Louisiana insurers use loophole to deny AIDS patients insurance

The state of Louisiana has only three insurance companies offering healthcare insurance under the Affordable Care Act, and all three are denying insurance to people who are HIV positive. Blue Cross and Blue Shield of Louisiana was the first insurer to deny benefits under the ACT. Soon after two smaller insures, The Louisiana Health Cooperative and Vantage Health Plan, followed the path of Louisiana BCBS by rejecting HIV positive customers. 

The insurers are basing the rejection of HIV positive customers healthcare on the guidelines issued by the Centers for Medicare and Medicaid Services (CMS), the main ACT agency. They claim that CMS prevents them from accepting third party payments regardless from where they come from including government programs. The specific program they are referring to is the Ryan White HIV/AIDS Program which helps people living with HIV and AIDS, including payment of medical insurance. CMS has stated that federal government programs, including Ryan White funds, are not included in the "third party ban". CMS has now stated that they may amend the rules to require insurers to accept Ryan White money. Humana is a fourth company offering insurance and accepting all third party payments from federal programs including Ryan White, but is only available to those who live in Orleans Parish.

Lambda Legal, a non-profit group that advocates on behalf of HIV patients, filed a federal civil rights complaint against Blue Cross Blue Shield of Louisiana’s decision shortly after it was announced. It has since filed separate complaints against Louisiana Health Cooperative and Vantage Health Plan, Reuters reported, in an effort to force insurers to accept third-party payments made by federal assistance programs.

"The worst nightmare for people with HIV/AIDS is coming true in Louisiana: they're being turned away in what's become a race to the bottom by insurers,” Susan Somme, the group’s director of constitutional litigation, said to Reuters.

"What we're seeing in Louisiana is a crisis for low-income people with AIDS," she said. "These are exactly the people the Affordable Care Act was designed to provide a safety net for."

According to the advocacy coordinator at Shreveport, LA’s Philadelphia Center, Eric Evans, prescriptions for HIV patients can cost as much as $10,000 a month. He now tells The Advocate that Lambda Legal is considering filing lawsuits against the three insurer carriers if the federal complaints don’t cause the companies to reconsider.

In the meantime, Louisiana Blue reiterated just last week that it will stop accepting third-party payments for premiums beginning at the start of next month. That new policy, the company told Reuters, is “a safeguard against ... patient steering and other fraudulent activities."

According to the news wire, the CMS said this week that it "is considering amending the rules to require," and not merely allow, "issuers to accept these (Ryan White) payments."

Louisiana healthcare providers are putting the lives of thousands of people in danger. An important part of the Affordable Care Act was to be sure that people with pre-existing conditions, including HIV/AIDS, would not be denied healthcare. People living with HIV must have ongoing treatment. Any break from treatment, especially a break from life-saving drugs, can be deadly. The media should ask the question: Will we see more states follow this harmful path?

RT.com has more on the story.