New insurance rights for same-sex couples

AP News
Posted: Mar 14, 2014 5:49 PM

WASHINGTON (AP) — Addressing gay and lesbian concerns, the Obama administration Friday moved to expand health insurance access for same-sex couples and close a loophole that threatened to leave some HIV/AIDS patients without coverage.

In separate announcements, the Health and Human Services Department said:

— Insurers offering spousal coverage for heterosexual couples must also provide it to legally married couples of the same gender.

— Insurers cannot turn down HIV/AIDS patients whose premiums are being paid through the federal Ryan White program.

The administration acted after gays and lesbians complained about confusing rules on spousal coverage in the new health insurance exchanges, particularly in states that do not recognize same-sex marriage.

HHS also countered a move by insurers in Louisiana to stop accepting premium payments made by the federal Ryan White program on behalf of HIV/AIDS patients.

The insurers, who said they were relying on another federal policy that discourages third parties from paying premiums for individuals, wound up in federal court after advocates filed suit. The issue is seen as a national test of whether insurance companies will be able to continue avoiding costly patients. President Barack Obama's health care law requires insurers to take all applicants, regardless of their medical history.

The new rule says insurers must accept third-party premium payments from the Ryan White and other federal and state programs.

Ryan White was an Indiana teenager with hemophilia who was diagnosed with AIDS in 1984, at a time when there were fewer precautions to safeguard blood supplies. Congress first authorized the federal HIV/AIDS program in 1990, the year White died. Lawmakers named the program in his honor to recognize White's stand against AIDS-related discrimination.

The policy on coverage for same-sex spouses takes effect next year and applies to plans offered in the health care law's new insurance markets. It also covers many — but not all — individual and employer plans offered outside that marketplace.

The administration said it intends to make coverage "more accessible and equitable for married same-sex couples." It's part of a government-wide effort to codify the rights of same-sex spouses. That follows the Supreme Court decision last year striking down the federal Defense of Marriage Act, which opened the way for same-sex spouses to receive government benefits.

The new HHS policy says that if an insurance company offers spousal coverage to heterosexual couples, it must also provide that benefit to same-sex couples who were legally married in a jurisdiction that recognizes marriage between people of the same sex.

The administration is urging insurers to voluntarily comply with the same-sex rule right away. It will be a requirement for coverage starting Jan. 1, 2015, or later.

Many large employer plans are already operating under similar rules issued last fall by the Labor Department. These are so-called self-insured plans in which an employer sets aside its own money to cover most of the expected medical costs of workers. Self-insured employers generally hire an insurance company to administer their benefit plan.

The new rules apply instead to plans that are sold directly by insurance companies to individuals and employers, usually small to mid-sized companies.

There are exceptions:

—"Grandfathered" plans that were in existence when the health law passed four years ago and have changed very little since then do not have to offer coverage to same-sex spouses. Those plans, however, represent a dwindling share of the market.

—The new policy does not apply to Medicaid coverage for low-income people. The administration encourages states to offer Medicaid benefits to same-sex spouses, but state authorities have the final say.

Separately, HHS issued another one-month extension for the Pre-Existing Condition Insurance Plan, known as PCIP. Patients in the temporary program will now have until April 30 to find a new policy. PCIP was created as a transitional program for people turned down for coverage because of health problems.