WASHINGTON—The partisan fever surrounding the rollout of the Affordable Care Act did little to lessen the positive fervor of patients who stood to gain the most from the law’s protections, like those living with HIV or AIDS. With one eye on their bank accounts and the other on their T-cell counts, some insurers are pulling out all the stops to avoid the costly risks of covering these patients.
Newly barred from denying coverage or charging more for individuals with preexisting conditions, insurance companies are no longer immune to the financial risks of making healthcare accessible to people who rely on costly drugs to keep their conditions in check.
Certain health insurance companies have started testing the waters to see if they can circumvent the new provisions.
Said actuary Chuck Denton of Cigna, “I’m not sure we want people infected with HIV in our risk pool. Casual contact may not spread the virus, but being contractually obligated to provide care for the seriously ill is just not something I signed up for when I entered this business relationship.”
A complaint by the AIDS Institute and the National Health Law Program accuses Cigna and three other insurers of discrimination by assigning all specialty HIV drugs—including generics—to the highest payment tier on Florida’s health insurance marketplace. In some cases, that meant patients would have to shoulder monthly pharmacy bills of $1000 or more, on top of their premiums.
What CoventryOne, Cigna, Humana, and Preferred Medical Plan are doing “has no rational reason other than to drive people with HIV and AIDS away from their plans,” according to a staff lawyer for the National Health Law Program.
“Other [mid-tier] plans don’t do this for HIV,” claims Carl Schmid of the AIDS Institute, “and that’s why we’re proving that it’s discrimination.” Comparable insurers in the marketplace offer the same prescriptions with out-of-pocket costs between $10 and $25.
When reached for comment, a spokesperson for Humana remained positive in her prognosis of the complaint, which is now in the hands of the Department of Health and Human Services’ Office for Civil Rights. “It’ll be dismissed. It has to be, right? I mean, this was our first time forgetting to provide adequate coverage under ObamaCare.”
At press time, lawyers from CoventryOne were busy calling each and every one of the company’s trustees to recommend testing their business models to ensure lawful HIV coverage.