America Living With AIDS

AM E R IC A Living With

The linking of health insurance to
employment is problematic for people
living with HIV disease. People with
HIV disease may become too debilitated to work. Even when they are
able to work on a reduced schedule,
employers may not be willing to
accommodate their needs for time off
to cope with intercurrent illnesses or
to keep various medical appointments. In addition, many with HIV
disease have faced discrimination in
the workplace. They have been fired

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or laid off because of their
HIV status, without
regard to their ability to
continue working. One
study of work loss among
individuals with HIV disease found that in a sample of 193 individuals, 50
percent who worked prior
to the onset of symptoms
stopped working within
two years. The authors
noted that improved
treatments would help
slow the rate of work loss
(Yelin et al., 1991).
Individually purchased
health insurance is not
commonly held by people
with HIV disease because
most insurance companies screen out people
who are already HIV
infected and even those
believed to be at risk.
There are other problems with private insur
ance, even when it is available. For
instance, the range of health care benefits provided under private insurance
varies considerably and may not
include coverage for costly prescription drugs. In rare instances, insurers
or self-insured groups have attempted
to impose restrictive caps on payments
for AIDS-related treatments, caps that
have not been used for any other lifethreatening diseases.
Another fundamental limitation of
private insurance that is particularly
relevant for people with HIV disease is
the traditional restrictions on coverage
of experimental drugs and procedures.
Treatments that are technically experimental may be the standard of care for
HIV disease. To exclude coverage of
experimental treatments may be to
exclude the sole choice available to
someone with HIV disease.
Medicaid
Medicaid is currently the most important source of financing for AIDS and
HIV-related health care benefits
(HCFA, 1990). Forty percent of people with AIDS are covered by Medicaid, and ninety percent of children
with AIDS are covered by Medicaid.
Recent studies reveal a strong trend
that has been dubbed the "Medicaidization" of AIDS, that is, a shift in
the distribution of individuals with
third-party financing from private
insurance to Medicaid (Green and
Arno, 1990; Merlis, 1990). It is
unclear whether this can be explained
better by the increase in the number of
low-income individuals contracting
the disease or by the reduction in cov
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