Health care for patients with chronic conditions like ESRD is expensive. But having health insurance is not something that should only be available to healthy people.

A growing number of insurers nationwide are refusing to accept charitable insurance premium payments on behalf of their policy holders—a trend that should alarm anyone with a chronic or expensive-to-treat medical condition.

These insurers are effectively “redlining” ESRD patients—erecting barriers that make it difficult, if not impossible, for them to pay their insurance premiums.

One elderly Tennessee man learned his insurance company had rejected his wife’s Medigap insurance premium payment from AKF after his wife died of a serious infection that required hospitalization. Her policy was canceled for nonpayment while she was in the hospital, and he had no way to pay the medical bills he received for her care at the end of her life.

Several insurers have changed their policies to disallow direct or indirect charitable assistance—requiring patients to sign an attestation that they are not receiving help from a nonprofit. For low-income patients who could not otherwise afford their health insurance premiums, this often leaves no option other than to pay out of pocket and accumulate medical debt until they can qualify for Medicaid.

These insurer actions are driven by profit, pure and simple. By dumping their sickest and most expensive patients, insurers boost their profits. It’s cruel and it discriminates against a disabled group of low-income, mostly minority Americans.