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Study: Insurers May Using Drug Costs to Discriminate

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In this photo taken Aug. 21, 2014 shows health care tax forms 8965, in Washington. Being uninsured in America will cost you more in 2015. In 2015, all taxpayers have to report to the Internal Revenue Service for the first time whether or not they had health insurance the previous year. Most will check a box. It’s also when the IRS starts collecting fines from some uninsured people, and deciding if others qualify for exemptions. (AP Photo/Carolyn Kaster)

In this photo taken Aug. 21, 2014 shows health care tax forms 8965, in Washington. (AP Photo/Carolyn Kaster)

KELLI KENNEDY, Associated Press

FORT LAUDERDALE, Fla. (AP) — Insurance companies, perhaps more than previously thought, may be charging the sickest patients extra for drugs under the federal health law, in an effort to discourage them from choosing certain plans, according to a study released Wednesday.

One of the cornerstones of President Obama’s signature health law forbids insurance companies from turning away people with pre-existing conditions such as diabetes or cancer. Yet hundreds of patient advocacy groups say insurance companies have found a way to discriminate against these people, who are more expensive to cover because they require life-long treatments.

The companies do this by putting all of their medications in a special category where the patient is required to pay a percentage of the cost of the drug, rather than a flat co-pay. Some are as high as 50 percent, leaving people on the hook for thousands of dollars. That compares to the average $10 to $40 per-medication co-pay that most pay.

A study published in the New England Journal of Medicine only examined HIV drugs, but noted the problem applies to mental illness, cancer, rheumatoid arthritis, diabetes and other chronic conditions. Patient advocates have complained that prescriptions for these patients were virtually unaffordable in some plans offered on healthcare.gov.

The AIDS Institute even filed a formal complaint with Health and Human Services officials last summer about four plans in Florida. Georgia plans to file a similar complaint, but the scope of the problem has been difficult to gauge as many of the complaints have been anecdotal.

The researchers studied 48 plans in 12 states using the federal marketplace: Delaware, Florida, Louisiana, Michigan, South Carolina, Utah, Illinois, New Jersey, Ohio, Pennsylvania, Texas, and Virginia.

They found that one-quarter of the plans placed all of the HIV drugs into the highest-cost category and required consumers to pay at least 30 percent of the drug costs instead of a flat co-pay. Annual drug costs in these plans were more than triple compared with other plans ($4,892 to $1,615), according to the analysis. And 50 percent had to pay a separate deductible for drugs, compared to only 19 percent of consumers in other plans.

Insurers have historically placed drugs in categories with higher co-pays to encourage consumers to select generic or preferred brand-name drugs. The problem is exacerbated as more plans place all drugs, including generics, in the more expensive category.

“Our findings suggest that many insurers may be using benefit design to dissuade sicker people from choosing their plans,” the study noted.

Over time, researchers predicted sicker people will enroll in plans that don’t charge such high prices. That means certain plans could have a higher number of sicker, more expensive consumers than their competitors. The federal law has financial protections for those plans but some will be phased out in 2016.

The law does ban insurers from charging an individual more than $6,350 in out-of pocket costs a year and no more than $12,700 for a family policy.

Insurance companies say the main issue is increasing drug costs and they’re shouldering the bulk of it. But they acknowledge the increased prices are also passed onto consumers.

For example, Atripla, the most popular HIV AIDS treatment and one of the highest-selling drugs in the U.S., costs insurers $27,026 a year. Patients only pay a portion of that, said Clare Krusing, a spokeswoman for the trade association America’s Health Insurance Plans.

But insurers noted consumers have the flexibility to choose from plans at all levels with different cost-sharing requirements and that the health law has a component that rewards plans for value and efficiency “not on their ability to attract healthier enrollees,” Krusing said.

Advocates have asked federal health officials to intervene and nearly 300 patient groups sent a letter last month urging Health and Human Services Secretary Sylvia Burwell to beef up enforcement. The federal government has warned against such discrimination.

“We analyze plan information submitted by insurance companies to uncover discriminatory benefit designs, and work with outlier plans to update formularies so they do not discourage enrollment of consumers with specific medical conditions,” agency spokesman Aaron Albright said in an email.

It’s unclear what the penalties are for insurance companies who discriminate.

Meanwhile, insurance officials in some states are stepping in. Three out of four insurance companies restructured their plans in Florida late last year.

Copyright 2015 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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Doctors Seeing More Cases of Preventable Childhood Illnesses

OAKLAND POST — Physicians have said vaccine skepticism has expanded beyond childhood immunizations. Doctors also reported growing resistance to other preventive treatments.

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By Stacy M. Brown

Doctors across the United States say they are treating children for illnesses that routine vaccinations once made increasingly uncommon, raising concerns that years of declining immunization rates are beginning to reverse decades of public health progress.

Pediatricians have described seeing more cases of whooping cough, rotavirus infections, bacterial pneumonia and other potentially life-threatening illnesses that vaccines have long helped suppress. Some physicians reported treating conditions they had rarely encountered during their careers, while others said that growing vaccine hesitancy is changing how emergency rooms and hospitals care for children.

The reports come as measles outbreaks continue to spread across multiple states and vaccination coverage remains below federal public health targets.

Johns Hopkins University’s International Vaccine Access Center reported 2,077 confirmed measles cases nationwide as of May 29. Researchers warned that outbreaks reported across the country have raised concerns about continued transmission, additional hospitalizations and deaths, and the possible loss of the nation’s measles elimination status.

Public health experts have long viewed measles as a warning sign because of its ability to spread rapidly through communities with lower vaccination coverage. The New York Times reported that physicians increasingly fear the resurgence of measles may be followed by the return of other vaccine-preventable diseases.

Doctors say that is already happening.

Dr. Meghan Hofto, a pediatric hospitalist at the University of Alabama at Birmingham, said she has already treated roughly as many children with rotavirus this year as she saw during the previous decade. Rotavirus once caused tens of thousands of hospitalizations annually before vaccines sharply reduced its spread. None of the children she treated this year had been vaccinated.

Hofto also described caring for infants with pertussis, commonly known as whooping cough.

“It’s hard to know when they’re safe to go home,” Hofto told The Times.

The rise in whooping cough cases has been particularly striking. More than 28,000 cases were reported nationwide last year, compared with approximately 7,000 in 2023, according to figures cited by The Times. Many of the affected infants were too young to receive vaccinations themselves and relied on broader community protection to reduce their exposure.

Other doctors described similarly troubling cases.

Dr. Jessica Kirk, a pediatric hospitalist in Alabama, recently treated an unvaccinated toddler hospitalized with pneumonia caused by simultaneous infections of Haemophilus influenzae and Streptococcus pneumoniae. Vaccines exist to protect against both illnesses. The child required oxygen and antibiotics to recover.

Researchers at Johns Hopkins have been tracking vaccination trends nationwide and found continuing signs of vulnerability.

At the same time, vaccine policy has become increasingly contentious in state legislatures.

Johns Hopkins researchers reported that lawmakers across the country continue to introduce bills affecting childhood vaccination requirements, vaccine access and non-medical exemptions. Researchers also noted that state policies governing exemptions remain a significant factor in vaccination coverage and disease transmission risks.

Physicians have said vaccine skepticism has expanded beyond childhood immunizations. Doctors also reported growing resistance to other preventive treatments.

For doctors confronting the return of illnesses that vaccines once pushed to the margins of American medicine, the challenge is becoming increasingly personal.

“It just feels like you’re a tiny little boat with a giant tidal wave coming at you,” Dr. Erin Charles, a regional pediatric hospitalist at Seattle Children’s Hospital, told reporters. “And you might convince one family here and there.”

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Community

Asm. Isaac Bryan’s Environmental Reparations Bill Passes on Assembly Floor

“All this bill does is allocate resources from that repair fund and direct cash assistance to families that have had negative health impacts as a result of living next to that oil field,” said Bryan during remarks on the Assembly floor.

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Asm. Isaac Bryan (D-Ladera Heights). File photo.

By Bo Tefu, California Black Media

On May 26, the California State Assembly passed legislation to provide direct financial assistance to families harmed by pollution from a major urban oil field in South Los Angeles.

Assembly Bill (AB) 1661, introduced by Assemblymember Isaac Bryan (D-Ladera Heights), cleared the Assembly floor with a 44-10 vote after lawmakers concluded debate on the measure.

The bill would direct money from a community repair fund toward families who suffered negative health effects from living near what Bryan described as the state’s largest toxic urban oil field. The repair fund was created under legislation approved two years ago that shut down the oil field and required polluters to contribute financially to community recovery efforts.

“All this bill does is allocate resources from that repair fund and direct cash assistance to families that have had negative health impacts as a result of living next to that oil field,” said Bryan during remarks on the Assembly floor.

Bryan called the proposal “the largest environmental reparations opportunity for South LA” and told lawmakers the bill had not received opposition during the legislative process.

The legislation is part of California’s broader push to address environmental justice concerns in communities historically exposed to industrial pollution. South Los Angeles residents and environmental advocates have long raised concerns about health risks associated with oil drilling operations near homes, schools and parks.

Supporters say the measure represents a new approach to environmental accountability by ensuring that communities affected by pollution directly benefit from funds collected from responsible companies.

After debate concluded, Assembly leadership opened the roll call vote, and the measure passed with majority support from lawmakers.

AB 1661 now moves to the Senate for further review.

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Activism

Rep. Kamlager-Dove Introduces Bill to Protect Women in Custody After Reports Detailing Miscarriages and Neglect

The Pregnant Women in Custody Act would expand safeguards beyond the federal prison system to include women detained by U.S. Immigration and Customs Enforcement, U.S. Customs and Border Protection and the Office of Refugee Resettlement. The proposal follows reports of pregnant women being shackled, denied medical care and suffering miscarriages while in immigration detention.

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By Bo Tefu, California Black Media

Congresswoman Sydney Kamlager-Dove (D-CA-37) on May 7, reintroduced updated legislation aimed at strengthening protections and healthcare standards for pregnant and postpartum women held in federal custody, including in immigration detention facilities.

The Pregnant Women in Custody Act would expand safeguards beyond the federal prison system to include women detained by U.S. Immigration and Customs Enforcement, U.S. Customs and Border Protection and the Office of Refugee Resettlement. The proposal follows reports of pregnant women being shackled, denied medical care and suffering miscarriages while in immigration detention.

The legislation builds on a bipartisan version previously passed by the House during the 117th Congress. The updated bill includes new standards for healthcare access, mental health and substance use treatment, high-risk pregnancy care, family unity protections and increased federal oversight.

“Proper pregnancy care is a human right, regardless of your immigration or incarceration status,” Kamlager-Dove said in a statement. “It’s unacceptable that there are virtually no legal safeguards for pregnant women in federal custody.”

The bill would also limit the use of restraints and restrictive housing for pregnant women, improve data collection on maternal health in custody and require additional staff training and enforcement measures.

Supporters of the measure said the legislation is intended to address long-standing concerns about maternal healthcare and safety in detention settings, particularly for Black women and low-income women who are disproportionately impacted by incarceration and health disparities.

“Pregnant women in custody should never be subjected to dangerous and inhumane treatment that threatens their health, dignity, or the well-being of their babies,” said Patrice Willoughby, chief of policy and legislative affairs for the NAACP and a longtime public policy and government affairs strategist, in a statement.

A 2021 report estimated there are about 58,000 admissions of pregnant women into U.S. jails and prisons each year. Kamlager’s statement also cited a recent investigation by NBC News and Bloomberg Law that identified allegations of severe mistreatment or medical neglect involving at least 54 pregnant women or families in county jails between 2017 and 2024.

Federal policy under the Department of Homeland Security restricts the detention of pregnant, postpartum and nursing immigrants except in extreme cases. However, the agency reported that ICE deported 363 pregnant, postpartum or nursing women between January 2025 and February 2026, including 16 recorded miscarriages during that period.

The bill is cosponsored by several House Democrats and backed by organizations including the NAACP and the Vera Institute of Justice.

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