Health Care Reform and HIV/AIDS

How Does the Affordable Care Act Impact People Living with HIV/AIDS?

On March 23, 2010, President Obama signed the Affordable Care Act and set into place an effort that will help ensure Americans have secure, stable, affordable health insurance and the relief they need from skyrocketing health insurance costs. Historically, people living with HIV and AIDS have had a difficult time obtaining private health insurance and have been particularly vulnerable to insurance industry abuses. People with HIV/AIDS also face barriers to obtaining care from qualified providers. Consistent with the goals of the President’s National HIV/AIDS Strategy, the Affordable Care Act makes considerable strides in addressing these concerns and advancing equality for people living with HIV and AIDS.

Improving Access to Coverage

Currently, fewer than one in five (17%) people living with HIV has private insurance and nearly 30% do not have any coverage. Medicaid, the Federal-state program that provides health care benefits to low-income people and those living with disabilities, is a major source of coverage for people living with HIV/AIDS, as is Medicare, the Federal program for seniors and people with disabilities. The Ryan White CARE HIV/AIDS Treatment Extension Act of 2009 is another key source of funding for health and social services for this population.

The Affordable Care Act began addressing these problems in 2010. As of September 23, 2010, insurers are no longer be able to deny coverage to children living with HIV or AIDS. Insurers also are prohibited from cancelling or rescinding coverage to adults or children unless they can show evidence of fraud in an application. And insurers no longer can impose lifetime caps on insurance benefits. These changes will begin to improve access to insurance for people living with HIV/AIDS and other disabling conditions and help people with these conditions retain the coverage they have.

These changes will provide an important bridge to the significant changes in insurance that will be made in 2014 as the Affordable Care Act is fully implemented. Beginning in 2014, insurers will not be allowed to deny coverage to anyone or impose annual limits on coverage. People with low and middle incomes will be eligible for tax subsidies that will help them buy coverage from new state health insurance Exchanges. The Affordable Care Act also broadens Medicaid eligibility to generally include individuals with income below 133% of the Federal poverty line ($14,400 for an individual and $29,300 for a family of 4), including single adults who have not traditionally been eligible for Medicaid benefits before. As a result, a person living with HIV who meets this income threshold no longer has to wait for an AIDS diagnosis in order to become eligible for Medicaid.

The Affordable Care Act also phases out the Medicare Part D prescription drug benefit “donut hole,” giving Medicare enrollees living with HIV and AIDS the peace of mind that they will be better able to afford their medications. Beneficiaries who reached the donut hole in 2010 will receive a one-time rebate of $250. In 2011, these beneficiaries will receive a 50% discount on brand-name drugs while they are in the “donut hole,” a considerable savings for people taking costly HIV/AIDS drugs. In addition, ADAP benefits will be considered as contributions toward Medicare Part D’s true Out of Pocket Spending Limit (“donut hole”), a huge relief for low-income individuals living with HIV and AIDS.

Ensuring Quality Coverage

The Affordable Care Act also seeks to make sure that people with public or private coverage have access to the information they need to get the best quality care. This includes:

• Better information. Because of the Affordable Care Act, people living with HIV and AIDS will also be offered more information and services. With the passage of the new law, plans will be required to provide information in a user-friendly manner that clearly explains what is and isn’t covered. (Go to www.HealthCare.gov).
• Quality, comprehensive care. A new comprehensive benefit package that equals that of a typical employer plan will offer all Americans who purchase insurance policies in the individual or small group market a fair and comprehensive set of services that includes prescription drugs, preventive care, chronic disease management, and substance abuse and mental health treatment.
• Preventive care. Beginning September 23, 2010 some private insurance plans began covering recommended preventive services like regular check-ups and certain cancer screenings at no additional cost to eligible people. Comparable provisions took effect in Medicare starting on January 1, 2011. This will help people living with HIV and AIDS stay healthy.
• Coordinated care. The law calls for new investments in community health teams to manage chronic disease. The new law also recognizes the value of patient-centered medical homes (coordinated, integrated, and comprehensive care) as an effective way to strengthen the quality of care, especially for people with complex chronic conditions, and it is proven to be effective as demonstrated by the Ryan White HIV/AIDS Treatment Extension Act of 2009, the pioneer in the development of this model in the HIV health care system.

Increasing Opportunities for Health and Well-Being

Despite significant advances in HIV treatment and education, there are over 56,000 new HIV infections annually with significant racial and gender disparities. The health of people living with HIV and AIDS is influenced not only by their ability to get coverage but also economic, social, and physical factors.

• Prevention and wellness. The new law makes critical investments in prevention, wellness, and public health activities to improve public health surveillance, community based programs, and outreach efforts. The new law requires new insurance plans to offer coverage without cost-sharing for HIV screening tests for at-risk individuals. This will enable more people to get access to life-saving treatment more quickly.
• Diversity and cultural competency. The Affordable Care Act expands initiatives to strengthen cultural competency training for all health care providers and ensure all populations are treated equitably. It also bolsters the Federal commitment to reducing health disparities.
• Health care providers for underserved communities. The Affordable Care Act expands the health care workforce and increases funding for community health centers, an important safety-net for low-income individuals and families. A key recommendation of the National HIV/AIDS Strategy is to increase the number and diversity of available providers of clinical care and related services for people living with HIV. The new law will lead to significant new investments to support critical healthcare workforce expansions to better serve vulnerable populations.

Learn more about the Affordable Care Act.

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