May 15, 2018
On behalf of the members of National Taxpayers Union (NTU) across the country, I write to express our concerns about efforts to limit the utilization of charitable premium assistance (CPA) to cover costs associated with end-stage renal disease (ESRD).
Everyone agrees that ESRD is a horrible disease. However, when it comes to the best manner of ensuring that patients have access to affordable, high-quality treatment options, there is some disagreement among stakeholders. NTU has long advocated for health care policies that provide patients and their families with as many options as possible, while simultaneously minimizing costs to taxpayers. In fact, more than 10 years ago we provided comments to the Senate Finance Committee on Medicare proposals that included support of patient coverage extension for privately insured consumers undergoing ESRD treatment. Given this history, we are concerned about possible limitations on the use of CPA that could effectively force some ESRD patients into government programs. Such restrictions would reduce access to private coverage and impose greater financial burdens on Medicare and Medicaid, both of which are already facing tremendous fiscal challenges.
To be sure, these government programs serve as valuable and important safety nets for patients who are afflicted with ESRD and may not have the financial means to pay for private care. But private insurance -- oftentimes supported with CPA -- should be the first option for health care whenever possible. We also hope you would agree that this principle is consistent and appropriate with the patient-centered care philosophy that is so prominent in HHS’s Value-Based Transformation initiative.
As you know, the Centers for Medicare and Medicaid Services predict that national health care spending will grow at an annual rate of 5.5 percent from 2017 to 2026. This rate exceeds expected GDP growth by a full percentage point; meaning health care expenditures will consume a larger share of the economy and the federal budget. It is therefore increasingly important to find ways to reduce cost exposure to the federal government while ensuring patients have access to the care they need. We hope you will strike this balance through policies that maximize utilization of private insurance options and we respectfully urge you to oppose attempts to curb the usage of CPA.