Vol 23, 2014 Annals of Health Law 44
THE ACA AND PEOPLE LIVING WITH HIV/AIDS
and restrictions for insurance providers when it comes to insuring groups
that providers consider “high cost.” 125 However, PPACA fails to address a
variety of longstanding medical care access problems in both the private126
and public market. 127 In the private market, PPACA creates substantial
ambiguity regarding what benefits insurers must cover. 128 PPACA also
does nothing to address the damaging effects of commonplace drug
formularies. 129 In the public market, PPACA does nothing to rectify the
dispute over Medicaid reimbursement rates, and the resulting Medicaid
access crisis that has affected the neediest in our society. 130 National
Federation has also called the Medicaid Expansion into question, while
creating coverage gaps in non-participating states. 131 Finally, PPACA
contains little in the way of accountability measures, which the country’s
experience in the Medicaid context has shown are indispensable. 132
A. Essential Health Benefits and Benchmark Plans
Assuming that someone has health insurance, PPACA leaves the
question of what this coverage will ultimately look like largely
unanswered. 133 Because Congress has ceded substantial authority in
defining EHBs to the states, 134 the states now have the opportunity to decide
what medical procedures insurance providers are required to cover. 135
Unfortunately, the chances that states will uniformly institute strict
regulation of private plans, without substantial pressure by HIV advocates,
are slim. 136 Federal regulation has also failed to consider the health care
transportation, case management, and dentistry for PLWHA).
125. See supra Part III.
126. See infra Part IV. A.
127. See infra Part IV. B.
128. See infra Part IV. A.
129. See infra Part IV. A. 2.
130. See infra Part IV. A.
131. See infra Part IV. A.
132. See infra Part IV. C.
133. Stacey A. Tovino, A Proposal for Comprehensive and Specific Mental Health and
Substance Use Disorder Benefits, 38 AM. J.L. & MED. 471, 515 (2012) (noting that a staff
member of the Senate Health, Education, Labor, and Pensions Committee described the
categories as “buckets of care” and explained that they were intentionally left vague); see
also supra Part III. C.
134. See supra Part III. C.
135. Abigail R. Moncrieff & Eric Lee, The Positive Case for Centralization in Health
Care Regulation: The Federalism Failures of the ACA, 20 KAN. J. L. PUB. POL’Y 266, 267
(2011); Tovino, supra note 133, at 515.
136. See U.S. GEN. ACCOUNTABILITY OFF., HEALTH INSURANCE REGULATION:
VARIATION IN RECENT STATE SMALL EMPLOYER HEALTH INSURANCE REFORMS 4 (1995),