From: nyt%nyxfer%igc.apc.org@MIZZOU1.missouri.edu (NY Transfer News)
Subject: NEWS:Court OKs Denial of AIDS Coverage/ww
Followup-To: alt.activism.d
Originator: daemon@pencil.cs.missouri.edu
Organization: The NY Transfer News Service
Resent-From: "Rich Winkel" <MATHRICH@MIZZOU1.missouri.edu>
Date: Tue, 17 Nov 1992 00:30:32 GMT


Via The NY Transfer News Service * All the News that Doesn't Fit

      INSURANCE FRAUD: HIGH COURT OKs SLASHING AIDS COVERAGE

                        By Brenda Sandburg
                          San Francisco

Women with AIDS have won a victory in their battle to be
recognized by the Centers for Disease Control (CDC). For some,
however, the triumph was short-lived. In the same week, the
Supreme Court dealt a blow to medical coverage that will
immediately affect many people with AIDS and has dire
implications for anyone with a catastrophic illness.

It was a grim reminder of how many lives are held hostage to the
profits of the medical care and insurance industries.

On Nov. 9, the Supreme Court voted 7 to 2 not to review a
precedent-setting case that allows companies to cut insurance of
employees with AIDS. In John McGann v. H & H Music Company, the
company was sued for discrimination after it changed its group
medical plan to reduce the lifetime maximum payment for AIDS
treatment from $1 million to only $5,000--the cost of half a
year's medication.

The U.S. District Court in Houston had ruled that H & H did not
discriminate against McGann, but acted simply to avoid the
expense of paying for AIDS treatment. The Fifth Circuit Court of
Appeals upheld the decision a year ago.

Many working people now pay thousands of dollars a year for
medical insurance. The whole point of insurance is that it's
there for you if you get sick. Under this ruling, medical
coverage can be cut back just when people need it the most.
Undoubtedly, insurance companies are already planning to use this
ruling as a precedent in limiting payments for other catastrophic
illnesses.

It's another shocking confirmation that medical needs and costs
have vastly outgrown the antiquated private-profit healthcare
system in this country.

H & H was able to retroactively reduce its insurance coverage by
becoming self-insured and thus not subject to state law. Many
states prohibit insurers from providing coverage that does not
treat all diseases equally.

The 1990 Americans with Disabilities Act (ADA) may provide a
legal route to fight insurance discrimination. However, the ADA
currently exempts self-insured companies from state laws that
prohibit discrimination and does not address the placement of
ceilings on insurance benefits.

Clearly, the struggle for a national, comprehensive, non-profit,
government-funded health system will now become more urgent then
ever.

MANY WOMEN WITH AIDS WEREN'T RECOGNIZED

On another front, AIDS activists have been fighting for a broader
definition of the illness, particularly one that includes
illnesses commonly diagnosed in women with HIV. On Oct. 22, CDC
added three illnesses to its definition of an AIDS case:
pulmonary  tuberculosis, recurrent pneumonia and invasive
cervical cancer.

Last November, CDC had proposed expanding the definition to
include anyone with a CD4 white blood cell count of less than
200. AIDS activists argued that this definition would still
exclude a lot of people with AIDS.

The original definition, published in 1987, covered a list of 23
clinical conditions, but not gynecological conditions common in
women with HIV. Marion Banzhaf of the New Jersey Women and AIDS
Network says that the addition of three illnesses to the
definition is a "bittersweet victory," since it should have
happened three years ago. Citing the importance of including
cervical cancer, Banzhaf noted that women with herpes virus and
HIV will in all likelihood develop cervical cancer.

In addition, the course of the cancer is more rapid and requires
more aggressive treatment in HIV-positive women. Banzhaf says the
inclusion of this illness will alert gynecologists to look for
HIV in women with rapidly advancing dysplasia.

Women with AIDS will now have greater access to health care. This
is especially important for the large proportion of them who are
poor and Third World. Since women are often diagnosed with HIV
very late in their illness, they miss the opportunity for early
medical intervention. Banzhaf points out that an AIDS diagnosis
will also make women eligible for housing and transportation
subsidies and such programs as home-bound meal services. She
cites the case of a woman hospitalized in New York City who could
not get subsidized housing without an AIDS diagnosis. She had 37
bouts of bacterial pneumonia in the four months before she died.

SOME ILLNESSES STILL NOT INCLUDED

Several illnesses that activists fought for remain excluded from
CDC's definition, including cervical dysplasia (a precancerous
condition), pelvic inflammatory disease and recurrent bacterial
infection. Banzhaf says that  at one clinic in Brooklyn, 25
percent of HIV-positive women were found to have cervical
dysplasia.

CDC expects the number of official AIDS cases to double when the
new definition is implemented Jan. 1. As more women are diagnosed
with AIDS, more federal funds may be directed to studies of
women. The expanded figure will also give a more accurate
reflection of the seriousness of the epidemic.

(Copyright Workers World Service: Permission to reprint granted
if source is cited. For more info contact Workers World, 46 W. 21
St., New York, NY 10010; "workers" on PeaceNet; on Internet:
"workers@mcimail.com".)


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