Annals of Health Law - Vol 23 Issue 1

Vol 23, 2014 Annals of Health Law 49
THE ACA AND PEOPLE LIVING WITH HIV/AIDS
without health insurance.170 Unfortunately, the recent nature and high cost
of this treatment create incentives for providers to deny coverage for
PrEP.171

However, depending on how states interpret PPACA, it could mandate that such treatment be covered by providers with no cost sharing. Previously, insurance providers, both public and private, required the insured to pay deductibles and co-pays in order to access these services.172 These costs discourage people from utilizing these preventative services that can catch illnesses at their early stages.173 PPACA prioritizes preventive services by requiring that plans cover a wide range at no cost to the insured.174 The services that plans must cover fit into four categories: ( 1) evidence-based screening and counseling; ( 2) routine immunizations; ( 3) childhood preventative services; and ( 4) preventative services for women.175 PPACA includes screenings and counseling for high-risk populations and women with HIV/AIDS in its definition of preventive services.176 Neither HHS nor the courts have clarified whether PrEP fits within any of PPACA’s four categories of preventative care. However, as the treatment becomes more widespread and practitioners develop the infrastructure to effectively prescribe PrEP, state actors will likely be faced with the question of whether PrEP fits within PPACA’s mandate on preventative care.

B. Challenges with Medicaid Expansion
PPACA and National Federation have also created new problems for
Medicaid, while failing to address other longstanding ones. After the

170. See Sunny Bjerk, The Hidden Costs of PrEP, AIDS ISSUES UPDATE BLOG (Aug. 21, 2012), http://www.housingworks.org/advocate/detail/the-hidden-costs-of-prep/.

171. See Lahr, supra note 162, at 613 (noting that many have criticized the experimental/medically necessary paradigm as an excuse by providers to deny coverage for expensive treatments).

172. See Dep’t Health & Human Servs., Affordable Care Act Rules on Expanding Access to Preventive Services for Women (Aug. 1, 2011), http://www.hhs.gov/healthcare/ facts/factsheets/2011/08/ womensprevention08012011a.html (noting that before Congress passed PPACA, Americans utilized preventive services at about half the recommended rate partially because of cost).

173. Jill Bernstein et al., Mathematica Pol’y Res. Inc., Encouraging Appropriate Use of Preventive Health Services 1, 2 (2010), http://www.mathematica-mpr.com/publications/ PDFs/Health/reformhealthcare_IB2.pdf.

174. Kaiser Family Found., Preventative Services Covered by Private Health Plans under the Affordable Care Act (Sept. 2011), http://kaiserfamilyfoundation.files. wordpress.com/2013/01/8219.pdf.