chronic con­di­tions. Hos­pi­tals treat­ing unin­sured and chron­i­cally ill pa­tients and drug com- pa­nies sell­ing ex­pen­sive name-brand drugs for people with par­tic­u­lar con­di­tions have a strong fi­nan­cial self-in­ter­est in pay­ing for their cov­er­age, since those pa­tients would other­wise lack fund­ing for treat­ments and drugs.

In­sur­ers fear that most people cov­ered through third-party pay­ments will be sicker than aver­age, skew­ing their ex­change plan mem­ber­ship to­ward more costly pa­tients. In a le­gal fil­ing, the Louisiana Blues said its pol­icy “is one of sim­ple ne­ces­sity to avoid the po­ten­tially dev­as­tat­ing ef­fects of ad­verse se­lec­tion caused by providers pay­ing for cov­er­age only as soon as a pa­tient needs it.”

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