The foundations of the ACA are built on the promise to provide health insurance without discriminating on the basis of medical history and pre-existing conditions. However, it seems that not all health insurers are following the mandates set by the law and subtly discriminating among the type of enrollees they have received in the first enrollment period. Ironically, the discrimination is on the basis of HIV/AIDS, one of the conditions, which absolutely requires quality primary care administration. Let’s take a look at how this discrimination has infested the new, post ACA healthcare system.
Currently, health insurers follow the practice of dividing prescription drugs into tiers, depending upon the cost of drugs to the consumer. Other than drug costs, this procedure also weighs other variables, such as deductibles and pre-approvals. Unfortunately, this division is unmonitored and there are no rules in place to define division, giving health insurers full freedom to distribute prescription drugs across tiers. Certain health insurers have capitalized on this lack of regulations, and have placed every drug required for HIV/AIDS treatment in the most expensive tier. The incident has come to light after a review of silver plans was conducted in a state. The review found as many as four top health plans were utilizing this practice, which effectively qualifies as discrimination against people with the preexisting condition of AIDS.
Almost all types of anti-retroviral drugs, which are used in the treatment of HIV, have been placed in the highest tier. Unsurprisingly, the cost of these prescription drugs is extremely high, which has prompted these health insurers to place them in tiers that require as much as $1,000 deductible with a 40 percent coinsurance payment and prior approval. With these drug costs presenting themselves after people have enrolled in the system, keeping up with the bills will get daunting for these patients. Naturally, this affects the potency of the ACA by annulling the mandate of providing health insurance to people with preexisting medical conditions. In effect, health insurers are not directly discriminating against people with HIV/AIDS, but they are discouraging enrollment by mounting the cost challenges they would face after enrollment.
Congress is preparing charges on grounds of discouraging enrollment of people with special health needs. There is an official complaint by the National Health Law Program and The AIDS Institute in the Office of Civil Rights. The complaint wants the Obama administration to step in and evaluate the situation through careful analysis and inspection. Post investigation, if found guilty of discrimination, the administration will instruct the offending health plans to make distribution better and altogether remove any kind of subtle discrimination. Certain penalties would also be a part of the fine slapped on these health insurers for breaking the ACA mandate of discrimination.
A disturbing facet of this implementation by health insurers is the clandestine way in which they subtly discriminated against HIV+ patients. The sky high prescription drug costs will definitely be detrimental for people afflicted with this condition, and would deter people from enrolling with these health plans, thereby reducing their risks, and in turn, costs. To check this, the administration will have to get deep into the mechanics of this to prove that the insurers are, in fact, discriminating.
If the Obama administration wants to prevent anything like this happening again, it will have to take some strict measures against the offenders of this case. There is already a major push coming from activists and nonprofit organizations rallying against discrimination of people with AIDS.