Access and affordability of health care continue to dominate headlines, providing daily reminders that the health care landscape is rapidly changing and increasingly complex. But has access to care improved over the last year? How about affordability?
Questions remain, but one thing is clear: Insurance companies continue to dominate the conversation.
As a chronic disease patient, I am continually surprised by the new jargon, new programs and ever-changing rules orchestrated by insurance companies. For example, prior to 2018, I had never heard of “copay accumulator” programs, yet they’ve quickly become an access issue within the chronic patient community for those who rely on drug manufacturers’ coupons or other assistance to help cover their prescription copays. Under the rules of these programs, insurers can refuse to count the payments made by patients using coupons toward their plan deductibles or out-of pocket maximums. Insurers designed these programs to save themselves big money by shifting costs onto patients and drug manufacturers. These programs not only discriminate against people with chronic health conditions, but they also have a disproportionate impact on the most vulnerable, low-income patients, who often rely on financial assistance to afford lifesaving treatments.
Insurance companies are also becoming bolder when it comes to funding ballot initiatives and proposing legislation. California was a battleground state between insurers and patients in 2018. The wealthy insurance lobby backed both Proposition 8 and Senate Bill 1156, two initiatives which failed. Thankfully.
Prop 8 could have greatly reduced access to care for kidney patients, especially those in low-income or rural communities with limited access to dialysis clinics. Had it not been vetoed, Senate Bill 1156 would have brought considerable harm to patients who receive charitable financial assistance. The bill would have allowed insurance companies to reject patients’ payments if they rely on charitable aid to help pay their premiums, leaving them unable to afford health care plans and forcing them into plans that may provide far less coverage – a potential disaster for chronically-ill patients such as those who rely on regular kidney dialysis.
In most states, it is still legal for insurance companies to make chronic disease patients “fail first” by using cheaper but less effective medications and procedures. Here, despite what a patient’s doctor believes is best, an insurance company can dictate the course of treatment. It’s only after a patient “fails” to respond to cheaper treatments that insurers are supposed to authorize coverage for the next level of treatment. The problem is that damage done during this time can be irreversible. For example, a person with ankylosing spondylitis, a horrible form of arthritis that bends and permanently fuses the spine, doesn’t have the luxury of half-measures or cheap treatments often proffered by insurance company bureaucrats.
In Oregon, the Chronic Disease Coalition will join forces with the National Psoriasis Foundation and the Oregon Medical Association during the upcoming legislative session to propose utilization management legislation, which would allow patients to manage costs by using evidence-based criteria or guidelines to assess the appropriateness of health care benefits.
Together, we’ll fight step therapy and prior authorization to create an easy exception process for patients so those who need medication can get it in a timely fashion.
It’s clear that legislators and policymakers will be hearing from insurance companies and their high-priced lobbyists. Those of us with chronic disease must also make our voices heard. If we don’t, we will continue to lose access the treatments and medicines we need.