Vol 23, 2014 Annals of Health Law 43
THE ACA AND PEOPLE LIVING WITH HIV/AIDS
Health Benefits (EHBs) as defined by PPACA. 116 This provision mandates
that insurance providers offer “comprehensive coverage” to avoid harmful,
and common, gaps in care. 117 PPACA defines EHBs as the following: ( 1)
ambulatory patient services; ( 2) emergency services; ( 3) hospitalization; ( 4)
maternity and newborn care; ( 5) mental health and substance abuse
disorders, including behavioral health treatment; ( 6) prescription drugs; ( 7)
rehabilitative and habilitative services and devices; ( 8) laboratory services;
( 9) preventative and wellness services and chronic disease management;
and ( 10) pediatric services, including oral and vision care. 118 All ten EHBs
must be included in the benefits that health plans offer. 119 The scope of
these benefits is supposed to equal the scope of benefits provided by the
typical employer health plan. 120 Although PPACA allocates the
responsibility of defining the typical employer health plan to the Secretary
of HHS, HHS has since decided that it will give states a choice of four
“benchmark plans.” 121 These benchmark plans will act as minimum
coverage mandates, effectively defining EHBs for the state. 122
IV. PROBLEMS AHEAD IN IMPLEMENTATION
While PPACA contains substantial potential to expand access to
insurance for PLWHA, it also fails to address certain longstanding access
issues, while simultaneously creating new ones. 123 PPACA must be
implemented with an eye to the challenges PLWHA face if it is going to
achieve a reduction in the incidence of HIV, an increase in access to care
and an optimization of health outcomes for PLWHA, and a reduction in
HIV-related health disparities. 124 PPACA implements numerous incentives
116. § 18022(b)( 1).
117. Kathleen Sebelius, Sebelius: In Defense of Health Care Law’s ‘Essentials’, USA
TODAY (Jan. 3, 2012), http://usatoday30.usatoday.com/news/opinion/forum/story/2012-01-
118. 42 U.S. C. A. § 18022(b)( 1) (West, WestlawNext through P.L. 111-48).
119. See § 18021(a)( 1)( B).
120. § 18022(b)( 2)( A).
121. See CTR. FOR CONSUMER INFO. & INS. OVERSIGHT, ESSENTIAL HEALTH BENEFITS
BULLETIN 8–10 (2011), available at http://www.cms.gov/CCIIO/Resources/Files/
122. See id. at 9-10.
123. See infra Part IV.
124. See Crowley & Kates, supra note 4, at 10 (noting that the ACA contains a number
of ambiguities that have special implications for the specialized treatment that PLWHA
require); Christine Vestal, How the ACA Will Affect People with HIV and AIDS, USA TODAY
(Oct. 29, 2013), http://www.usatoday.com/story/news/nation/2013/10/28/how-the-aca-will-
affect-people-with-hiv-and-aids/3285897/ (noting that it is unclear whether states will
interpret the ACA’s essential health benefits requirements to cover currently existing gaps in