Fwd: qotd: Blue Cross and Blue Shield of Louisiana dodges HIV/AIDS patients

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-------- Original Message --------
Subject: qotd: Blue Cross and Blue Shield of Louisiana dodges HIV/AIDS
patients
Date: Mon, 10 Feb 2014 12:05:20 -0800
From: Don McCanne <don@mccanne.org>
To: Quote-of-the-Day <quote-of-the-day@mccanne.org>



Reuters
February 9, 2014
CMS may require Obamacare insurers to accept Ryan White payments
By Bill Berkrot and Sharon Begley

The 1990 Ryan White Act offered people with HIV/AIDS federal financial
help in paying for AIDS drugs and health insurance premiums, especially
in state-run, high-risk pools. Obamacare, which bans insurers from
discriminating against people with preexisting conditions, was designed
to replace these high-risk pools.

Hundreds of HIV/AIDS patients are dependent on Ryan White payments for
Obamacare because they fall into a coverage gap. They are not eligible
for Medicaid, the joint federal-state health insurance program for the
poor, because Louisiana did not expand the low-income program, and
Obamacare federal subsidies don't kick in until people are at 100
percent of the federal poverty level.

Hundreds of people with HIV/AIDS in Louisiana trying to obtain coverage
under President Barack Obama's healthcare reform are in danger of being
thrown out of the insurance plan they selected in a dispute over federal
subsidies and interpretation of rules about preventing Obamacare fraud,
Reuters reported on Saturday.

Blue Cross and Blue Shield of Louisiana, the state's largest health
insurer, is rejecting checks from a federal program designed to help
these patients pay for AIDS drugs and insurance premiums, and has begun
notifying customers that their enrollment in its Obamacare plans will be
discontinued.

The insurer insists it is not trying to keep people with HIV/AIDS from
enrolling in one of its policies under the Affordable Care Act, but is
instead rejecting third party premium payments in an effort to prevent
potential fraud.

http://www.reuters.com/article/2014/02/09/us-usa-healthcare-obamacare-idUSBREA180W620140209


Comment: One of the advantages of the Affordable Care Act (ACA) is that
private insurers can no longer reject the applications of individuals
with serious, expensive disorders, such as HIV/AIDS. But the response of
Blue Cross and Blue Shield of Louisiana - the largest insurer in
Louisiana - is another example of how private insurers are not inclined
to change from their business model to a patient service model.

For HIV/AIDS patients, the need was so great that Congress passed the
Ryan White Act in 1990 in order to provide funds to pay premiums for
them in high-risk pools. Since ACA requires insurers to accept all
applicants, many of the high-risk pools are transferring their
beneficiaries to the exchange plans. These are expensive patients yet
the premiums the insurers receive are the same as for everyone else in
the individual risk pools.

Clearly, the insurers do not want these patients, yet the Ryan White
funds are still available to pay the premiums, especially for those with
incomes below poverty in a state that has refused to expand its Medicaid
program.

So what did Blue Cross and Blue Shield of Louisiana do? They refused to
accept Ryan White checks to pay for the premiums on the basis that such
payments could expose the insurer to fraud. What? A federal government
check creates a greater potential for fraud?

The fraud is obviously on the part of Blue Cross and Blue Shield of
Louisiana which is using this ruse to keep high-cost HIV/AIDS patients
out of their health plans - patients which they are required to cover.

HHS's response? They are going to encourage insurers and Marketplaces to
accept Ryan White payments. They offer what doesn't even amount to a
tweak when what we need is get rid of the private insurers and cover
everyone with our own improved version of Medicare. The goal should be
optimal patient service, not optimal business success for private insurers.