Some healthcare advocates see discrimination in the move, but Blue
Cross and Blue Shield of Louisiana says it is not trying to keep
people with HIV/AIDS from enrolling in one of its policies under the
Affordable Care Act, also known as Obamacare.
The state's largest carrier 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 carrier says it no longer will accept third-party payments, such
as those under the 1990 Ryan White Act, which many people with
HIV/AIDS use to pay their premiums.
"In no event will coverage be provided to any subscribers, as of
March 1, 2014, unless the premiums are paid by the subscriber (or a
relative) unless otherwise required by law," Blue Cross Blue Shield
of Louisiana spokesman John Maginnis told Reuters.
AIDS FUNDS EXEMPT FROM FRAUD CONCERNS
The dispute goes back to a series of statements from Centers for
Medicare and Medicaid Services (CMS), the lead Obamacare agency.
In September, CMS informed insurers that Ryan White funds "may be
used to cover the cost of private health insurance premiums,
deductibles, and co-payments" for Obamacare plans.
In November, however, it warned "hospitals, other healthcare
providers, and other commercial entities" that it has "significant
concerns" about their supporting premium payments and helping
Obamacare consumers pay deductibles and other costs, citing the risk
The insurers told healthcare advocates that the November guidance
requires them to reject payments from the Ryan White program in
order to combat fraud, said Robert Greenwald, managing director of
the Legal Services Center of Harvard Law School, a position
Louisiana Blue still maintains.
"As an anti-fraud measure, Blue Cross and Blue Shield of Louisiana
has implemented a policy, across our individual health insurance
market, of not accepting premium payments from any third parties who
are not related" to the subscriber, Maginnis said.
On Friday, CMS spokeswoman Tasha Bradley told Reuters that, to the
contrary, Ryan White grantees "may use funds to pay for premiums on
behalf of eligible enrollees in Marketplace plans, when it is
cost-effective for the Ryan White program," meaning that having
people with HIV/AIDS enroll in insurance under Obamacare could save
the government money.
"The third-party payer guidance CMS released (in November) does not
apply to" Ryan White programs.
Maginnis did not respond to further requests, sent after business
hours, for comment on CMS's Friday statement.
Hundreds of indigent HIV/AIDS patients are dependent on Ryan White
payments for Obamacare because they fall into a 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.
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Before Obamacare, 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
Starting on October 1, AIDS advocates and others in Louisiana "were
enrolling anyone and everyone we could" through the Obamacare
exchange, said Lucy Cordts of the New Orleans NO/AIDS Task Force.
Last month, her clients and those of other AIDS groups began to hear
from Louisiana Blue that their enrollments were in limbo because the
company would not accept the Ryan White checks for premium payments.
The only other carrier that is refusing to accept such payments is
Blue Cross Blue Shield of North Dakota, according to a CMS official.
North Dakota Blue "restricts premium payment from third parties
including employers, providers, and state agencies," said
spokeswoman Andrea Dinneen, but "is currently reviewing its
eligibility policies with respect to recipients of Ryan White
"SURE LOOKS LIKE DISCRIMINATION"
Healthcare advocates are worried that the refusal to accept Ryan
White payments is an effort by insurers to keep AIDS patients from
enrolling in their plans and last month began pressing the issue,
including with the office of Democratic Senator Mary Landrieu.
In an email reviewed by Reuters, a healthcare expert on Landrieu's
staff wrote, "BCBS LA told me their decision was not due to the CMS
guidance or any confusion (as we thought before) but was in fact due
to adverse selection concerns. I have also recently learned North
Dakota's BCBS plan has implemented the same policy."
Jessica Stone, the Landrieu staff member, declined to elaborate on
the email further or to discuss her interactions with Louisiana
Adverse selection refers to the situation where an insurer attracts
patients with chronic conditions and expensive care. Louisiana
Blue's action "sure looks to us like discrimination against sick
people," said John Peller, vice president for policy at the AIDS
Foundation of Chicago.
Asked if it were engaging in efforts to avoid adverse selection by
refusing to accept Ryan White payments for would-be customers with
HIV/AIDS, Louisiana Blue said it was not trying to keep such
customers out of its plans. "We welcome all Louisiana residents who
chose Blue Cross and Blue Shield of Louisiana," said Maginnis.
(Reporting by Sharon Begley and Julie Steenhuysen;
editing by Peter
Henderson and Prudence Crowther)
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