Posted on 01/19/2014 8:54:14 AM PST by csvset
Jeremy has AIDS and no income. He lives with his parents in Chesapeake.
Up to now, most HIV-related medical care for him and other low-income, uninsured patients in Virginia has been paid for by government grants.
Starting this year, they will be enrolled in health insurance through the Affordable Care Act's marketplace.
The new plans cover not just HIV care, but also other medical needs. That means Jeremy might finally be able to see a specialist to find out why one medication makes him nauseous and another makes him so dizzy that he can't drive.
But he's not rushing to make any appointments yet. In fact, he's canceled four because he's concerned about the copays and cost sharing required by his new policy.
"I'm not going to run up bills and expect somebody else to pay until I know for a fact that they're going to pay," said Jeremy, 34. He asked that his last name not be published.
A patchwork of government grants through the federal Ryan White Program has been covering prescription drugs and some medical care for HIV- and AIDS-related ailments in lower-income patients.
Now, one of those initiatives - Virginia's AIDS Drug Assistance Program - plans to pay monthly premiums and medication costs for patients eligible for marketplace policies.
It's a step that similar programs in other states also are taking.
In Virginia, the move could save millions at a time when funding is desperately needed.
Enrollment in the state AIDS Drug Assistance Program is at an all-time high at 5,200. It continues to grow faster than ever, thanks to guidelines recommending an earlier start to treatment, more funding for HIV testing, and efforts to keep people from dropping out of care.
Marketplace plans will allow the program to be more cost-effective, said Steven Bailey, director of HIV care services for the Virginia Department of Health. With insurance paying some of the bill, the program can reduce its spending to an average of $8,000 per patient per year, compared with $11,000, the previous average for medication alone.
Patients stand to gain from the switch because private plans provide coverage they don't have - for hospital and emergency care, as well as medical needs unrelated to HIV or AIDS.
However, the change has worried some.
The policies require members to pay a share of the bills for doctor visits and laboratory tests until they reach an out-of-pocket maximum - expenses that, when they involved HIV-related care, were covered by Ryan White funds in the past.
Medication costs paid by the drug-assistance program will allow patients to hit the maximum within about four months, Bailey said.
But until then, it will be up to others receiving Ryan White money - including cities and health care providers - to determine how copays and coinsurance not related to medications are covered.
In states that choose to expand Medicaid eligibility, as the Affordable Care Act allows, the poorest patients are covered by that state-federal program. So far, Virginia has opted out.
In the past few weeks, Jeremy has spent hours making calls and writing letters, trying to figure out whether his costs would be covered.
Larry Ripley, another AIDS patient, has done the same.
"At one point, I was yelling," said Ripley, 48, who lives in Hardyville, northeast of Gloucester. He supports his partner and ill mother with a monthly $1,700 disability check.
Answers began to emerge late last week.
Christine Carroll, program manager for the Ryan White Part A grant, which covers southeastern Virginia and northern North Carolina, said either that grant would pay out-of-pocket costs that aren't covered for local patients, or administrators would arrange for the costs to be covered through another grant.
The budget beginning March 1 includes money earmarked for such expenses, and other funds can be shifted, she said.
"It's going to take some time. It's going to take a lot of education," Carroll said. "And I'm sure there's going to be some trial and error, but I think that eventually it will all smooth out, so hopefully nobody will get lost in the midst of it all."
That money and other Ryan White grants will help pay costs for low-income HIV and AIDS patients at clinics run by Eastern Virginia Medical School.
Dr. Edward C. Oldfield, director of the EVMS Center for the Comprehensive Care of Immune Deficiency, also has worried about how low-income patients would pay their shares of health costs under the insurance plans.
He said that he was glad their needs would be taken care of, but that a lot of work was necessary to figure out the logistics.
"Now we have the potential to make it work," he said. "A week or two ago, we had no idea what was going to happen."
Bailey, the state's director of HIV care services, said that he hoped to enroll about 3,000 patients from the drug-assistance program in marketplace plans, but that finding workable insurance policies hasn't been simple.
Some plans don't cover certain HIV drugs. Some require multiple prescriptions for the component drugs in a single tablet. That makes it harder for a patient to stay on a regimen that requires strict compliance.
Also, because of Ryan White funding rules, patients in the drug-assistance program can sign up only for plans that cover all HIV medications included on the program's formulary.
Plans from Anthem Blue Cross and Blue Shield of Virginia don't include them all. That means none of the program's clients can sign up for an Anthem policy.
Although the health care law prohibits insurance companies from denying coverage or charging more because of a pre-existing condition, the approach taken by the state's biggest insurer means it will avoid enrolling some of Virginia's most expensive patients.
Scott Golden, an Anthem spokesman, said in an email that the insurer's plans meet requirements for the marketplace and cover many of the drugs used for HIV and AIDS treatment, including one of the most popular.
"Our goal in developing our marketplace products was to balance the need for affordability with choice," Golden wrote. "To help lower premiums for our members, we developed an affordable drug list with quality choices."
In southeastern Virginia, patients in the drug-assistance program have just one option for an insurance company: Optima Health, the insurance arm of Sentara Healthcare.
Jeremy is skeptical about how much he'll be able to benefit from the plan.
He doubts that insurance will help him much until a $6,250 out-of-pocket maximum is met. That could take months.
He's also wary of promises that his copays and coinsurance will be covered: "Until I see it in writing and I actually have it in black-and-white, I don't believe anything."
Ripley was told that his doctor visits will be covered the way they used to be until April 1. He continues to worry about what will happen next, but he's hopeful about having insurance.
"I still feel the pro outweighs the con," he said. "At the end of the day, when all of it's all worked out, I have access to care that I didn't have at the end of December."
Amy Jeter, 757-446-2730, amy.jeter@pilotonline.com
Mighty understanding of you you f'ing depraved parasite.
Meanwhile, another homosexual weighs in.
"At one point, I was yelling," said Ripley, 48, who lives in Hardyville, northeast of Gloucester. He supports his partner and ill mother with a monthly $1,700 disability check.
So what's wrong with the other faggot?
Drudge has a story up about a county in Oregon signing up all their jail prisoners onto Obamacare.
Uh look here miss jeremy... your deductible is $100,000 per year. How are you going to pay for your initial treatment?
Actually, WE support him, his “partner” AND his mother on that $1700. disability per month. And his ill mother must be getting a check of her own - courteous of us all.
I get that people with this self-inflicted disease want to live, or at least not die a long terrible death without the relief meds provide. I am not heartless. But hey, WE all pay for their meds, Dr. visits, etc. Now we must pay for their lovers and parents and themselves to live their daily lives? WTH?
“Your death panel will see you now.”
Another satisfied Obama voter, riding the wheezing gravy train of freebies after making very poor life style choices. There are millions of those needy riders. What happens when they run out of other people’s money?
And oh yeah, I don't want to pay a single dime to keep a POS like you alive for one more second if you don't renounce the lifestyle that made you ill in the first place. You're nothing but a leftist leech.
Hey, did you know that when you do your taxes on TurboTax you will get a hustle about signing up for obamacare?
It notes that I mentioned I have healthcare through the end of 2014, which means I’ll “likely meet the new regulations under the new healthcare law.” Then it says, “ After we wrap up your 2013 taxes, we’ll see if more affordable health care options are available to you for 2014.”
Which makes no sense since I HAVE insurance through 2014. But it wants to slam me into an obamacare policy. I stopped at that point because I was just pre-filling before my W2s arrive. I imagine each online tax preparing service and the storefronts will be doing this. THIS is how they will get the numbers they need! A lot of people won’t be paying attention to what is going on. I just bet that the sign up numbers for obamacare in FEB. will be huge!
Yep, it was great to grow up in the 1950s when these “things” were firmly in the closet.
This is one group almost certain to be guaranteed everything they need.
And then they will be paraded around as success stories
There’s one piece missing from the story, unless I missed it.
It is a three part question about Jeremy.
1. Did Jeremy acquire AIDS through casual homosexual activities?
2. Did Jeremy acquire AIDS through a ‘dirty intravenous self-applied device’?
3. Did Jeremy acquire AIDS through a blood transfusion?
If any of the first two answers are ‘yes’, Jeremy ‘made his bed’, and will get no money from me.
Pat? See http://www.pinterest.com/saltykitty/ My guess is that Pat is older and got infected earlier, but that's just a guess. Plusses for the lovely couple: pro-second and pro-kitty. Minuses: everything else.
I’m continually amazed by the irrational left. How in the world can they be so up in arms over cigarette smoking but totally ignore the (health) risks of smoking dope? How can they be so focused on physical fitness, eating only organic foods for example, yet totally ignore the obvious health risks from sodomy? It boggles my mind.
The left simply doesn’t make any sense. Words don’t even mean the same things to them. I’m serious. The left uses the same words, but they have entirely different meanings. Tolerance, for example, means suppressing the speech of anyone who disagrees with you. It truly astounds me.
Ideology uber alles.
-— The left uses the same words, but they have entirely different meanings -—
The truth divides. And we know Who Truth is.
So either way, we the American tax payer who stays in school, practices safe life styles and plays by the rules have to pay for all the idiots who don’t...suck us dry and there will be nothing left.
But...but..you’re not allowed to ASK because it’s being “judgemental”, dontchaknow...
just shut up and pay up.....
Add to that having indiscriminate sex then using tax payer funded abortion to get rid of the consequences.
I don't think he would be qualified for the exchange if he has no income. Maybe he could get Medicaid.
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