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Class Claims Blue Cross Avoids|HIV Patients to Duck Obamacare

BATON ROUGE (CN) - Blue Cross-Blue Shield and two other insurers discriminate against poor people with HIV, just in time to avoid having to cover them under the Affordable Care Act, a class action claims in Federal Court.

Lead plaintiff John East sued Blue Cross and Blue Shield of Louisiana, the Louisiana Health Cooperative, and Vantage Health Plan in a 41-page lawsuit.

East claims the defendants changed their policies to they can deny coverage to HIV patients.

Blue Cross did this, East claims, by stating that it would no longer accept funds from the Ryan White HIV/AIDS Program. The federal program makes grants to states, cities and nonprofit organizations to provide people living with HIV access to health care by helping them pay of health insurance premiums.

East claims that Blue Cross has accepted payments from the Ryan White program since at least 2009.

Blue Cross's policy change came just as open enrollment began for the Affordable Care Act's insurance exchange marketplace, East says in the complaint.

Blue Cross claimed it made the change under guidance from the Centers for Medicare & Medicaid Services, which advised not to accept third-party premium payments from hospitals, health care providers and other commercial entities.

But that guidance did not discourage insurers from accepting payments from other sources, such as federal programs like the Ryan White program, East says.

Despite receiving clarification that Blue Cross could receive payment from federal programs, on Feb. 13 it issued a statement that it would not accept payment from the Ryan White program.

Defendants Louisiana Health Cooperative and Vantage Health Plan followed suit by informing enrollees that payments made by the Ryan White program would not be accepted beginning in March 2014, East says in the complaint.

East says that a recently disclosed email makes it clear Blue Cross changed its rules in the pursuit of cold, hard cash. The complaint states: "Indeed, in an email that was recently made public, a congressional staffer in Senator Mary Landrieu's office wrote that BCBS LA told me their decision was not due to the CMS [Centers for Medicare & Medicaid Services] guidance or any confusion (as we thought before) but was in fact due to adverse selection concerns." (Italics, brackets and parentheses as in complaint.)

Under Affordable Care Act, known as Obamacare, health insurers that receive federal funds are prohibited from discriminating against anyone on the basis of a disability or pre-existing condition.

East claims the defendants' policy changes are clearly discriminatory, as they would deny coverage to hundreds, perhaps thousands, of low-income Louisiana residents with HIV - which could hasten their deaths and increase their suffering.

Residents of Jefferson Parish who are eligible for assistance through the Louisiana Health Insurance Program may be able to pay for a health insurance plan offered by Humana Medical Plan using the Ryan White Program.

But With Blue Cross and other insurers refusing to accept funds from the Ryan White Program, Humana may have difficulty maintaining its position as the only insurer in Louisiana complying with the Affordable Care Act, East says.

According to a study by the Centers for Disease Control and Prevention, Louisiana has the second highest rate of HIV infection in the United States.

East seeks class certification, an injunction and damages for discrimination, violations of the Patient Protection and Affordable Care Act, disparate impact, unlawful marketing practices to discourage enrollment in health insurance plans, breach of contract, breach of faith and negligent misrepresentation.

His lead attorney is Jeffrey Bushofsky with Ropes & Gray of Chicago.

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