It turns out under Obamacare an insurance company may not refuse to cover someone who is HIV positive but they can make them pay for their own costly prescription drugs. The issue applies to many of the chronically ill that Obamacare was supposed to help. 

As the details of the benefits offered by the new health-care plans become clear, patients with cancer, multiple sclerosis, rheumatoid arthritis and autoimmune diseases also are raising concerns, said Marc Boutin, executive vice president of the National Health Council, a coalition of advocacy groups for the chronically ill.

"The easiest way [for insurers] to identify a core group of people that is going to cost you a lot of money is to look at the medicines they need and the easiest way to make your plan less appealing is to put limitations on these products," Boutin said.

Like many aspects of Obamacare, this one will eventually affect those with employer based plans.

In recent years, employers have compelled workers to pick up a growing share of the costs, especially for brand-name drugs. But insurers selling policies on the exchanges have pared their drug benefits significantly more, according to health advocates, patients and industry analysts. The plans are curbing their lists of covered drugs and limiting quantities, requiring prior authorizations and insisting on "fail first" or "step therapy" protocols that compel doctors to prescribe a certain drug first before moving on to another - even if it's not the physician's and patient's drug of choice.

The AIDS lobby is vocal and has allies in the press. This also pits two industries against each other -- pharmaceuticals and health insurance -- that both promoted Obamacare because the crony capitalists leasing them saw financial opportunity in the mandates.  Call it just another unanticipated consequence of attempting the top down management of such a complex system as health care..

What is covered by Insurance affects the very way medicine is practiced. Prescription drugs are not only a major component of health care costs but the economic tradeoffs aren't always obvious.   Many new drugs are expensive but not only may they be more effective in treating the disease, they can also offset other costs in complex ways.  For example, recent and expensive new prescription blood thinners reduce the need for regular trips to the clinic for testing.  An insurance company may consider the cost of that test in deciding to cover a new alternative, but what about that hour and a half a month minimum average per patient in lost productivity?  The insurance companies couldn't care less about that.  And now with the politicians in charge here is yet another factor to consider.  How will HHS react if all those clinical pharmacists conducting those monthly tests are SEIU  members? 

Welcome to the brave new world of American medicine.  Somehow I suspect it won't just be painkillers that get handed out by the tens of thousands to those too expensive and too politically inconsequential to treat.