When the Affordable Care Act became law in March 2010, it was the biggest overhaul of the U.S. healthcare system since the birth of Medicare in 1965.
ACA was supposed to increase access to health insurance, lower the number of uninsured Americans by expanding coverage and reduce healthcare costs. It introduced mandates, subsidies and marketplaces, requiring health insurers to provide applicants with standardized coverage. In 2012, the U.S. Supreme Court upheld one of the law’s core provisions — that every individual citizen obtain health insurance.
As of mid-2015, the percentage of uninsured Americans has dropped from 18 percent to as low as 11.9 percent, according to recent estimates. This is a remarkable development in only a few short years. Moreover, with one of the highest rates of uninsured in the country, Florida now has 1.6 million Obamacare enrollees, more than any other state in the union.
Despite the fact that Obamacare has become an integral part of the landscape here, the new law still has a ways to go in leveling the playing field between medical patients and insurance companies. One central component of ACA — the so-called “guaranteed issue” provision — prohibits insurers from denying people coverage for pre-existing conditions.
But now, CIGNA, one of the nation’s largest health insurers, has been accused of discriminating against patients with HIV/AIDS by trying to circumvent this provision, according to a class-action lawsuit filed this week. According to the complaint, CIGNA is discouraging these patients from coverage by forcing them to obtain meds through the mail, creating a health and privacy risk.
Law firm Whatley Kallas and the nonprofit advocate Consumer Watchdog already settled two similar lawsuits against United Healthcare and Anthem Blue Cross. Under those settlements, HIV/AIDS patients have a right to opt-out of mail-based programs like the one at the heart of the CIGNA complaint. Another lawsuit filed last December against Aetna is still pending in California.
The plaintiff in the CIGNA lawsuit is John Doe, a 55-year-old resident of Fort Lauderdale, who has been HIV positive for 23 years. He had been a United Healthcare customer but was able to opt out of the mail program thanks to the previous John Doe case against United. But then he wound up changing employers and health insurance companies. When he went to fill his first prescription, he was told by a CIGNA representative that he had to use the CIGNA-owned, mailing service and could not opt out, despite his living conditions. He was told to raise the issue with his employer, consider Saturday deliveries or ask friends to accept the deliveries on his behalf, all of which enraged him.
So he called lawyer Alan Mansfield at Whatley Kallas for help. The case is now pending before Judge Darrin P. Gayles.
“I know both sides based on my experience in the insurance industry,” said Doe. “They’re screwing the insured to get the biggest benefit. They are supposed to be a service provider, but I’m not getting the service applicable to my situation.”
Jerry Flanagan, an attorney with Consumer Watchdog in Santa Monica, California, explained that insurers like CIGNA provide patients with access but then make them jump through flaming hoops to get life-saving medications. Clients like John Doe do not want the whole world to know they are sick, they prefer HIV experts as pharmacists and want to avoid the possibility of vital shipments getting lost or stolen.
The real bottom line continues to be how America’s health insurance industry is structured. When ACA passed, the industry’s profit motive was not touched. Paying a medical bill is still considered a loss on an insurer’s income statement. A company’s profit motive remains diametrically opposed to the welfare of patients yet aligned with a fiduciary responsibility to shareholders, a debate that flared up in Congress before Obamacare was eventually enacted.
Much like what happened in banking, energy, defense and now health insurance, our profit-driven economic system perpetuates and rewards Darwinian competitiveness so whole industries eventually surrender to a handful of firms.
Barring systemic change, the CIGNA case is only one of many that will need to be filed under Obamacare to better reconcile the universal healthcare needs of ordinary Americans with the quarterly earnings statements of federally subsidized financial giants to ensure the most needy always receive quality care.
