Insurance denied for some with incurable diseases

Columnist Kendall Grove

Columnist Kendall Grove

In 2010, the Affordable Care Act was passed and it was said to create much needed insurance reforms. Besides making insurance more affordable, accessible and a better quality, the act ruled that insurance companies could not discriminate against gender or preexisting medical conditions.

This was an incredible feat for people who have cancer that runs in their family, but never wanted to have their genes tested because the results could be considered a preexisting medical condition and could lead to them not being able to get affordable medical insurance.

The situation was the same for people diagnosed with HIV. Once diagnosed, they would be unable to switch medical insurance in fear of not finding another affordable insurance to take them on.

Although the Affordable Care Act should have put an end to these frustrating situations, it seems that even after the act, some insurers are still finding loopholes to discriminate.

National Public Radio reported seven insurers are making HIV drugs unaffordable or unavailable to HIV patients. Not only does this create a negative effect on the health of the patient, but it also discourages HIV patients from seeking the medical attention that they deserve.  

The way insurance companies can control drug accessibility is by creating certain plans that do not cover all the needed drugs for AIDS prevention.

The Harvard Law School’s Center for Health Law and Policy Innovation filed claims against insurance plans in eight states. They believe that the plans provide for inaccessibility to necessary drugs for HIV patients or ask the patients to pay more for them.

Kevin Costello, director of litigation at the health law center, said, “What’s most important to us is that there’s a robust enforcement mechanism around the promises in the [Affordable Care Act] and its regulations, especially the anti-discrimination provisions.”

The Harvard Law School’s Center for Health Law and Policy Innovation found that some plans in Wisconsin cover only four out of the 16 drugs.

They also reported that some plans place many of the drugs on a higher cost tier that forces patients to pay 50 percent of the cost out of pocket.

Many directors of the alleged discriminating insurance plans argue that the real problem is the cost of HIV prescription drugs.

Although prescription drugs may be excessively expensive, patients rely on the insurance companies making the drugs they need affordable. Patients are handing over their lives to these insurance companies thinking that they will be able to live a long and healthy life, which is entirely possible with progressive HIV treatment.

The Affordable Care Act failed to regulate areas where discrimination could come into play. Federal regulators claim that they will look at discrimination cases when they happen, rather than opting for prevention.

Provisions for discrimination prevention in insurance plans needs to be put in place. Without a change to the Affordable Care Act, many people could suffer from inaccessibility to the drugs they need, or live in poverty trying to make ends meet while paying for expensive prescription drugs.

Currently, the litigation happening is directly referring to HIV patients, but heavier discrimination regulation could also benefit patients who suffer from chronic illness and pain and are unable to access certain drugs.