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 President Barack Obama's 2010 Affordable Care Act outlawed
discrimination based on pre-existing conditions. Insurers cannot ask
about current or past illnesses, charge people with, say, diabetes
or cancer more than healthy people, or deny coverage.
Some, however, have found a way to discriminate anyway, wrote
researchers at the Harvard T.H. Chan School of Public Health,
"resorting to other tactics to dissuade high-cost patients" from
enrolling.
Traditionally, insurers use formularies, lists of covered drugs and
their out-of-pocket costs, to steer patients toward generic drugs or
medicine for which a company has negotiated a favorable price. But
formularies can be structured to put off people with pre-existing
conditions, said co-author Ben Sommers.
He and Douglas Jacobs analyzed 48 Obamacare policies in 12 states
using the federal Healthcare.gov marketplace. In 2014, 12 of the
policies placed all covered HIV drugs called nucleoside
reverse-transcriptase inhibitors, including generics, in tiers with
at least a 30 percent co-pay, usually the highest. Some did not
cover the drugs at all.
Customers in the 12 plans had an average annual cost per HIV drug
more than triple that of customers in the other plans, $4,892
compared with $1,615.
Premiums in plans with the highest out-of-pocket costs for HIV drugs
were lower than others', but someone with HIV would pay $3,000 more
each year, the researchers calculated.
"This matches what we've seen in Illinois, where four of seven plans
have what we consider unaffordable HIV drugs," said John Peller,
president of the AIDS Foundation of Chicago. "We think insurers are
looking for ways to make plans less welcoming to people with chronic
conditions."
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Insurers disagree.
"Individuals can pick the policy that is best for them," said Clare
Krusing, spokeswoman for America's Health Insurance Plans, the
industry's lobbying group. Subsidies "reduce out-of-pocket costs for
prescription drugs even more."
In addition, Obamacare requires that insurers with few costly
patients pay those with many, so deterring HIV customers makes no
financial sense, she said.
Most of that transfer program phases out after 2016, however.
In late 2014, the Obama administration proposed a rule that would
consider policies with all drugs for a condition in the highest
out-of-pocket tier discriminatory and therefore disallowed.
(Reporting by Sharon Begley. Editing by Andre Grenon)
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