Some HIV-positive patients in Missouri will lose critical health coverage in 2018, thanks to high costs and little marketplace competition. Many of the affected individuals live in rural areas, where access to health care is already limited.
According to the Missouri Department of Health and Senior Services, about 95 patients in 51 counties will lose coverage starting January 1. The state has begun notifying the patients of this change, the St. Louis Post-Dispatch reported.
These patients rely on the federally funded Ryan White Care Program, which serves more than 2,300 low-income HIV-positive people in Missouri. The program includes the AIDS Drug Assistance Program (ADAP) to provide patients with access to HIV-related drugs. ADAP either covers the cost of insurance or the cost of medications, depending on which route is most cost effective.
The Ryan White Care Program has been around for 27 years, but after the implementation of the Affordable Care Act (ACA), many patients were able to use the program funds to obtain health insurance rather than just the drugs to treat HIV. This allowed them to gain broad access to health care, including hospital visits and appointments with physicians.
“Until the ACA came along, the majority of our clients were uninsured,” Lynne Meyerkord, executive director of AIDS Project of the Ozarks, told ThinkProgress. “It was kind of a big surprise,” she added, referring to the increase in the number of patients who were able to obtain insurance.
But limited competition in Missouri’s marketplaces has complicated matters. In 2017, two insurers — Humana and Blue KC — announced their exit from the Missouri health exchange. A third, Anthem Blue Cross Blue Shield, pulled out of 16 Missouri counties. This, Meyerkord said, was an especially “big problem” for HIV-positive patients in Columbia, Missouri, many of whom were forced to switch from physicians with whom they had developed lasting relationships, as fewer providers were being offered through the insurance companies.
According to the St. Louis Post-Dispatch, only one insurance carrier, Anthem, sells plans in the 51 affected Missouri counties. Because Anthem places most HIV drugs on the highest tier of drug coverage, the costs are often expensive, especially without competition from other insurance companies.
Due to high costs, insurance companies in those 51 counties will no longer offer ADAP-supported plans in 2018. “The plans on offer in those counties do not meet [Health Resources and Services Administration]-mandated cost effectiveness and medication formulary coverage criteria and are therefore no longer covered,” Sara O’Connor, spokesperson for the Missouri Department of Health and Senior Services, told ThinkProgress in an email.
The affected patients will continue to receive HIV-related medications through ADAP. And those with an annual income at or below 300 percent of the federal poverty level will continue to receive HIV-related medical care.
But Meyerkord, whose organization provides medical, prevention, and testing services to 29 of the 51 affected counties, said the change will be especially harmful to HIV-positive patients who have additional medical conditions. Without health insurance, many of these patients will likely struggle to obtain treatment for serious ailments.
While Missouri appears to be the only state impacted by the shifting of ADAP funds, according to the St. Louis Post-Dispatch, the problem of limited competition is widespread. A recent Brookings report found that, in 2017, more than 1,000 counties in the United States had only one insurer in the ACA health insurance marketplace. “This lack of choice was disproportionately concentrated in rural America,” the report reads.
In a July 2017 blog post, the Center for Economic and Policy Research said many of these counties are in states with Republican governors, arguing that, in red states, “there has been little effort to make the ACA work.” Insurance companies, in turn, end up pulling out of the marketplaces, like Anthem Blue Cross threatened to do in July, citing the potential instability of the ACA that has been caused, in large part, by the Trump administration.
“I think, as the ACA is gradually dismantled … I see this as a growing problem,” Meyerkord said, adding that traditionally under-served populations, like those living in rural areas, will be the hardest hit.
“But that is clearly not the focus of the current administration,” she said.