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March 31, 2010

Health Reform and HIV: The Community Responds

by James Wortman

It’s official: President Obama’s sweeping overhaul of the U.S. health care system has been signed into law. But what does this landmark legislation mean for people living with—or at risk for—HIV/AIDS?

On March 23, President Barack Obama signed the sweeping $940 billion Patient Protection and Affordable Care Act, ending his and other Democrats’ yearlong struggle with Republican opponents in Congress (and vocal throngs of Tea Party protesters) to extend health coverage to 32 million uninsured Americans and require most citizens to purchase insurance. Obama lent his pen to a separate reconciliation bill—which includes a package of “fixes” to the Senate version of the bill—one week later.

HIV/AIDS organizations from around the country are applauding the measure, which includes several provisions that will improve the lives of people living with the virus.

“The president and Congressional leaders are to be commended for championing legislation that will extend health insurance coverage to nearly 95 percent of all people in the U.S. when the program is fully implemented,” David Ernesto Munar, vice president of the AIDS Foundation of Chicago, told POZ. “For the fight against HIV/AIDS, nothing could be more important. Health inequality perpetuates late testing and entry into care, HIV-related health disparities and high rates of preventable infections and deaths. Medicaid expansion, Medicare fixes and greater insurance market regulation will make vital health and preventative care services more affordable and accessible for people living with and at risk for HIV/AIDS.”

For HIV-positive Americans, perhaps the most important piece of the new legislation is its provision barring insurance companies from denying or discontinuing coverage based on preexisting conditions, which include HIV/AIDS and other chronic illnesses such as cancer, diabetes or heart disease. The provision goes into effect in 2014 for adults, but will apply to children and teens starting in September.

“With HIV, both because of its medical component but also around the stigma associated with it, there are many people who dread their employer, particularly a new employer, finding out about their status,” says Marjorie J. Hill, PhD, chief executive officer of Gay Men’s Health Crisis, a leading New York City AIDS service organization. “And while this bill doesn’t necessarily change the stigma piece—we still have lots of work to do—it does mean that if someone who is HIV positive changes their job, they don’t have to worry about losing their medical benefits.”

Furthermore, the law prohibits caps on how much health care a plan will cover during a person’s lifetime. It also adds 16 million people to Medicaid—the federal health program for low-income people and those with certain disabilities—by raising the eligibility threshold to 133 percent of the poverty level. At present the federal poverty level stands at $14,404 for individuals and $29,326 for a family of four.

Many advocates, such as Kathie Hiers, CEO of AIDS Alabama and member of the Presidential Advisory Council on HIV/AIDS, hope the bill takes some pressure off individual states’ AIDS drug assistance programs (ADAP). According to a recent report by the National Alliance of State and Territorial AIDS Directors (NASTAD), ADAPs in 11 states have been forced to put a total of 777 people on drug waiting lists this year as of March 25.

“A lot of people living with HIV are now going to qualify for Medicaid, so we’re very excited about that,” Hiers says. But she advises people living with HIV that the Medicaid expansion— including the aforementioned preexisting conditions provision and the ability to buy coverage through state-run marketplaces called “exchanges”—does not go into effect until 2014.

“We’ve got a ways to go before all of this gets implemented,” Hiers explains. “I would encourage [HIV-positive] folks to be careful to protect the benefits they have now and not do anything to lose their placement on an ADAP or anything like that, until these changes actually do go into effect and we see how states are going to be able to afford them.”

Of particular interest to people living with HIV—especially those of advancing years or classified as “disabled” because of an AIDS diagnosis—is the law’s provision that would close the Medicare treatment gap, colloquially called the “doughnut hole,” by 2020, making prescription medications more affordable for senior citizens and people with AIDS. In addition, the bill prevents Medicare recipients who receive their HIV treatment through an ADAP from being subject to additional prescription drug costs.

In spite of these successes, many advocates say they are disappointed that the Early Treatment for HIV Act (ETHA) did not make it into the final version of the bill. ETHA would give states the option of extending Medicaid coverage to low-income people who are HIV positive but have not yet progressed to AIDS, at which point they would be considered disabled. However, others argue that since the new law extends Medicaid to all Americans with incomes within 133 percent of the federal poverty level, many HIV-positive people will be eligible for coverage. ETHA advocates were hoping to extend Medicaid for HIV-positive people within 200 percent of the poverty level.

“There were some legislators who suggested that maybe there wasn’t going to be a need [for ETHA] because of health care reform,” Hill says. “But we felt there was a strong need and there obviously continues to be a need. Medication is still a challenge for many individuals.”

Many advocates also lament the relatively early abandonment of the measure’s “public option,” which would have been a government insurance option to compete with private companies.

“I think we could have done better with health care reform,” says Jay Adams, president of the AIDS Task Force of the Upper Ohio Valley and HIV care coordinator for the Ryan White Part B program in West Virginia. “But given the political environment, I think we did the best we could.”

In spite of some health care reform setbacks, Hill reminds the HIV advocacy community to remain vigilant in supporting—and advising—the president on issues most important to those living with the virus. 

“The Obama administration is a friend, and with so much hope and so much need, it’s easy to forget that,” Hill says. “We need to stand with our friend—but not stand silently.”

Where do you stand? Weigh in on the Patient Protection and Affordable Care Act by commenting below.

Search: health care reform, Obama, Medicare, Medicaid, House of Representatives, Senate, Congress, reconciliation, ETHA, GMHC, AIDS Task Force, Upper Ohio Valley, West Virginia, Kathy Hiers, AIDS Alabama, AIDS Foundation of Chicago, David Munar, Jay Adams, Marjorie Hill, NASTAD, ADAP, disability, preexisting condition, doughnut hole


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  comments 1 - 13 (of 13 total)    

Kurtis, St Petersburg, 2010-04-13 18:38:42
I am glad that I am not the only POZ person who is not excited about this bill/ law now. It does nothing to address the lack of action on the part of Social Security personnel who process paperwork to even get Medicaid / Medicare.

TC, Orlando, 2010-04-06 17:09:16
Government make our HC better? Our government cannot even balance their own checkbook. Anyone who wants the politicians and bureaucrats in DC anywhere near their HC is insane. Just check out the fight in the UK right now about funding cancer drugs for their national HC system. Govt money comes from peoples pockets, others should not have to pay for my mistakes (HIV) or for Obamas (smoking). Freedom allows us to fail or succeed. Not to fail and rob your neighbor to compensate.

Steven Dornbusch, Los Angeles, 2010-04-06 17:08:39
Regarding health reform, Jay Adam's (qualified) statement "I think we did the best we could” is not the case. There were 51, 52, or 53 US Senators in support of the public option. HIVers are "sick" for life. I am one of the 700,000 CA self-insured with Anthem Blue Cross threatened with another whopping 35-39% premium increase (I already paid 5 increases totaling 117%) the President suddenly took an interest in. I may, or may not, get anything out of the package enacted. Off to a feeble start.

jerry, Saint Petrsburg FL, 2010-04-05 12:44:58
I am on the verge of making over the low income subsidy will this knock me out of medicaid support

Jeff, Phoenix, 2010-04-01 22:16:50
How does it end employement blackballing by Insurance companies, as they have been doing for the last 20+years. Make the 90 day probation period and the company puts the employee in for benifits and poof the raive praises of work well done turns into a pink slip......... They may be mandated to cover but they are not blocked from hitting the employer with a penalty rate if they add a preconditione employee.

Drew Herbert, Virginia Beach, 2010-04-01 16:59:18
I am 45yo and been poz for just over 2yrs. I have lost my life insurance before I got out of the hospital. While there I had to endure religious hate and public shamimg from a nurse because I was poz. This healthcare bill is a step in the right direction in leveling the playing field between those who control health insurance and those who need it to survive and live.

Bill, California, 2010-04-01 16:48:58
My concern is the payments to docs who see Medicare and Medicaid patients! More Medicaid recepients, the less in benefits and payments to docs. Did they stop the Medicare pymt cuts to docs of 21%? I've been reading horror stories of the Medicaid system and how people are'nt able to find a doc because of the low pyment from the state. Medicare could be next. What are all of us going to do when docs drop us?? Go onto an HMO?? HMO=DEATH! We shall see!!

Richard B., New York, New York, 2010-04-01 16:31:41
Poz reports that HIV is rising for Senion Citizen, which I am. Viagra, and all other helping vascular drugs for sex are not approved for coverage. When a man stops in the middle of a romantic situation to apply a rubber, The errection may be gone, for good. The Hard-on has no conscious, (You have heard that one before) Sex, part of all life, is stopped. This is not encouraging and this a BIG reason why we need coverage for Viagra. We can put on the rubber. Duh!

Benjamin I. Carr, Macon, 2010-04-01 16:11:08
I am 32 years old and all i see is a site of scare for me and others with and without HIV/AIDS. THis bill is going to be very bad for the younger generation. I just hope the ones that did vote for this stupid bill cant ever get any sleep on their own pillow . I also think it is Very unconstitutional to the American PPL to make them buy something of a good product in which most dont want. And why dont the american ppl make the President and congres himself take this healthcare plan if it so great

Daniel Brower, Fairbanks, 2010-04-01 14:48:18
I should be the poster child for the new health care bill. I have HIV my T-count at one time dropped below 100. During the course of a dispute with the IRS, the IRS garnished my wages. I can't get meds or see doctors because of this. The IRS is aware of my status and the importance of my medical needs but refuses to budge. Is this what you want. Is this what you want for your children. This bill will bring nothing but more hardship and grief to the American people. Dan

Jim, Pleasant View, 2010-04-01 14:24:31
Here recently I tried getting 2 different prescriptions, 1 for me and 1 for my partner. We ran across this either it cost too much or you have to step back and work up again from prior med one of these meds was atripla which was 1800 dollars. My question is who is going to decide who is the people that get to decide what meds we can take and what we can not? Or will there be yet another group that has to agree to the ones above them? This obamacare isnt all what it seems to be and will be bad.

Scott, Minneapolis, 2010-04-01 11:51:53
It means that this law will not let us, and our doctors, make the decission on what drugs will work best for us. It means when times are bad, rationing will take place. Who will not get the medical treatment, when this happens? People who cost more to treat than the average person with out HIV/AIDs, will receive treatment first. It means less doctors to treat us. It means Mom I love you, sorry this healthcare reform means you must give up your most loved things, Your life. Obama=Failure

kckBud, kansas city, kansas, 2010-04-01 10:14:48
I think the president did a wonderful job, worked very hard and kept alot of his promises. I have been HIV poz for 24 years and president Obamha and former president Bill Cliton , ALSO Hilary Clinton have een devoted to health care reform and ave made this historic change possible. often i have experianced that others with hiv or aids havea feeling of entitlement to benifits and think we should rember that is is a prevliage to have the health care that we have as if Bush was still in offi

comments 1 - 13 (of 13 total)    


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