Kentucky can be a leader in suspending the third-party payer rule

By Gwen Cooper


Help me understand this…according to a recent Families USA study, during the early stages of the pandemic a staggering 5.4 million laid-off Americans lost their health insurance in a matter of weeks, a historic drop off and nearly 40 percent higher than during the Great Recession of 2008 and 2009. Yet, nonprofit organizations, or places of worship might be prohibited from helping these newly uninsured people afford their health insurance. And why is that exactly? Because of a misguided Obama-era federal policy that is preventing charities from being charitable.

In 2014, the Centers for Medicare & Medicaid Services (CMS) failed to include non-profit charities – including religious organizations – on the list of organizations that are allowed to provide financial support to patients to help them afford their health insurance and treatment costs. As a result of this “third-party payer rule,” health insurers can deny coverage to patients when they need it most, simply because they receive financial support from charities. 

As the new CEO for Patient Services, Inc., the oldest organization in the US created to help patients living with chronic diseases afford their insurance premiums and copay costs for high cost treatments, I was surprised to learn that some health insurance companies don’t view charitable assistance as the white knight – as a temporary lifeline and last resort for many families who cannot afford their care – but instead as a willing participant in a program that is subsidizing the high costs of pharmaceuticals. Nothing could be further from the truth. In fact, patient assistance is a cost-saver: a recent Avalere Health study concluded that $1 in patient assistance reduces spending on Medicare by $1.83.

I firmly believe that what is needed is to take a step back from all the noise and policy jargon and look at this from a human, person-to-person perspective. Consider: Patient A has a rare form of cancer that has only a few FDA approved treatments. Those treatments cost a lot of money because not many people need that treatment and the cost of researching, developing, testing and getting FDA approval for human prescribing is expensive.

When COVID-19 hit, Patient A and countless other patients who were working, managing their chronic illnesses, and living their best lives as productive taxpaying citizens suddenly found themselves unemployed and unable to afford their health insurance premium or the increased cost of COBRA. Or maybe they could afford to pay their premium but not the cost of their life sustaining medication. Or they continued to pay for their meds, but they couldn’t afford the electric bill, or food, and suddenly they had to choose. These are all scenarios where non-profit charitable assistance could help, but we are currently prohibited. Assistance helps patients keep working, contributing to society, paying taxes, loving their family members, and LIVING! 

The dialogue needs to change to put people and common-sense back at the center. Take out the politics of payer vs pharmaceutical company, insurance costs vs co-pay costs, deductibles vs cost caps and look at the lives saved simply by providing a little bit of financial assistance during the most vulnerable time in a person’s life. In my 21-year healthcare career, I have always said everyone is one health catastrophe away from bankruptcy. Organizations like PSI help patients avoid bankruptcy by throwing the financial lifeline to those who need us most. 

At a minimum, Congress should suspend the third-party payer rule during this pandemic to allow those newly uninsured to catch our lifeline so they can continue to receive the treatments they need. Want to talk about overburdening our healthcare system? Think about the domino effect of 5.4 million newly uninsured not continuing life-sustaining treatments because they can’t afford them anymore and are told they have to let the safety net we just threw them sink to the bottom of the Ohio river. What would our ERs or ICUs look like then?

It makes no sense. Let’s talk about how Kentucky can be a leader in suspending the third-party payer rule until at least December 2021. We will save lives.

-Gwen Cooper is CEO of Patient Services, Inc.