Per Reader's Request

I recently received a request from a reader to ponder the recent CDC suggestion that HIV/AIDS testing be done on a routine basis. This opens a huge can of worms, and I will briefly touch on a few of those topics here. I would like to say off the bat though that I think the motivation behind these suggested guidelines is good, not sinister. I simply think that many docs, and many researchers, and CDC people simply don't understand the true problem of un/underinsurance in this country.

The first question this raises is: what happens after the test? I've seen news articles talk about the emotional impact these test results might have on unprepared patients. But what I haven't seen talked about is the question of what will happen to people who are uninsured at the time that the test is taken, and the diagnosis given. People transition between jobs, can't afford the COBRA, can't afford their employer sponsored coverage, aren't offered employer sponsored coverage, don't think they need coverage, are an independent contractor and can't afford or are ineligible for an individual coverage policy, are ineligible for Medicaid, don't know about Medicaid/Medicare, are in the process of becoming approved for it, or in the process of aging out of it if you are a child, especially if you are a foster child. What I mean to say is that there are any number of reasons that 48 million plus individuals in this country are uninsured for a year or more (that # jumps to the 70 millions when looking at if a person has been uninsured for any period of time during that year). The article that I link to above says that "high-risk" individuals who come in through the urgent care or ER should be tested 2 times a year. If you are in that category and are using an urgent care or ER, you are likely uninsured.

And then there is the fact that we are witnessing the erosion of employer sponsored coverage right before our eyes, yet no safety net, no insurance product is keeping pace with this erosion. As it continues to erode, more and more people will fall through those cracks and will for some period of time at least, become uninsured. It is inevitable. It's not just a matter of being high risk, or low income or anything. This is a problem that is touching us all.

There are certain programs that will pay for HIV/AIDS treatment for uninsured individuals, but funding is limited, and what will happen if all of a sudden there are a large number of these individuals trying to tap into that pool of money? In DC they have been doing massive testing lately, and the results show something like 3% of those tested are coming back with positive results. That's something like 2x the national rate (or the assumed national rate).

And then there are those who are insured, and their insurance companies. I recently read (don't remember where) an article about an insurance company trying to retroactively deny coverage to a little girl who was found to have a tumor. This girl's mom had filled out the paperwork to sign her up for insurance, and then took her in for a routine physical, where they found the tumor on her jaw. The insurance Co. claims that the woman lied on the paperwork because she knew that her daughter had a bump on her jaw and didn't include that as a preexisting condition, in which case they would have denied her coverage. But she didn't put it down as a preexisting condition, because it wasn't. It hadn't been diagnosed by any doctor. This woman had no idea that her daughter had a tumor and that it would cost $60,000 in medical bills.

Paul Krugman from the New York Times recently did an Opinion piece (click here for a summary) on the issue of insurance companies trying to not only deny coverage to people because of preexisting conditions, but now are pulling this retroactive BS in denying people's claims.

More health insurers "are finding ways to yank your insurance when you get sick," but the industry continues "growing rapidly," in part by "working harder than ever at identifying people who really need medical care and ensuring that they don't get it," columnist Paul Krugman writes in a New York Times opinion piece. In the past, Krugman writes, health insurers "mainly concentrated on screening out applicants likely to get sick," but today they have begun "devoting a lot of effort to finding pretexts for revoking insurance after they've already granted it," often by "claiming that they weren't notified about some pre-existing condition, even if the insured wasn't aware of that condition when he or she bought the policy."

It's disgusting. This trend, when coupled with the overall erosion of health care coverage, the growing ranks of the uninsured, and the idea to test every person in the country for HIV/AIDS is a potentially volatile and dangerous mix.