Obamacare’s Growing Pains

Ending the Epidemic Blog
Three years ago, I asked you “Are You Ready?” With the passage of the Affordable Care Act (ACA), I understood that our organizations and clients were facing radical change. Little did I know the extent of this change. In addition to getting ready for ACA implementation, in the last two years we’ve also witnessed a scientific revolution, providing us a pathway to end the epidemic and hope for a cure. I moved from asking “Are You Ready” to discussing ways that we can further the vision of ending the HIV/AIDS epidemic in America.

The latest domestic epidemiological profile of this disease in America showed the overwhelming impact this epidemic continues to have on marginalized populations, from IV drug users and sex workers to women of color and gay men, especially young black gay men. These same populations are also the most likely to lack access to affordable insurance coverage.

According to CDC data:

  • There were 47,300 new HIV infections (in America) 2010
  • Approximately 1.1 million people are living with HIV in the U.S.
  • Since the beginning of the domestic epidemic 658,992 people have died, including more than 16,000 in 2010
  • 18% of Americans living with HIV are unaware of the status
  • Only 25% of Americans living with HIV/AIDS are virally suppressed.

We are nowhere close to hitting the necessary targets for any of our highly impacted populations. That’s why it is so important that we continue to work to successfully implement the ACA. The Health Resources and Services Administration (HRSA) estimates that as many as 140,000 Americans living with HIV currently being served by the Ryan White Program will be newly eligible for private or public health insurance under the Affordable Care Act. That’s a lot of individuals that we need to enroll. And as we’ve seen, the roll out of the exchanges has been rocky so far.

As of last week, only about 160,185 people have signed up for private insurance plans under the federal or state exchanges – a number far short of numbers needed to sustain them. But while some opponents of the law use this fact to claim that the law is fundamentally flawed, ignore the almost 1 million Americans that have already signed up to compare insurance plans via the state and federal exchanges. While they have not yet selected a plan, it is clear that the public has an appetite for affordable, quality coverage. It is our job to work with the administration and our local partners to ensure that they and our clients can access it.

For the HIV/AIDS community, it’s especially important to understand and educate our clients about the full range of benefits that come with specific plans. We’ve seen some state essential health benefits packages that do not cover all the drugs necessary to support the lives and health of people living with HIV. Some plans lack a “grandfather” clause, meaning that some plans might not cover a particular drug regimen even if you have already successfully reached viral suppression on that regimen. Additionally, some insurance companies still have not disclosed specifics about the HIV medications they will cover. While we continue to work with our coalition partners to address these issues, it is important that the community remain engaged and continue to review plans and policies closely before selecting them.

The Federal AIDS Policy Partnership (FAPP) and the HIV Health Care Access Working Group have been doing fantastic work on this front. Please reach out to the coalition co-chairs to get on the listserves to receive updates and go to www.HIVhealthreform.org for updates on coverage on once-a-day regiments and coverage assistance with copays.

There’s no doubt that it has been a rough month and a half. But we must remember that it has only been 50 days. Our nation spent decades trying to pass large-scale health care reform. We cannot expect it to be perfect or address all the challenges that our constituents face on day one. We’re here for the long haul, and will continue to work to address any short falls or gaps in the law. Nobody said transforming health care in America was going to be easy. We are being asked to transform our systems of HIV care, while simultaneously facing budget cuts and a shifting prevention paradigm. But doing this important work is essential to ending this epidemic. And successful implementation of the Affordable Care Act is central to that vision.

Yours in the struggle,

Paul A. Kawata
Executive Director
National Minority AIDS Council