by Michael Wysolmerski (JD ’16)
On January 12, 2015, I attended the 55th Presidential Advisory Council on HIV/AIDS (PACHA) in Washington, D.C. I attended the panel titled 2015 Healthcare Marketplace: A Review of Essential Health Benefits and Provider Networks. My supervisor at CHLPI, Carmel Shachar, presented on the panel, along with Doug Wirth, President and CEO of Amida Care, Melissa Harris, Acting Deputy Director of the Disabled and Elderly Health Programs Group at the Center for Medicare and Medicaid Services (CMS), and Brian Webb, Manager of Health Policy at the National Association for Insurance Commissioners.
I attended the panel as part of my work as a student in the Health Law and Policy Clinic of the Center for Health Law and Policy Innovation (CHLPI). This semester at CHLPI, I am working on the Speak Up project. The Speak Up project encourages consumers living with HIV to report issues they are having with insurance as the Affordable Care Act (ACA) is implemented to advocates. Some of the data used in Carmel’s presentation was drawn from Speak Up activities.
The panel was extremely interesting because it demonstrated the difference in effectiveness of care in different parts of the country. Mr. Wirth started the panel with an uplifting presentation about Amida Care, a Medicaid Special Needs Plan for people with HIV in New York City. This Medicaid Managed Care Plan takes a holistic approach to providing HIV care, offering not only standard medical care but also whole person care services such as African dance classes and yoga classes. Amida Care includes a Member Advisory Council, which allows elected members to meet with the CEO, COO, Medical and Pharmacy Directors to make recommendations. Amida Care’s member participation struck me as refreshingly different than a normal insurance plan.
Despite the incredible program at Amida Care, the panel highlighted for me how much more work needs to be done. Carmel’s presentation laid out the issues that CHLPI is seeing with marketplace plans using actuarial value to pass on costs disproportionately to people living with chronic health conditions such as HIV. As a result, people enrolling in these plans are facing unaffordable copays for drugs. While Amida Care represents an example of what can happen with HIV care, it also struck me as very far off in the future for many states, especially those in the South where the problems of a lack of insurance coverage and of affordable health care are the most acute.
Already, the ACA is being implemented unevenly throughout the country. If the Supreme Court decides in King v. Burwell that federal subsidies only apply to state run exchanges, this problem will be exacerbated. The panel, though, provided some useful strategies going forward to increase coverage for people living with HIV in states that are lagging behind. Regardless of the result of King, Ms. Harris from CMS had an exchange with Professor Greenwald (a member of the PACHA and co-chair of its Health Care Access Committee) that showed me how advocates and the government can work together to help resolve these issues. Professor Greenwald noted that the cost-control language in Medicaid regulations has proven very effective and urged HHS to work towards implementing similar regulations for marketplace plans along with stronger anti-discrimination provisions. The agreement among the panelists and others in the room that this was needed made me hopeful that, with increased government scrutiny on insurance companies, some of the practices CHLPI has been documenting might begin to be fixed.
The panel provided the unique opportunity for me to see the work of the Speak Up project being used to advocate directly for policy changes (and I also enjoyed the momentary break from Boston’s constant snow). Though the panel definitely showed me that an uphill battle still exists to fix many of the issues regarding HIV care, the example of Amida Care highlighted that real change is attainable that will make a difference at both the individual and the public health level.
The views reflected in this blog are those of the individual authors and do not necessarily represent those of the Center for Health Law & Policy Innovation or Harvard Law School. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.