"Private Health Insurance during the AIDS Crisis: Underwriting Practices and Government Intervention"

The HIV/AIDS epidemic during the 1980s and 1990s was a major healthcare crisis in contemporary U.S. history. Reflecting the lack of societal attention to marginalized patients, much scholarly work has focused on activist groups combating the apparent negligence of the healthcare industry and the government (Bell et al. 2017). However, the healthcare industry’s response to the crisis has not been thoroughly investigated. To address this gap, it is crucial to examine the following question: “How did the health insurance industry perceive and behave during the AIDS crisis?” This question is significant because health insurance has long been the chokepoint for access to U.S. healthcare (Chapin 2015, 2019). Hoffman (2012) highlighted that HIV/AIDS patients were often denied insurance coverage, while the government implemented patchwork protections that fell short of systemic reform. In contrast, my research (1) delves further into the varied perceptions and behaviors of different health insurance business models, particularly highlighting the emergence of ‘managed care,’ (2) contextualizes the healthcare industry within the macroeconomic landscape of the 1980s and 1990s, connecting broader population’s healthcare situation to the healthcare accessibility for HIV/AIDS patients, and (3) explores the industry’s evolving perceptions and behaviors amid public criticism and government intervention. Particular emphasis is placed on the link between health insurance and employment in these three aspects, examining how employment became a crucial platform for health insurance coordination among all stakeholders. The research draws on newspaper and magazine articles, government survey reports, law journal articles, and conference proceedings, most of which were classified under ‘Insurance’ within Archives of Sexuality and Gender of Gale Primary Sources and Aetna AIDS Collection of Northeastern University Library.