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NEWS PWA Sues Storehouse Over AIDS Cap Are Health Benefits Only for the Healthy? by Beverly Gaucher As lawyers prepare to fight one of the country’s most difficult ethical and financial battles of this decade, 36- year-old Richard Owens fights for his life with minimal medical care. Owens, an employee of Storehouse, Inc., has AIDS. In October he was unable to undergo a critical pancreas operation because Storehouse's health-benefits plan changed its policy from one with a maximum cap of one million dollars for all illnesses to one with a cap of $25,000 for employees suffering with AIDS and AIDS- related illnesses. Storehouse claims potential financial ruin if it has to pay for the medical treatment of Richard Owens, not to mention three other AIDS-afflicted employees under the Storehouse health-benefits plan. Owens had worked for Storehouse for three years when he was diagnosed as having AIDS in 1988. From 1988 to March of 1990, the furniture and accessory retailer's plan paid out $250,000 of its original one mil lion dollar limit for Owen's health care. According to the Employee Retirement Income Security Act (ERISA), a self-insured policy, such Storehouse's, can be modified so as to deny benefits dur ing a treatment regimen. (Only self-insured programs may do this: traditional health plans administered by insurance companies cannot legally modify a plan during treatment.) In March of 1990, the Storehouse modified its employee health coverage to carry a maximum cap of $25,000 for AIDS and AIDS-related illnesses in an attempt (according to Storehouse) to avoid financially destroying its entire employee health-benefits plan. At the time this article was written, all Storehouse financial information was under seal. Despite that change the company has, since March, paid Owens an additional $90,000 for medical care "out of good faith," it claims. Owens' suit states that the retroactive change in the company's insurance plan violated the anti-discrimination provision of ERISA. His attorney, Chip Rowan, will take the case to the 11th U.S. Circuit Court of Appeals within the next few weeks. While awaiting that trail, Rowan had requested a temporary restraining order from the Court. Rowan made the move in an attempt to force Storehouse to continue payments for Owen's medical care under its health-bene fits plan. U.S. District Court Judge Owen Forrester denied his request. Forrester found that only a future trial could determine who is responsible for Owen's medical bills. Thus, he reasoned, it would be unfair to require the Storehouse health-benefits plan to continue paying bills for which they might not be responsible, and for which they possibly could never recover. Meanwhile Owens' health continues to deteriorate, with minimal medical care—substantially less than he'd been previously receiv ing, anyway. Is a health-benefits plan responsible for the claims of those it had previously agreed to insure even if those claims could potentially destroy the company financially Susan McCartey/Fulton County Daily Report and thereby render the company unable to cover the med ical expenses of all others who have paid into their plan? Storehouse says no. Rowan thinks otherwise. And Rowan and his client are also willing to contest whether Storehouse would actually be financially destroyed if the company followed through on its original health-benefits plan. Rowan shudders at the potential precedents being set. If Storehouse wins this suit, self-insured policies will be able to pick which diseases, illnesses, disaoilities, etc. that they do not want to cover depending on how much the company is willing to spend. The amount the individ ual was guaranteed at beginning of the coverage, the amount of medical treatment needed, and the amount she or he has paid into the plan will be rendered irrelevant. Also, if Storehouse wins the suit, many in need of medical attention will be forced to use the country's already overloaded and underfunded public assistance programs. If Owens wins the suit, then self-insured policies would need to increase premiums for everybody and/or cover a smaller percentage of medical costs per case than are currently covered. Owens v. Storehouse is not the first time self insured health-benefits plans have challenged AIDS patients' claims here in Georgia. This year, both Galaxy Carpets, Inc. of Dalton and the Peasant Corporation of Atlanta attempted to apply caps for AIDS claims to their self-insured policies. In both cases ACT UP used a com bination of negotiations and political pressure to get the caps removed. Only one other suit similar to Owens v. Storehouse has been filed in the U.S. In McGann v. H&H Music, H&H Music put a $5,000 cap on its treatment of AIDS related disease six months after an employee, McGann, was diagnosed with AIDS. Last June in a summary judg ment, a U.S. District Judge ruled that an employee under a self-insured policy was not subject to a policy that never changed and, as well, the particular policy at hand had not violated the anti-discrimination provision of ERISA. McGann is awaiting an appeal before the 5th Circuit Court. Dear Friends, Sticks and stones may break our bones, but words can hurt like hell too!! Whether it's a physical attack against you, or words hurled like a stone from a passing car, report Hate Crimes by calling 286-BIAS. The information you give counts because you count. Let's make it stick. GET ~mcB HENCE BRING IN THIS AD TO GET YOUR NEXT PURCHASE AT Shakespeare & Company Greeting Cards • Gifts • Books 122 North Avondale Road • Avondale Estates, GA 30002 296-4088 (more parking in rear) Store Hours: Mon-Sat, 10-7; Sun, 1-7 j Southern Voice/November 22, 1990 5