WASHINGTON – Consumers for Quality Care (CQC) today sent a letter to the nation’s governors urging them to protect patients in their states by steering clear from adopting harmful insurance practices in their state’s Medicaid programs.

CQC notes that while the country’s political attention has been focused on the debate in Washington, D.C. over the fate of the Affordable Care Act (ACA), governors can use a lesser-known option to request waivers from federal Medicaid standards.

The letter notes: “Each of you holds in your hands today the ability to radically reshape Medicaid for your state’s most vulnerable citizens regardless of the outcome of [the ACA] debate. This power is significant considering the 69 million Medicaid enrollees living across your states.”

In March, U.S. Department of Health and Human Services Secretary Tom Price and Centers for Medicare and Medicaid Services Administrator Seema Verma encouraged the governors to seek to “align Medicaid and Private Insurance Policies for Non-Disabled Adults.”

CQC, an organization led by health care advocates and former policy makers, wants to ensure that harmful insurance practices are avoided by governors who respond to the Trump Administration’s call to alter state Medicaid programs through federal waivers.

The group noted that this year alone private insurers have taken steps that may save them money, but leave patients with unreasonable – and in some cases, dangerous – burdens.

These include:

• Emergency coverage: Just this month, one insurer implemented a policy in which they can decide after the fact that they will not cover a patient’s visit to an emergency department, even when such emergency coverage is in the consumer’s policy. As of July 1 of this year, consumers in four states – Georgia, Missouri, New York, and Kentucky – were placed in the untenable position of having to assess whether their condition would later be determined sufficiently dangerous to warrant emergency coverage. Doctors should be assessing emergency situations, not patients.
• High Deductibles: Studies show that low-income individuals and families with high-deductible plans often delay or forgo necessary doctor visits and emergency care because they just can’t afford it. Vulnerable Medicaid beneficiaries should not be effectively locked out of using their health care coverage because of excessive out-of-pocket costs.
• Denials of life-saving care: Cases of insurance companies taking on the role of doctor and denying patients life-saving medicines that have been ordered by physicians is also becoming all too common. The Wall Street Journal recently detailed several cases in which patients were forced to go through countless hours of paperwork and appeals just to get vital cholesterol medication approved by their insurance carriers. As one cardiologist put it, “At the end of the day, you would like to do what is best for the patient. But you really don’t have the time to play the insurance games.”

“Your constituents are counting on you to defend their needs and we know that you – our nation’s governors – are committed to ensuring they have quality health care,” the CQC Board wrote. “As such, we implore you to keep Medicaid beneficiaries top of mind as you consider requesting waivers from federal Medicaid standards.”

CQC is led by a board of directors that includes the Honorable Donna Christensen, physician and former Member of Congress; Jim Manley, former senior advisor to Senators Harry Reid and Edward Kennedy; Scott Mulhauser, visiting fellow at The University of Pennsylvania and former senior advisor to the Senate Finance Committee and Vice President Joe Biden; and Jason Resendez, Executive Director of the LatinosAgainstAlzheimer’s Network and Coalition.