AHA: Hospitals Can Pay Patients' HIX Premiums

Cheryl Clark, for HealthLeaders Media , November 18, 2013

Some hospital officials have suggested that hospitals, or county health departments that own hospitals and clinics, or other entities might pre-select patients for subsidies based on their history of receiving uncompensated care, especially if their illnesses suggest the likelihood of repeat hospitalizations.

The AHA weighed in that too.

"The ACA requires tax-exempt hospitals to have a written financial assistance policy that describes the criteria that will be applied and the financial assistance that will be provided to help patients afford health care," the AHA legal advisory said. "Premium subsidies could be one form of financial assistance."

If large numbers of hospitals take advantage of this, funding hundreds of their most expensive patients, they may reap major financial benefit. Instead of writing off that care, they will now be paid at health plan rates.

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3 comments on "AHA: Hospitals Can Pay Patients' HIX Premiums"

Stuart Showalter (11/25/2013 at 11:08 AM)
The AHA advisory is basically their advocacy position. It remains an open question whether subsidizing an insured's premium would be a violation of the kickback laws (state or federal) or some other anti-fraud statute. Regardless of the opinion of AHA, HHS or the DOJ, it would ultimately be for the courts to decide. Using a charitable foundation may be an option, but I urge careful legal analysis on a case-by-case basis.

Martha Carlton (11/19/2013 at 3:07 PM)
How is this different from healthcare systems offering HMO policies through HIX for $1 per month? As long as the patients can choose where they access it seems like a in- win.

Manuel H. Moraleda (11/19/2013 at 11:26 AM)
Ultimately this money that the hospital is using comes from insured patients. Would the federal government provide a bailout later in the event that the insurance company is placed at financial risk and would consider bankruptcy ?




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