The Obama administration is launching an investigation to ensure health insurance companies are not discriminating against people with costly chronic conditions like AIDS, diabetes and mental illnesses, the administration announced on Monday.
The administration said that some companies have been biased in their coverage and even encouraged people with certain conditions to opt out of enrolling.
With multiple studies revealing pre-existing health conditions such as diabetes plague huge portions of the Black community and severely impact the type of medical care they can afford, the results of the investigation could be key in the push to close the health care gap.
The administration claims it has already been made aware of some “discriminatory benefit designs” that directly violate the Affordable Care Act.
Under the Affordable Care Act all insurers are required to accept all applicants and cannot change rates or premiums based on pre-existing conditions.
Officials issued a letter to health insurers across the nation warning them that any health plan that restricts access to all drugs needed to treat a certain illness or condition will be considered discriminatory.
It was revealed that some health insurance providers have been charging higher co-payments or requiring prior authorization for drugs used to treat AIDS, mental illnesses such as bipolar disorder and schizophrenia, diabetes, rheumatoid arthritis and more.
The idea of healthcare providers creating high barriers to necessary medication is troubling for all families, but it’s a particularly troubling fact for the Black community.
The amount of Black people with HIV is eight times greater than that of whites.
Black people are also far more likely to have high blood pressure and develop type 2 diabetes.
That means these discriminatory practices have been taking aim at a disproportionately high proportion of Black people who may have been left without adequate medication due to financial barriers.
The investigation will focus mainly on companies in the federal insurance marketplace and aim to estimate the “out-of-pocket costs associated with standard treatment protocols for specific medical conditions using nationally recognized clinical guidelines.”
Unfortunately this is far from being a new issue in health care.
Florida insurance commissioner, Kevin M. McCarty, took matters into his own hands recently when he reached agreements with major health insurance providers that would slash the percentage of costs that HIV patients had to come up with.
The percentage dropped 40 percent for HIV patients insured by Humana under the new agreement, which means they will now only be paying 10 percent of the costs of HIV medications.
Even after slashing the costs for patients, however, Humana insisted that it did not break any laws.
Instead, Humana said that Florida simply has a “unique law” that gives certain protections to HIV/AIDS patients.
“Florida has a unique law providing insurance-related protections to individuals with HIV/AIDS,” said Thomas T. Noland Jr., senior vice president of Humana. “We understand the affordability challenges facing those with HIV/AIDS because of the relatively high cost of their specialty medications.”
McCarty also reached agreements with Cigna and Coventry Health Care.
Now, all health insurance providers in the Federal marketplace may have to follow suit.
“If an issuer places most or all drugs that treat a specific condition on the highest-cost tiers, that plan design effectively discriminates against, or discourages enrollment by, individuals who have those chronic conditions,” the administration’s letter to insurers said.
So far the new standards are receiving a warm welcome by health care advocates, including one lobbyist at the National Alliance on Mental Illness, Andrew Sperling.
“When a doctor follows recommended treatment guidelines the cost-sharing should not be so burdensome that it discourages patients from adhering to the treatment,” Sperling told the NY Times.
Much like patients with HIV/AIDS, patients with mental illnesses like bipolar disorder or schizophrenia are also required to pay up to 50 percent of the medication costs, making it extremely hard for the average family to afford.