Vol 23, 2014 Annals of Health Law 42
THE ACA AND PEOPLE LIVING WITH HIV/AIDS
the program in 2014 HHS has allowed enrollees to participate in the
program through the end of January to facilitate their transition into the
private market. 109
2. Annual and Lifetime Limits
Another method insurance providers commonly used before Congress
passed PPACA to deny claims from PLWHA was the instituting of annual
and lifetime spending limits. 110 These policies limited the amount that
insurance providers would spend on an insured’s covered benefits by a
specific amount over a predetermined period. 111 If a person exceeded his or
her spending limit, he or she had to pay all healthcare costs in excess of that
amount. 112 For PLWHA, annual limits often made vital medication
unaffordable because the cost of their medical treatment typically far
exceeded their plan’s limit. 113 PLWHA would then face the prospect of
paying for medical treatment they could not possibly afford. 114 Since
January 1, 2014, PPACA has prohibited these practices entirely. 115 By
prohibiting this practice, PPACA eliminates one of the industry’s most
common means of limiting benefits of the insured.
C. Essential Health Benefits
Both public and private plans also have to offer the insured Essential
facts.org/comparereport.jsp?rep=94&cat=17 (last visited Oct. 12, 2013).
109. Dep’t Health & Human Servs., About PCIP, https://www.pcip.gov/About_
PCIP.html (last visited Jan. 13, 2014).
110. Crowley & Kates, supra note 4, at 6.
111. Annual Limits, supra note 97.
112. See Dep’t Health & Human Servs., Centers for Medicare and Medicaid Services,
services/ (last visited Nov. 16, 2013).
113. See Christy Feig, Study Explores High Cost of HIV Care in U.S., CNN HEALTH
(July 10, 2002), available at https://bslenvironmental.wikispaces.com/file/view/Study%
114. See Centers for Medicare and Medicaid Services, supra note 112.
115. 42 U.S. C. § 300gg- 11 (West, WestlawNext through P.L. 112-283); note that
despite this prohibition on annual limits, HHS has issued 1300 waivers to this rule that is
estimated to allow more than three million people to be subject to annual limits on healthcare
spending. Matthew Sturdevant, Health Insurance Waivers Allow Spending Limits on Care
for 3 Million People, HARTFORD COURANT (June 16, 2011), http://articles.courant.com/2011-
insurance-oversight. This is notable for a number of reasons, including the fact that it
highlights the possibility that even clear mandates and prohibitions can be avoided through
waivers. See id.