Ninety days without dialysis

5.14.18

If passed, California S.B. 1156 may result in catastrophic consequences for thousands of lower-income chronic disease patients. It would do this by limiting their access to charitable financial aid, which many vulnerable patients need to afford their health care. Insurers claim that they are not restricting a patients’ access to charitable financial assistance and forcing patients off their current health plan. This could not be further from the truth.

As heard in committee, the legislation requires that patients battling kidney failure, or end-stage renal disease (ESRD), go through a complex 90 day process before insurers determine if they will accept a charity’s premium or copay assistance made on behalf of the patient. The process to determine a patient’s eligibility for charitable financial assistance outlined in the bill poses dangers to the patient’s health. Perhaps insurance companies aren’t aware of what could happen to a kidney patient during a 90 day waiting period?

To help them understand, the Chronic Disease Coalition looked at the language in S.B. 1156 and how this would directly impact patients.

The first 60 days:

If passed, S.B. 1156 would require charitable nonprofit organizations to contact the insurance company 60 days before they make the first premium or copay payment on behalf of the patient. Most patients don’t know 60 days in advance that they will need help affording their health care. Instead, they are often turning to a charitable organization because it is their last option and they desperately need immediate help.

ESRD patients require regular, frequent dialysis treatment to survive. A patient may undergo as many as 20 lifesaving dialysis treatments a month. If they are not able to afford their monthly insurance premium, they lose coverage at the end of the month, leaving them to pay for their treatment out-of-pocket, or cease treatment and jeopardize their life.

Meanwhile, the bill also requires that a patient seeking access to charitable financial assistance “…has completed and submitted an application for Medi-Cal” and is not eligible for “financial assistance from Medi-Cal.” If passed, this legislation requires patients who require regular lifesaving treatment, and are struggling to afford their health care and are currently unable to access charitable financial assistance, to use their time and resources to apply for different plans to see if they eligible for financial assistance.

The last 30 days:

After the initial 60 days, the patient would lose their health care coverage because they couldn’t afford their premium costs. Yet insurers then have an additional 30 days to “make a determination regarding eligibility.” Now supplied with information about a patient’s eligibility for Medi-Cal, insurers can determine if they will allow the patient to access charitable financial assistance that may help them maintain coverage on a private health plan where insurers aren’t as profitable. Simply put, this is nothing but big insurance companies using their overwhelming power to pad their bottom-line at the expense of patient health outcomes.

By requiring patients and charitable organizations to go through a 90 day process, S.B. 1156 allows insurers to dictate the type of health care coverage a patient can access. Patients, not insurers, should be responsible for making a decision that will affect their health care and quality of life. Join the CDC and oppose California S.B. 1156.