Vol 23, 2014 Annals of Health Law 40
THE ACA AND PEOPLE LIVING WITH HIV/AIDS
program. 90 According to a recent report published by the Kaiser Family
Foundation, seventy percent of people who use Ryan White already have
some form of insurance. 91 These people rely on Ryan White to supplement
costs associated with limits on their coverage or help with co-pays. 92 Such
people still require supplemental funding for care because the substantial
cost sharing imposed by many plans can make HIV treatment
B. Private Health Plans
In the private arena, PPACA creates a number of consumer protections
that will prevent insurance providers in the individual and small group
markets from excluding PLWHA. Since January 1, 2014, PPACA has
prohibited insurance providers from ( 1) denying anyone coverage based on
pre-existing conditions94 and ( 2) imposing lifetime and annual limits. 95 For
individual and group plans issued after March 23, 2010, or renewed on or
after September 23, 2010, the law also prohibits providers from denying
children under the age of 19 coverage because of a pre-existing condition. 96
Plans that started between September 23, 2010 and September 22, 2011,
could not have annual limits of less than $750,000.97 The restricted limit
then increased to $1.25 million for plans that started on or after September
23, 2011, and then to $2 million for plans that started between September
23, 2012 and January 1, 2014.98 These provisions prohibit insurance
providers from using two of their most common tools to deny PLWHA
comprehensive health insurance coverage. 99
1. Pre-existing Conditions
Perhaps the most common way in which the health insurance industry
has denied insurance to PLWHA is through its practice of denying health
94. 42 U.S. C. A. § 300gg- 3 (West, WestlawNext through P.L. 112-283).
95. 42 U.S. C. A. § 300gg- 11.
96. Dep’t Health & Human Servs., Children’s Pre-Existing Conditions,
(last visited Jan. 13, 2014).
97. Ctrs. for Medicare & Medicaid Servs., Annual Limits, http://www.cms.gov/
CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/ Annual-Limits.html (last
visited Nov. 21, 2013).
99. See infra Parts III. A. 1-2.