A Centers for Medicare and Medicaid Services (CMS) regulation in 2014 gave Marketplace Insurers the discretion to refuse premium assistance from third-party assistance programs, with the exception of 3 entities: Ryan White HIV/AIDS Program, Indian tribes and tribal organizations, and Federal and State entities. Currently, many plans across the country are denying payment from non-profit organizations, denying assistance for many patients who need it most. Patients with bleeding disorders have exorbitant medical costs, and rely on these assistance programs for access to their care. Costs for treatment of bleeding disorders can easily be over $300,000 a year, and without access to proper treatment and medication, this care is out of reach. Without access to care, patients end up in ERs with painful and often life-threatening bleeds, driving up the costs that may go unpaid and eventually be charged to the state.
HR 3742 is a bipartisan bill, introduced by Representative Kevin Cramer (R-ND) in October 2015 that would add non-profit assistance programs to the list of entities insurance plans must accept payment from. It would prevent insurers from deliberately making Marketplace plans unaffordable and inaccessible for persons with costly medical conditions.
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