Legislation meant to protect people who take pre-exposure prophylaxis medication for HIV prevention from insurance discrimination was not on the slate of new state laws that went into effect in July.
Gov. Glenn Youngkin vetoed House Bill 2769 in March — which would have prohibited insurers from denying, limiting or charging a different rate for life or disability insurance coverage for people on a PrEP regimen.
In June, the US Supreme Court upheld an Affordable Care Act mandate requiring health insurers to fully cover PrEP — which has been FDA-approved since 2012 — and certain other preventive health measures.
But other types of insurance, such as life, disability and long-term care, are generally subject to state laws. Only a handful of states have legal protections specifically prohibiting life insurers from discriminating against people who take PrEP. Youngkin’s veto came ahead of nationwide reductions to HIV surveillance, treatment and prevention efforts.
In July, the Virginia Department of Health announced that funding reductions from $29.8 million to $9.7 million for health organizations that care for people living with HIV. The bulk of cuts were due to decreased rebates from drug companies, according to Virginia Health Commissioner Karen Shelton.
The federal US Centers for Disease Control and Prevention’s HIV programs have also been significantly cut as part of a $1.5 billion budget reduction.
Health care advocates fear potential gaps in HIV treatment and prevention drug regimens due to looming federal cuts to Medicaid, and the possible end of expanded tax credits subsidizing ACA healthcare coverage through 2025.
Amid changes to the health care landscape, life insurance denials solely for PrEP use could contribute to the spread of HIV, said attorney Ben Klein at GLAD Law, an advocacy group for LGBTQ+ issues and people with HIV.
The New York Times reported in 2019 that some individuals said they ended PrEP regimens to obtain life insurance, despite the health risks.
“We’re in an era where healthc are is getting more and more expensive, and we should be doing everything we can to encourage preventive care,” Klein told VPM News. “Discriminatory practices against people who use PrEP will result in more HIV transmission when we’re actually making good progress in stopping the epidemic.”
PrEP lowers the risk of contracting HIV from sex by about 99% when taken as prescribed. Insurer risk management models typically favor individuals who choose to take highly effective preventive health measures, but Klein said this isn’t the case for people who use PrEP.
“Many insurers … exclude people who are on [PrEP] but would insure the same person who is not taking PrEP,” Klein said. “… What insurers are doing is they’re providing the insurance to the people who are at higher risk and denying the people who are at lower risk. The exact opposite of the way insurance companies rationally act in their regular business practices.”
Klein, as well as other attorneys and activists, say it is discriminatory to deny life insurance for taking PrEP. The denials disproportionately impact gay men, who are the majority of PrEP users, though care providers recommend PrEP to anyone at risk of contracting HIV.
California and New York enacted policies specifically prohibiting life insurance discrimination against PrEP users in 2023 and 2024, respectively. In Massachusetts, Klein successfully litigated a case against Mutual of Omaha Insurance Co. in 2019 for denying long-term care insurance to people who use PrEP.
Activists have also said that life insurers don’t deny people for receiving similar forms of preventive care, such as the Gardasil vaccine that protects against the human papillomavirus (HPV) — which is most commonly spread through sexual activity. Life insurers also cover individuals with chronic diseases currently managed by medication, such as diabetes and bipolar disorder.
Del. Jeion Ward, D–Hampton, said she drafted the General Assembly bill to address discrimination and promote consistent use of PrEP, particularly in Hampton Roads, a region with some of the highest HIV rates in Virginia: “I wanted to make sure that we were doing everything we could to encourage the use of PrEP.”
“Anytime you want to protect yourself and those around you, and you are being denied that possibility or that right, it does begin to affect your dignity as a human being,” Ward added.
Ward’s bill passed the Virginia House on a 53-44 vote, then passed the state Senate 24–15 before the governor’s veto. No one spoke in opposition to the legislation in either chamber.
In the statement accompanying his veto, Youngkin wrote that prohibiting life insurance companies from denying or limiting life insurance for PrEP users undermines the insurance underwriting process.
“While insurers are rightly prohibited from discrimination based on race, ethnicity, gender, religion, or marital status, they retain the ability to assess risk using relevant health and behavioral factors,” Youngkin wrote. “Singling out one medical treatment for special protection undermines this established process and could set a precedent that invites broader exemptions, potentially destabilizing the insurance market.”
Peter Finocchio, a spokesperson for Youngkin, declined additional comment.
The American Council of Life Insurers, the leading trade organization for life insurers in the US, told VPM they were “neutral” on Ward’s bill.
