California would no longer allow insurance companies to use a person’s HIV status as a reason to deny life and disability income insurance coverage, if a new bill introduced last week is passed.
At a press conference in Sacramento, co-authors of the Equal Insurance HIV Act, or Senate Bill 961, California insurance commissioner Ricardo Lara, state Sen. Lena Gonzalez (D-Long Beach), and Rick Zbur, executive director of the LGBTQ advocacy group Equality California, announced that the bill would not only revise existing state law, but also close a loophole in the Affordable Care Act, which prohibits denial of coverage in health insurance—but not life and disability insurance—based on pre-existing conditions.
“Everyone deserves access to life and disability income insurance, regardless of pre-existing conditions,” Gonzalez said at the press conference. “I am so proud that my first bill introduced in the legislature will ensure access to these critical resources for residents who are HIV positive. It is time that we end the practice of insurance companies refusing to provide services to those who need it most.”
“Thanks to modern medicine, people living with HIV lead happy, healthy lives,” Zbur said. “It’s time for our laws to keep up with the science and protect Californians living with HIV from insurance discrimination. Our goal to end HIV by 2030 means ending all HIV transmissions, deaths, and stigma. This bill is a critical step to getting there.”
The existing law was passed in 1989, when effective treatment for someone who tested HIV positive was extremely limited. This was seven years before the introduction of antiretroviral therapy, which helped turn HIV from a death sentence to a manageable condition for most people. The new bill, if passed, would treat HIV like any other chronic condition.
A 2013 study from the North American AIDS Cohort Collaboration on Research and Design showed that a 20-year-old, HIV-positive person on antiretroviral therapy can now expect to live into their early 70s.
That was backed up by a 2014 study of the Multicenter AIDS Cohort Study, which concluded that people who start antiretroviral therapy early could even see a life expectancy greater than the general population.
If the law passes, which is expected, given the lack of serious opposition and a Democratic-controlled legislature, it would not restrict insurers from using HIV as one factor among many in denying life and disability coverage, according to the California Department of Insurance (CDI). It would restrict insurers from using HIV as the only criterion for denial. But it could be used in underwriting as one consideration in their formula for denial. For example, if someone has diabetes, and is elderly, and has HIV, and has had a heart attack, all of those can be considerations in underwriting.
But when the bill passes in California, consumers will have a way to report incidents of discrimination with life and disability insurance companies. A consumer who has been declined for coverage could file a complaint with CDI’s Consumer Services Division at 1-800-927-4357 or on its website. The Consumer Services Division would draw the company’s attention to the statute and ask the company to either issue coverage for that consumer or justify why it did not issue coverage.
When CDI does a market conduct exam of an insurer, it will look to see if the company is not issuing coverage to applicants who are in similar health as other applicants, except that they are HIV positive.
A spokesperson from CDI suggested that the passage of the Equal Insurance HIV Act would bring California current with the federal government in terms of a person’s HIV status.
“With regards to federal Social Security Disability (SSD) and HIV status, the federal government already treats HIV as a treatable, chronic condition. Someone who is HIV positive does not automatically qualify for SSD benefits without documented evidence of a serious complication or an opportunistic disease,” the spokesman wrote.
Laws vary state to state, and there is no federal law preventing private companies from denying life and disability insurance coverage based solely on HIV status.
Rachel Klein, deputy executive director of The AIDS Institute, said she hopes other states will follow California’s lead in reversing laws based on an outdated understanding of HIV. “We have treatments that let people live a normal lifespan, so HIV should be like other manageable conditions.” But she also acknowledged that such a law would not prevent companies from considering HIV as a factor in underwriting. “HIV just can’t be the only factor in making a decision.”
California’s Equal Insurance HIV act is part of a new examination of all laws, or loopholes in laws, that could discriminate against people with HIV, or discriminate against people trying to prevent HIV.
Last June, California insurance commissioner Lara issued a notice to life, disability income, and long-term care insurers to remind them that California law already bans discrimination against people who use pre-exposure prophylaxis (PrEP) to prevent HIV.
This notice followed a CDI investigation that found that several insurers had denied, limited, or charged higher rates for life, disability, and long-term care coverage for people who took Truvada (emtricitabine/tenofovir disoproxil fumarate) for PrEP.
Also last year, insurer Mutual of Omaha agreed to no longer deny insurance to people taking PrEP. The company had received discrimination complaints after applicants said they were denied long-term care or life insurance solely based on using the medication to prevent HIV. “It really is counterintuitive, when someone is trying to protect their health, that a company would penalize them for that,” Klein said about the Mutual of Omaha case.
In 2014, The AIDS Institute and the National Health Law Program filed a complaint with the Department of Health and Human Services’ Office for Civil Rights, alleging insurers—CoventryOne, Cigna, Humana, and Preferred Medical—had required customers in Florida with HIV to pay higher out-of-pocket costs for their medications, including generics. The companies later revised their policies. But Klein told TheBody that watchdogs need to be vigilant to ensure that insurers don’t try to get around the antidiscrimination language of the Affordable Care Act, and that the Institute is trying to stop the Trump administration from enacting a current proposal to weaken antidiscriminatory language in the law.