BY NANCY HOWELL AGEE

What if the health coverage you need is priced out of reach?  Do you forego care knowing that you can’t afford your deductible? Or do you see the doctor knowing that you may not be able to pay your co-pay?

More than half of individuals who buy their insurance through the Health Insurance Marketplaces – 7 million people – could face that predicament if they didn’t have access to the cost sharing reduction (CSR) subsidies. CSRs help consumers cover their out-of-pocket health costs.  For instance, a lower-income patient who might normally have a $30 copay for a doctor’s visit might instead only pay $10. 

Funding for the CSRs is in jeopardy, and Congress must act to protect this program. The law requires that insurers reduce cost-sharing for low-income individuals regardless of whether the federal government pays them. If the funding stops, many health plans would either stop selling marketplace coverage – leaving consumers with fewer options – or they would increase their premiums to make up for the loss of funding on cost-sharing, resulting in rates that would be an estimated 20 percent higher.  

In southwest Virginia, where Carilion Clinic is based, I see this problem up close.  In many counties, insurers have already left the marketplace, and next year up to 40,000 people in our region may have no available insurer and be unable to buy a policy through the marketplaces at all, no matter how much they can pay, because of a lack of insurer participation.  It’s reasonable to believe that the uncertainty over CSR funding contributed to this outcome.

Patients with insurance take better care of themselves.  They see a doctor regularly and get care when they need it.  Patients who delay care because they lack coverage visit the emergency department more often, need higher levels of care when they get it, and face higher costs.

Now is the time to act to stabilize the Health Insurance Marketplaces. Funding the CSRs is a great first step. We urge Congress to take action now.

 

Nancy Howell Agee is the president and CEO of Carilion Clinic and chair-elect of the American Hospital Association.

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