Paying for insurance premiums using charity dollars should not be a problem

By Gwen Cooper


Food insecurity is an issue affecting many Americans. And never has it been more relevant than during the time of COVID. What would happen if the federal government issued regulations to charities and churches and they couldn’t help you and your family in obtaining the food you need or subsidizing the cost of that food? You would be outraged. You would speak up. You simply would not let it happen. Yet, this very situation is currently happening; but not with food–with health insurance. In 42 states, including Kentucky, insurance companies are denying the payment of health insurance premiums if the cost is paid by someone other than the insured.

Here’s why. In 2014, the Centers for Medicare and Medicaid Services (CMS) created a rule that allows health insurance companies to prohibit premium and cost-sharing assistance from nonprofit organizations. Passage of this rule allows health insurance providers the ability to deny patient assistance to those who need financial support to continue to afford their insurance premiums. Very often those who utilize nonprofit financial assistance programs like Patient Services, Inc. (PSI) suffer from rare and/or chronic diseases. Financial assistance is the lifeline that these patients need to continue receiving their life sustaining treatments and medications. Why should it matter who pays the bill? Does it matter who pays for your food? It should not matter who pays for your health insurance.

Thankfully, our Kentucky lawmakers agree. Senator Ralph Alvarado filed SB 44 to ensure that nonprofit organizations and places of worship can directly pay for the premiums of those patients in need. The legislation would also mandate that out-of-pocket expenses provided by these nonprofit third parties will count toward the out-of-pocket limit.

Patient assistance organizations serve as a vital link in the safety net for patients and their families and this legislation protects that link. Patient assistance programs serve as a last resort for many families, the alternative is spending down to qualify for Medicaid or going through the process to obtain Medicare coverage with Social Security Disability. Neither is an easy or quick process and diminishes the quality of life that these patients are working so hard to maintain. Their goal is not to rely on government for healthcare but to be contributing members of society who are able to live with their illnesses, not in spite of them.

According to the National Hemophilia Foundation, forty-two percent (42 percent) of patients with chronic conditions reported that they have not been able to afford out-of-pocket medical costs in the past year. Passage of this important legislation is the first step in lowering this statistic. In 2020, PSI provided over $1.27 million in assistance to 447 Kentucky patients. Your support is crucial to helping us continue providing this critical financial lifeline. Please contact your state Senator and Representative and ask them to support SB44 to protect access to Charitable Patient Assistance for Kentucky families.

-Gwen Cooper is the Chief Executive Officer at Patient Services, Inc.