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Sebelius: Marketplace Plans Are Not Federal Programs

 


 

Transcript:

This week in Washington—the health secretary states that marketplace health insurance plans are not federal health care programs. You are tuning in to the health policy update from America’s Essential Hospitals for the week of Nov. 4.

On Oct. 30, the U.S. Department of Health and Human Services Secretary Kathleen Sebelius stated in a letter that the U.S. Department of Health and Human Services does not consider health insurance plans sold through the marketplaces to be federal health care programs. As a result, certain federal laws that apply to federal health care programs will not apply to health insurance plans sold through the marketplaces.

Specifically, marketplace health insurance plans will not be subject to the federal anti-kickback statute, which is a broad statute that prevents fraud in federal health care programs. It prohibits the exchange of anything of value between health care providers and patients that would encourage the use of federal health care programs.

This decision is significant because it opens up a way for providers to potentially help patients pay for the cost of their marketplace health insurance plans. Many hospitals are interested in helping patients pay for the cost of these plans because they are concerned that some low-income patients may not be able to afford the premiums, even with federal subsidies.

Health insurance coverage is important because it makes health care services more accessible and affordable for people. When people have insurance, it is easier for them to see their doctors and nurses for both preventive and specialty care. A study published in the New England Journal of Medicine found that people who gained health insurance coverage increased their use of preventive services like cholesterol screenings. These services are critical for maintaining overall health and preventing expensive emergency room visits. When patients have insurance, they are less likely to be faced with huge medical bills that can cause serious financial hardship.

While it remains to be seen how arrangements in which hospitals pay for patients’ marketplace health insurance plans might work, this decision is an important step in clearing the way for hospitals to play a role in helping low-income patients access and maintain health insurance coverage.

Thanks for listening to another edition of This Week in Washington. I’m Erin Richardson; join us next week for another health policy update.

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