Vol 23, 2014 Annals of Health Law 41
THE ACA AND PEOPLE LIVING WITH HIV/AIDS
coverage based on pre-existing conditions. 100 PPACA stops this practice by
prohibiting insurers from rejecting people based on pre-existing
conditions. 101 Previously, insurance providers could deny people coverage
based solely on a preexisting condition from the moment they were born. 102
In order to ensure that these plans are affordable, PPACA also prohibits
insurance companies from charging higher premiums based on preexisting
To ensure that people with pre-existing conditions were not left without
insurance until 2014, Congress also created the Pre-Existing Conditions
Insurance Plan (PCIP). 104 The PCIP program provides health insurance to
U.S. citizens and legal permanent residents as long as insurance providers
have denied their application for health insurance because of a pre-existing
condition and they have been uninsured for at least six months. 105 This
program coveres basic health benefits for people with preexisting
conditions, including primary and specialty care, hospital care, and
prescription drugs. 106 As of June 30, 2013, 104,966 people had enrolled in
it. 107 While information on how many PLWHA are enrolled in the PCIP
program is not available, the AIDS Drug Assistance Program (ADAP)—a
jointly administered federal-state program that provides HIV-related
prescription drugs to low-income people with HIV/AIDS—had enrolled
4,693 clients as of December 2012.108 Although Congress planned to end
100. See Ctrs. for Medicare & Medicaid Servs., The Affordable Care Act and HIV/AIDS,
http://aids.gov/federal-resources/policies/health-care-reform/ (last visited Nov. 21, 2013).
102. 42 U.S. C. A. § 18001 (West, WestlawNext through P.L. 113-36); Lauren Cox &
Lara Salahi, Newborn Denied Health Insurance Coverage Days After Life-Saving Heart
Surgery, ABC NEWS (Mar. 27, 2010), http://abcnews.go.com/Health/HeartFailureNews/
103. See § 18001. PPACA also contains provisions more generally aimed at
affordability, such as the rule that all small group, large group, and individual health
insurance providers must meet the Medical Loss Ratio. Dep’t Health & Human Servs., How
Does the Health Care Law Protect Me?, https://www.healthcare.gov/how-does-the-health-
care-law-protect-me/#part= 10 (last visited Oct. 14, 2013). This rule mandates that all
insurance providers spend at least eighty percent of their premiums on direct medical care or
quality improvement. Id.
104. See § 18001.
105. Id. § 18001(d).
106. Dep’t Health & Human Servs., Pre-Existing Condition Insurance Plan: Costs and
Benefits, https://www.pcip.gov/Costs_Benefits.html (last visited Nov. 4, 2013).
107. Ctrs. for Medicare & Medicaid Servs., State by State Enrollment in the Pre-Existing Condition Insurance Plan, https://www.cms.gov/CCIIO/Resources/Fact-Sheets-
and-FAQs/ pcip-enrollment.html (last visited Oct. 14, 2013) (stating that the program had
107, 139 enrollees by January 31, 2013).
108. Kaiser Family Found., AIDS Drug Assistance Program (ADAP) Coordination with
Pre-Existing Condition Insurance Plans (PCIP), December 2012, http://www.statehealth