America Living With AIDS

Health Care Financing

care from such sources as the Department of Veterans Affairs, prisons,
public hospitals, or other programs.
As it is currently structured, private
health insurance is not well suited to
respond to HIV disease because of limitations in the range of services covered
and the eligibility for coverage. The
vast majority of individuals with private health insurance secure such coverage through their workplace or that
of a spouse or parent. When health
insurance is secured through large
employer-sponsored group plans,
there are few initial restrictions on
obtaining coverage.
Federal law requires employers with
20 or more employees to permit continued coverage for a period of time
following termination of employment
if the insured are able to pay the full
premium and additional costs. Health
plans for fewer than 20 employees are
likely to exclude people with AIDS or
HIV infection or charge higher premiums. Eight states and the District of
Columbia have taken steps to implement premium-paying programs for
individuals with chronic health conditions who are unable to continue paying their private individual or group
insurance premiums. The Commission believes that all states and/or the
federal government should adopt
some form of premium-paying policy.
Even good faith employers, fully
committed to keeping people with
HIV disease on their payroll and covered by employer-based insurance,
find it difficult to do so. When just
one person is diagnosed with HIV dis
INSURANCE COVER
INDIVIDUALS WITH A
Uninsured

Private Insurance
Source: Davis/ et al., 1991.
ease on an employer-based insurance
program, insurance premiums are
often raised. For many employers,
such a raise in insurance premiums
can make the insurance plan virtually
unaffordable. The cost of insurance
could, in fact, force an employer to
reduce or eliminate the health insurance program. In some cases, it may
force an employer out of business.
This is particularly true for small
employers who may have a number of
employees who need HIV-related services. The significant increase in premiums that can result when an insurance company discovers that one or
more employees need HIV-related services must be addressed.