New Fact Sheet: How the Health Reform Law Helps People with HIV

Still wondering how the Affordable Care Act helps people living with HIV/AIDS? Well, there’s no need to wonder anymore!

The HSS Office of Health Reform has developed a new fact sheet about how the Affordable Care Act (ACA) is particularly important for people living with HIV/AIDS, as well as other people living with serious medical conditions. The law has made significant progress in addressing the concerns and advancing the rights of people with HIV consistent with the goals of the President’s National HIV/AIDS Strategy.

Among the ways the new health law is helping people with HIV are the following:

• Ensuring that AIDS Drug Assistance Program (ADAP) benefits are now considered as contributions toward a Medicare beneficiary’s true Out of Pocket Spending Limit for drug coverage.
• Improving access to coverage and protecting people with HIV/AIDS now by making available a Pre-Existing Condition Insurance Plan in every state and making important insurance reforms to protect people from insurance company abuses;
• Offering quality coverage and care to every person with HIV/AIDS in 2014 and beyond via Medicaid expansion, additional insurance reforms, and closing the “Donut Hole”, and
• Increasing opportunities for health, well-being, and cultural competency.

So, whether you are just learning about the Affordable Care Act or looking for updated information, this fact sheet gives you the tools you need to make informed choices about your health. Read more details in the fact sheet (PDF) about what the health care law does to help people with HIV/AIDS.

This post originally appeared on the HIVHealthReform.org Blog.

Essential Health Benefits: What’s it mean for people with HIV?

On December 16, 2011, the U.S. Department of Health and Human Services (HHS) announced that states would decide what essential health benefits will be provided under health care reform.  Although we had urged HHS to adopt a uniform, national benefits floor that states could build on, the federal proposal offers important flexibility for states. (Check out our essential health benefits archive.)

So, what does the essential health benefits announcement mean for people with HIV?  The short answer is that we’re working on it.  Here are some of the hoops we’ll have to jump through just to figure out what the benefits might look like in a state.

Which plans are we talking about?  HHS gives states the choice of:

(1) the largest plan by enrollment in any of the three largest small group insurance products in the State’s small group market;
(2) any of the largest three State employee health benefit plans by enrollment;
(3) any of the largest three national FEHBP [Federal Employee Health Benefit Plan] plan options by enrollment; or
(4) the largest insured commercial non-Medicaid Health Maintenance Organization (HMO) operating in the State.

Yeah, we weren’t sure where to start either.  There’s no centralized federal repository of health plan data, since states regulate health insurance.  Every state publishes plan information online differently, or not at all.  We’ll probably have to submit a special data request to each of the 50 state insurance departments.

What benefits does each plan offer?  Once advocates identify the largest plans, the next step is to determine exactly what benefits they offer.  You can bet that Blue Cross doesn’t publish on their website a description of each of their hundreds of plans offered in a state.  We’ll might have to ask companies directly for plan descriptions, or pour through regulatory filings at state insurance departments.

Once we have this information, we can start to figure out what the plans will look like for people with HIV.  Of course, we’ll partner with national and state advocates to gather and analyze information.  At the state level, it’s more essential than ever that advocates work together to figure out the benefit puzzle and don’t duplicate effort.

And here’s an idea:  Could advocates, employers and insurance companies collaborate to gather all this information?  Sure, old adversaries would have to sit at the same conference table to share opinions and information – but that might be just “what the doctor ordered” in the new world of health care.

Read the federal fact sheet
Read the HHS Essential Health Benefits Bulletin
Federal white paper on benefits in small group and state and federal plans
Federal fact sheet on individual market benefits

John Peller, VP of Policy
AIDS Foundation of Chicago
jpeller@aidschicago.org

Originally posted here on HIVHealthReform.org