Hospitals exploring ways to assist consumers paying for ACA plans

Some hospitals across the country are exploring ways to help individuals and families pay their share of the costs of government-subsidized health coverage purchased though the ACA’s marketplaces – at least partly to guarantee the hospitals get paid when the consumers seek care (Source: “Hospitals Seek To Help Consumers With Obamacare Premiums,” Kaiser Health News, Aug. 14, 2014). 

But hospital efforts in states such as New York, Florida and Wisconsin have set up a conflict with insurers, who worry that premium assistance programs will skew their enrollee pools by expanding the number of sicker people who need more services.

Insurers argue that if federal regulators permit such programs, they should bar hospitals from selecting participants based on their health, or from directly paying the premiums. 

AHIP, the insurers’ trade lobby, has asked the government not to allow hospital-affiliated foundations to run aid programs. The funds “must be donated to a legally independent foundation that is separate from the organization with a potential financial interest,” AHIP said.

The hospital industry, meanwhile, wants insurers to be required to accept premium payments made by health systems as well as by their foundations.

“Any effort to limit the ability of hospitals or hospital-affiliated foundations to help individuals in need to obtain access to health insurance coverage is bad public policy,” wrote Rich Umbdenstock, president and CEO of the American Hospital Association. 

To date, the Obama administration has said insurers must accept payments toward premiums and other costs from government programs such as the Ryan White HIV/AIDS Program, which helps provide medical services and defrays costs for people living with HIV/AIDS. But it has been less clear about the role hospitals and other health care providers might play.