CMS may require Obamacare insurers to accept Ryan White payments
By Bill Berkrot and Sharon Begley
Reuters, February 9, 2014The 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-id…
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.
HHSās response? They are going to encourage insurers and Marketplaces to accept Ryan White payments. They offer what doesnāt 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.