By Sharon Begley and Julie Steenhuysen
NEW YORK
(Reuters) - Hundreds of people with HIV/AIDS in Louisiana trying to
obtain coverage under President Barack Obama's healthcare reform are in
danger of being thrown out of the insurance plan they selected in a
dispute over federal subsidies and the interpretation of federal rules
about preventing Obamacare fraud.
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 of fraud.
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.
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 pools.
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 Program funding."
'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 Blue.
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.
