America Living With AIDS

tions the Commission has put forward
to expand benefits for people with
HIV disease would include individuals
living in this part of the United States.
Congress and the Administration
should work together to raise the
Medicaid cap on funds directed to the
Government of Puerto Rico to ensure
equal access to care and treatment.
COBRA Premiums
States and/or the federal government
should pay the employer-based health
insurance premiums for people with
HIV disease who have left their jobs
and cannot afford to pay their premiums. The Consolidated Omnibus
Budget Reconciliation Act (COBRA)
includes a provision to require
employers with 20 or more employees
to permit continued coverage if the
insured are able to pay the premium.
If the employee is disabled when he or
she leaves a job, continued coverage
must be allowed for 29 months. For
people not disabled at the time they
leave their jobs, continued coverage is
for 18 months. This provision is
designed to ensure health care coverage during the time a person would be
waiting to become eligible for other
health insurance or, if disabled, for
Medicare. Many people with HIV disease cannot afford to pay the health
insurance premiums (referred to as
COBRA premiums) during the waiting period and are forced instead to
spend themselves into poverty in
order to become eligible for Medicaid.
Eight states and the District of
Columbia have implemented some
form of premium-paying program to

cover the private individual or group
health insurance premiums for individuals with chronic illnesses. The
Commission believes all states and/or
the federal government should pay the
COBRA premiums for low-income
people with HIV disease who have left
their jobs and cannot afford to pay the
health insurance premium.
If this option is limited to people
with HIV disease who have incomes
below the federal poverty level, it
would extend employer-sponsored
insurance to an estimated 2,000 people with AIDS and 8,000 people with
HIV infection. Of the 2,000 people
with AIDS receiving coverage under
this option, 1,600 would have previously been eligible for Medicaid. (It is
assumed that the low-income population cannot afford the COBRA premiums and would apply for Medicaid.)
If the Medicaid income eligibility level
is increased, that increased level
should apply to this COBRA recommendation as well.
This option has the advantage of
buying beneficiaries into private coverage, which is generally much more
attractive than Medicare or Medicaid in terms of benefits covered and
reimbursement rates. In addition, a
comprehensive package of benefits is
provided through many employersponsored group plans, which would
include early intervention treatments.
The more generous reimbursement
rates would be attractive to providers
and people with HIV disease, who

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