Patient groups urge HHS to define 'discrimination'

A coalition of 279 patient groups is urging the Department of Health and Human Services (HHS) to further define what constitutes insurance "discrimination" under the Affordable Care Act.

In a letter Friday, the "I Am (Still) Essential" alliance thanked HHS for recent guidance that would strengthen transparency on the exchanges and push insurers to cover more prescription drugs.

Groups urged regulators to do more, however, by issuing specific language prohibiting practices that can hamper sick patients in their effort to procure care and drug coverage.


"We call on [the Centers for Medicare and Medicaid Services] and others to begin to enforce the ACA non-discrimination provisions and to issue regulations that further define what discrimination is," the letter stated.

"As part of the plan review process for 2015, we thought there would be a better review of the plans for discrimination, but we are finding that the 2015 plans are utilizing the same practices as they did in 2014."

By way of example, the groups praised the CMS for saying that insurers that place most or all drugs for a specific condition on the highest cost tiers are "effectively" discriminating against certain patients.

"Patient groups have pointed out these practices and are waiting for action by the federal government," the letter stated. "Again, we call upon CMS and others to enforce the law."

The letter highlights ongoing tensions between patients and the health insurance industry as ObamaCare nears its fifth anniversary. Insurers argue that HHS risks raising costs for consumers by further boosting protections under the law.

HHS's final 2016 Notice of Benefit and Payment Parameters is expected in early 2015.