Complaint seeks to enforce ACA’s anti-discrimination provision

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ACA anti-discrimination provisions tested

In the first major test of the Affordable Care Act’s anti-discrimination measures, two advocacy groups filed a complaint against four insurance companies with the U.S. Department of Health and Human Services on May 29. The complaint challenges prescription drug prices for patients with HIV and AIDS.

Under the ACA, insurance companies, in almost all cases, are prohibited from charging patients higher premiums on the basis of preexisting conditions, which includes HIV, AIDS and many other disabilities.

In the complaint, the National Health Law Program and the AIDS Institute target four companies, each of whom sell insurance plans through Florida’s health insurance exchange. To compensate for the reduction in the premium costs for people with HIV and AIDS, these companies have allegedly begun charging these consumers significantly higher deductibles and out-of-pocket costs.

“This practice has no rational reason other than to drive people with H.I.V. and AIDS away from their plans,” Wayne Turner, a staff lawyer with the National Health Law Program, said in a conference call with reporters, according to the New York Times.

As the advocacy groups see it, this practice runs counter to the ACA’s broad anti-discrimination provisions.

The ACA states that insurance companies are prohibited from discriminating on the basis on the basis of “race, color, national origin, sex, age or disability.”

Moreover, insurance companies may “not employ marketing practices or benefit designs that have the effect of discouraging enrollment in such plan by individuals with significant health needs.”

As part of the complaint, the advocacy groups reviewed the options for consumers with HIV and AIDS in Florida’s health care exchange. While many of the insurers offered affordable drug prices for these patients, they found that four of these insurance companies lacked any affordable options.

“The (Quality Health Care) plans offered by CoventryOne, Cigna, Humana and Preferred Medical impose overly restrictive utilization management which unduly limits access to commonly used HIV/AIDS medications,” the complaint states. “Moreover, by placing all HIV/AIDS medications, including generics, on the highest cost-sharing tier, CoventryOne, Cigna, Humana and Preferred Medical discourage people living with HIV and AIDS from enrolling in those health plans – a practice which unlawfully discriminates on the basis of disability.”

According to a recent study from Kaiser Family Foundation, about 400,000 of the 1.1 million people living with HIV and AIDS in the United States are receiving treatment. Of those, about 23,000 are uninsured and eligible for insurance in the marketplaces.