Almost 32 years after the Centers for Disease Control and Prevention (CDC) first reported on what would become known as AIDS, our nation finds itself at a turning point. Decades of work to expand access to prevention and care services have culminated in the passage and implementation of the Patient Protection and Affordable Care Act (ACA). Set to take full effect starting January 2014, this year will be critical to ensuring that the law is implemented in a way that is fully responsive to the needs of those living with and vulnerable to HIV. But given our community’s laser-like focus on health care reform over the last several years, the question facing our movement now is: What next?
For several years, the HIV/AIDS community has, with the full support of the Obama administration, focused its advocacy on ensuring the passage and protection of the ACA. Now that the law is set to take full effect in under a year, our community must expand its focus and adjust our tactics to ensure that those communities that have suffered the greatest HIV-related health disparities receive the maximum benefits from these reforms. As a black gay man living with HIV, and someone who began his career providing HIV prevention services in Detroit, I know all too well that expanding access to insurance coverage alone is not enough. On its own, an insurance card is just a piece of paper. We must ensure that those communities that have historically been locked out of the health care system have the supportive and enabling services necessary to navigate a system that can be quite complicated.
To that end, the National Minority AIDS Council (NMAC) has released its list of legislative and regulatory priorities for 2013. While we will continue our advocacy around implementation of the ACA, especially as states develop their essential health benefits packages, we will expand our work to ensure these reforms have the greatest impact on reducing health disparities and promoting health equity. This means continued funding for traditional supportive and health completion services under the Ryan White CARE Act, but also means tackling immigration reform and repealing HIV-specific criminal statutes. It means ensuring that everyone has access to safe, stable housing and is protected from employment discrimination, regardless of sexual orientation or gender identity. It also means ensuring that every young person has access to confidential, evidence-based and culturally appropriate sexual health education and counseling.
We have already seen movement on some of these issues. On January 28, bipartisan legislation was introduced in the Senate that would overhaul our immigration system and provide a path to citizenship for the more than 11 million undocumented immigrants living in the United States. The next day President Obama gave a speech outlining his priorities for immigration reform, and the House of Representatives is expected to release its own plan shortly. Given that immigrant populations are particularly vulnerable to HIV and other sexually transmitted infections, and that health care reform only provides coverage for a select group of “qualified” legal immigrants, it is imperative that we work to ensure that health care access is included in any comprehensive immigration reform package.
The importance of immigration reform is made even more evident by the fact that the legislation authorizing the Ryan White program is set to expire in October. While immigrants can be served under Ryan White, the discretionary nature of the program leaves those served by the program at the mercy of annual Congressional budget negotiations. Finding a way to expand access to these populations permanently under the ACA must be a major priority. At the same time, there is and will be a continued need for the supportive and enabling services provided under the Ryan White program for all populations, especially communities of color, even after the ACA is fully implemented. NMAC is committed to working with Congress to ensure that the program receives continued appropriations to meet these needs.
The ACA will address many of the inequities that have persisted in our health care system for decades, and make huge strides in combatting both the spread of HIV and poor health outcomes for those living with the disease. But given what we know about this epidemic, expanding insurance coverage alone is not enough. We must do more to promote employment security for gay, bisexual and transgender workers. Funding for housing assistance is imperative, both for prevention of HIV acquisition and to improve health outcomes for those living with HIV/AIDS. And the federal government should lift its restriction on funding for evidence-based syringe services programs, while promoting the availability of comprehensive and culturally appropriate sex education for all ages.
This is a critical year for our movement and our country. Almost 30 million Americans, including hundreds of thousands of people living with HIV, will gain much needed access to health care coverage. But rather than marking an end to our advocacy work, this moment should serve as a clarion call to our movement and the nation at large that we must redouble our efforts. We have the science to end this epidemic. But we must do all that we can to address the root causes of HIV vulnerability if we are to successfully realize that goal and live up to the promise of our time. After more than three decades, we have a clear path forward and NMAC is committed to reaching the finish line.
Kali Lindsey is the director of legislative and public affairs for the National Minority AIDS Council (NMAC). For more details about NMAC's legislative and regulatory priorities for 2013, click here.