In a letter signed by 197 of its members, the I Am Essential, a coalition patient and community organizations that represent millions of American patients, has urged the federal government to better define and address discriminatory insurance plan practices.
Specifically, the coalition requests that the definition of discriminatory practices be more detailed in Sec. 1557 of the Affordable Care Act, which prohibits discrimination in the health care system on the basis of race, color, national origin, sex, age or disability in certain health programs and activities.
The proposed rule to implement Sec. 1557, entitled Nondiscrimination in Health Programs and Activities (RIN 0945-AA02), was issued Sept. 8 by the U.S. Department of Health and Human Services (HHS). The proposal “does an adequate job of defining discriminatory practices by insurance plans for some individuals,” the coalition said in comments filed this week.
However, the proposed rule doesn’t define discriminatory practices in plan benefit design as it relates to all beneficiaries, “particularly those with serious and chronic health conditions who rely on prescription medications and other healthcare services,” Carl Schmid, deputy executive director of the Washington, D.C.-based AIDS Institute, told Patient Daily News.
The AIDS Institute is one of the dozens of I Am Essential coalition members representing patients with myriad serious conditions, such as arthritis, epilepsy, lupus, cancer, diabetes, and heart disease. The groups also represent people who may be obese, suffer mental health illnesses, or have behavioral health issues, among other health problems.
All such patients seek “inclusion in these federal regulations,” Schmid said. “These patients seem to be the most hurt by some plans, though not all plans are engaged in discriminatory practices.”
For example, beneficiaries have witnessed discriminatory practices by some insurers particularly in the coverage of prescription medications, which the coalition says are needed to keep many beneficiaries with chronic and serious health conditions healthy and alive.
Some ACA marketplace plans, in fact, place all or almost all medications to treat a certain condition on the highest cost tier, according to the coalition’s comments.
And while HHS has previously stated that such practices could be discriminatory, the department hasn’t specifically named them as such in its proposed rule, Schmid said.
At the same time, according to the coalition, HHS needs to clarify that the definition of who is protected under Sec. 1557 is not only limited to beneficiaries who are “disabled” under the definition in the Americans with Disabilities Act (ADA), but to all beneficiaries with chronic health conditions or serious illness.
“Using the definition under the ADA will include only some individuals or health conditions and overlooks many beneficiaries who may be exposed to discrimination in their health care coverage,” the coalition notes.”These individuals should also enjoy the same patient protections.”
The coalition also asked that HHS and the Office for Civil Rights properly enforce the law, act on any discrimination complaints, and provide states with related guidance, Schmid said.
“Any law or regulation is useless if it isn’t properly enforced and states can't be expected to enforce it without guidance from the feds,” he said.
Read the HHS proposed rule online at: https://www.federalregister.gov/articles/2015/09/08/2015-22043/nondiscrimination-in-health-programs-....