Electronic Thesis/Dissertation


The Affordable Care Act’s Unfulfilled Promises for People Living with HIV Open Access

At long last, the Affordable Care Act has ended health insurance discrimination that targets people living with HIV. This concludes thirty-four years of discriminatory tactics that barred HIV-positive individuals from health plans at worst and provided meager coverage at best. The nondiscrimination requirements of the Act are unmistakable and aimed at insurance practices that would keep HIV-positive people from coverage. No longer can issuers exclude individuals on the basis of pre-existing conditions or impose dollar limits on coverage. No longer can issuers narrow their plan networks to exclude HIV care specialists. Gone are exorbitant out-of-pocket costs for vital HIV therapy. Gone are the holes in existing civil rights laws where insurance contacts could hide. But real change can only come through meaningful implementation of the sweeping promises of the Act, which must be translated into concrete rules that bind issuers selling plans in the health insurance exchanges. Only then can we proclaim that HIV-specific insurance discrimination is a relic of the past and that health insurance reform is a success. Regrettably, implementation of the Act has been anemic, irreconcilable, or non-existent. Health insurance issuers have easily exploited the agency’s regulatory missteps to continue to exclude HIV care specialists from networks and impose the highest cost-sharing on drugs that treat HIV. Moreover, health insurance issuers can refuse to cover highly effective preventive drugs that reduce the number of new HIV infections in populations at risk. Lackluster implementation means that issuers have barely missed a step in discriminating against HIV-positive individuals, almost as if health insurance reform never happened.It is not too late. The Department of Health and Human Services can still make good on the Act’s promises by overhauling agency regulations concerning HIV care specialists and essential prescription drugs. Most importantly, the agency can stop present and future HIV-specific discrimination by implementing the Act’s nondiscrimination provision, the strongest nondiscrimination law that health insurance has ever seen. Health insurance reform will be judged by whether it helps those who need it most. Without action, that judgment will be harsh indeed.

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