CMS policy denies health coverage

he rising costs of health care continue to be a challenge for all Marylanders and their families, and particularly those living with expensive, chronic health conditions. Unfortunately, a misguided policy from the Baltimore-based U.S. Centers for Medicare and Medicaid Services (CMS) may have inadvertently created a new “preexisting condition” that is making matters worse for many of the state’s most vulnerable patients.

Patients in Maryland living with chronic and life-threatening illnesses such as sickle cell disease, arthritis, hemophilia, cancer and HIV/AIDS often face higher insurance premiums simply to keep the health coverage they need to manage their conditions and live healthy and productive lives. The cost of care can be prohibitive for many patients and their families, often forcing them to make difficult choices, like whether to take their medication or pay rent.

Fortunately, there are charitable assistance programs available to help patients in precisely these circumstances. Historically, nonprofit premium and cost-sharing assistance programs have served as a temporary bridge to care to help patients with chronic conditions cover the costs of their insurance payments. These pro-

Tgrams help alleviate the onerous financial pressures for those living with chronic disease, as well as help them navigate the emotional — and even legal — challenges that often arise. Additionally, because this assistance comes from charitable donations rather than taxpayer dollars, patients receive help at no added cost to the public.

However, federal guidance issued by CMS is now making it possible for health insurers to deny coverage to patients who receive assistance from nonprofit charities. Maryland is one of 42 states with health plans that are now denying coverage to patients based on this CMS rule. The premium assistance programs that serve as lifelines to many patients, particularly those with debilitating and expensive medical conditions, must be protected.

Patients living with sickle cell disease, for example, often struggle to afford treatment, which causes some to abandon treatment altogether. Because sickle cell disease has no cure, early diagnosis, blood transfusions, antibiotics, pain management and sometimes surgery are necessary to treat pain and complications from the disease. When treated appropriately, sickle cell disease can be managed like many chronic diseases, but forgoing treatment can put patient lives at risk.

It is not only patients’ health that suffers when they cannot afford their medication. Prohibitively expensive medication and treatment have forced many patients into serious debt, leading some to declare bankruptcy. Others, who are lucky enough to qualify, enroll in government programs or visit hospitals for their primary care needs, which ultimately drives up costs for Maryland taxpayers.

Fortunately, there is common-sense bipartisan legislation that would fix the shortsighted and harmful CMS guidance. The Access to Marketplace Insurance Act (H.R. 3976) would protect the ability of nonprofit charities to continue to provide premium assistance under existing CMS guidelines.

Nonprofit premium assistance programs are invaluable resources for Maryland patients living with chronic diseases such as sickle cell. Several Maryland representatives have already signed on as cosponsors of H.R. 3976 — it’s time for the rest of the Maryland congressional delegation to join them and more than 150 bipartisan cosponsors to let charities be charitable.

I urge congress to pass H.R. 3976 to ensure that those who receive charitable premium assistance have access to the vital treatments and services they need.