A new resource is being offered by the United Way of the Greater Triangle to help low-income families pay for health insurance. In essence, they serve as a third party payer for six Blue Cross silver-level plans (and they are hoping to add other companies soon) to cover the costs of the premium for eligible families so that all families have to pay is their copays and coinsurance. Here is the basic description:
Target populations will be based on economic status, not health conditions, and PremiumHelp.orgwill cover the balance of the health insurance premium (the amount due after the federal subsidy) for Durham County residents whose annual income is between 100 and 175 percent of the federal poverty level between $23,850 and $41,738 for a family of four. Currently, six Silver-Level plans offered through the North Carolina Health Insurance Marketplace at Healthcare.gov are part of the program.
Qualifying individuals who have already enrolled can still get assistance with their premiums going forward. In addition, HHS advises that assistance in paying premiums must be based on financial need or geographic location rather than health status; premium assistance must be guaranteed for an entire calendar year; and people receiving premium assistance should not be limited in their choice of insurers or insurance plans.
BCBSNC recently announced that they will accept premium payments made by United Way of the Greater Triangle to help low-income families and individuals pay for health insurance. The United Way of the Greater Triangle’s pilot program meets the HHS requirements for third-party payments.
But why are there restrictions at all? The HHS guidelines are meant to minimize the chances that third-party premium payments could invite conflicts of interest or, more significantly, lead to adverse selection.
Adverse selection can change the makeup of the insurance pool – and not for the better. BCBSNC’s Director of Health Policy Walker Wilson explains the issue for us:
“There’s a correlation between income levels and overall health. If the people receiving premium assistance from third parties are sicker than average, the insurance pool will skew toward people who need more expensive health care. When that happens, insurance rates rise for everyone because there aren’t enough healthy people paying into the pool to cover the costs of the sick people.”
The United Way’s PremiumHelp program demonstrates the intense grass-roots commitment the Affordable Care Act has generated in North Carolina. Aggressive outreach efforts here have resulted in the state achieving the fifth-highest enrollment nationwide this year.
One of the primary goals of reform is to increase access to health care while improving its quality. That’s complicated and it won’t happen overnight, but with doctors, consumers and insurers working together, progress is being made.