Advocates welcome consent order to protect people livingwith HIV/AIDS, call for robust monitoring and enforcement of ACA non-discrimination provisions
WASHINGTON—The Florida Office of Insurance Regulation (FOIR) announced this week that it had concluded its market examination of Humana and fined the health insurer $500,000 for failing to cooperate with investigators. In a consent order dated February 16, 2016, Humana agreed to “maintain procedures to ensure that it does not by effect or design treat people living with HIV/AIDS less favorably than any other condition.” Health advocates from The AIDS Institute and the National Health Law Program (NHeLP) welcomed the news.
“The FOIR regulatory action sends a strong message that health insurers will be held accountable. Rigorous compliance monitoring and enforcement is essential to ensuring that the Affordable Care Act fulfills its promise of protecting patients against discrimination and providing affordable healthcare,” stated Wayne Turner, NHeLP Staff Attorney.
In 2014, The AIDS Institute and NHeLP filed a complaint with the U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) charging four Florida health plans, including Humana, with unlawful discrimination against people living with HIV and AIDS by placing all HIV medications, including generics, on the highest cost sharing tier, thus requiring enrollees to pay as much as 50 percent co-insurance for every HIV drug. In the complaint, the groups contend that such practices discourage people with HIV/AIDS from enrolling in the plans and violate the Affordable Care Act’s (ACA) non-discrimination provisions. The ACA bans plans from discriminating against individuals based upon disability and prohibits them from discouraging enrollment by people with significant health needs.
Last year, HHS issued guidance to all plans nationwide informing them that such practices are discriminatory; and in proposed regulations implementing the ACA’s non-discrimination provision, Section 1557, HHS made clear that plan benefits cannot be designed to discriminate. However, OCR has yet to issue a ruling on the complaint.
The AIDS Institute Executive Director Michael Ruppal commented, “We appreciate the steadfast leadership of Florida Insurance Commissioner Kevin McCarty in protecting people living with HIV/AIDS in Florida by ensuring qualified health plans in the state do not engage in discriminatory practices. Last year, the Commissioner issued a memo to all insurers that directed them to limit patient cost-sharing of all HIV medications to reasonable co-pays. While we are pleased with these results, we remain concerned that these discriminatory insurance practices continue to affect other patient populations in Florida and across the nation.”
The AIDS Institute’s analysis of Florida’s 2016 qualified health plans found that coverage for nearly all Hepatitis B and C drugs by several insurers remains subject to high co-insurance levels. Humana places almost all hepatitis C drugs on Tier 5, which translates into coinsurance of either a 40 or 50 percent of drug cost, after the patient pays a $3,800 deductible. Aetna and CoventryOne place all Hepatitis C drugs and almost all Hepatitis B drugs on Tiers 4 and 5, which carry coinsurance of 40 percent and 50 percent of drug cost, after a $2,750 deductible.
The AIDS Institute and NHeLP are calling for additional monitoring of health plans and stronger enforcement of the ACA’s non-discrimination provision by federal and state regulators.