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 The Louisiana Health Cooperative and Vantage Health
Plan, two smaller insurers, made the move following a decision by
the state's largest insurer, Blue Cross and Blue Shield of
Louisiana, late last year to reject the payments.
Lambda Legal, a non-profit group, filed a civil rights complaint
about the two smaller carriers' action with the Obama administration
on Thursday, following a similar complaint about Louisiana Blue last
week.
"Additional carriers are jumping on the discrimination bandwagon,"
said Susan Sommer, director of constitutional litigation for Lambda
Legal, which works to protect the civil rights of lesbians, gay men,
and people with HIV. "The worst nightmare for people with HIV-AIDS
is coming true in Louisiana: they're being turned away in what's
become a race to the bottom by insurers."
The issue involves the federal Ryan White HIV/AIDS Program which,
for 23 years, has made grants to states, cities and nonprofit
organizations to help low-income people with HIV purchase health
insurance.
The organizations assumed the federal money could be used to pay
premiums for Ryan White beneficiaries who purchased private coverage
on insurance exchanges created by the Affordable Care Act (ACA),
just as the funds had been used to pay premiums previously.
In recent weeks, however, Blue Cross and Blue Shield of Louisiana
began rejecting Ryan White payments sent on behalf of impoverished
HIV-AIDS patients who had enrolled in one of its Obamacare plans, as
did Blue Cross Blue Shield of North Dakota.
The insurers told healthcare advocates that guidance issued by the
Centers for Medicare and Medicaid Services, the lead Obamacare
agency, prevented them from accepting third-party payments for the
new health plans, even when the funds came from a government
program.
That guidance, issued in November, was meant to prevent self-dealing
or even fraud. "The worry was that a hospital, for instance, would
sign up and pay (Obamacare) premiums for their uninsured patients,"
said law professor Mark Hall of Wake Forest University. If a
hospital also steered patients toward an insurer that includes it in
its network, the hospital would turn a charity patient into a paying
one, something CMS regards as a form of prohibited self-dealing.
Last week, CMS said the ban on third-party payments "does not apply"
to those made on behalf of Obamacare enrollees by "state and federal
government programs or grantees (such as the Ryan White HIV/AIDS
Program)."
Over the weekend, CMS went further, said it "is considering amending
the rules to require," and not merely allow, "issuers to accept
these (Ryan White) payments."
On Thursday, Louisiana Blue nevertheless said it will stop honoring
Ryan White and other third-party payments for premiums beginning
March 1. The policy, it said, is "a safeguard against ... patient
steering and other fraudulent activity," adding that it knows "from
experience that there are people who want to game the system."
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ADVERSE SELECTION
Louisiana Health Cooperative has said it "will not be accepting
third-party insurance premium payments either," said Lucy Cordts of
the NO/AIDS Task Force. Her group, which advocates on behalf of
people with AIDS, has an estimated 350 Louisiana residents who chose
Coop plans. "They'll all now need to consider another company." Other healthcare advocates said they had informed Louisiana
Health Cooperative officials that CMS allows Ryan White payments to
be used for Obamacare insurance premiums, and were told that "they
would not change their policy unless required," said Moriba Karamoko,
director of the Louisiana Healthcare Coalition.
Coop spokeswoman Anisha Williams declined to comment.
The third carrier selling Obamacare insurance throughout Louisiana,
Vantage Health Plan, informed the state that it, too, will not
accept Ryan White payments. A spokesperson for the physician-founded
company did not return messages seeking comment.
Insurance experts point out that once one carrier in a market
institutes policies that drive away potentially high-cost customers
such as people with HIV-AIDS, other carriers feel pressure to do the
same for fear of being the only one to cover them, a situation
called adverse selection.
Last week, Lambda Legal filed an administrative complaint with the
Office of Civil Rights of the U.S. Department of Health and Human
Services, CMS's parent agency, against Louisiana Blue. On Thursday
it filed complaints against Vantage and Louisiana Health
Cooperative, arguing that their refusal to accept Ryan White
payments flouted a key provision of the ACA, namely its requirement
that insurers accept any customer regardless of health status.
"What we're seeing in Louisiana is a crisis for low-income people
with AIDS," said Lambda Legal's Sommer. "These are exactly the
people the Affordable Care Act was designed to provide a safety net
for."
One patient who enrolled in a Louisiana Blue plan learned in
December that the insurer would not accept Ryan White checks for his
premiums.
"So now I am without insurance," said Mark, 44, a former high-school
teacher who is unemployed and asked that his last name not be
published. He was able to obtain HIV medications from the NO/AIDS
Task Force, through the Ryan White program. But he cannot afford
medications for high cholesterol and high blood pressure that are
common side effects of HIV drugs.
"My health is in danger at this point," he said. "If we sit back and
let them do this, it goes against everything the Affordable Care Act
is about."
(Reporting by Sharon Begley; editing by
Michele Gershberg and Richard Chang)
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