June 4, 2010

June 4, 2010
Does Health Care Reform Impact People Living with HIV/AIDS?


Welcome to another day in my life. Today is Friday and we have almost made it through another work week. I hope you have had a safe and great week.

Now this has been a long week for me. There have been many conference calls and meetings on HIV/AIDS issues. Due to current and future changes in the way our country helps people with health care, there are as many questions as answers. So today I decided to do a blog on the issue.

How does health care reform impact people living with HIV/AIDS?

President Obama signed the final piece of historic health care reform legislation last Tuesday. Now that the reform process is finally over, here are some of the highlights of the legislation for people living with HIV/AIDS. Note that many of the changes take place in future years; few of the changes go into effect immediately.

Thanks to Advocates for Youth, AIDS Action, Health Law and Policy Clinic of Harvard Law School and the Treatment Access Expansion Project, Housing Works, Kaiser Family Foundation, National Organization for Women, and RH Reality Check for their syntheses from which this material was largely drawn.

Public health care

Creates Medicaid eligibility for individuals and families with incomes below 133 percent of the federal poverty line and eliminates the Medicaid disability requirement. This means that individuals living with HIV no longer must wait for an AIDS diagnosis before becoming eligible for Medicaid. This change will also relieve some of the strain on state AIDS Drug Assistance Programs (ADAPs) by expanding access to Medicaid.

Phases out the Medicare Part D donut hole and allows ADAP to be used to pay true out of pocket expenses. Currently, when people on Medicare Part D hit the initial coverage limit of $2,510 they are required to pay $4,550 out of pocket, referred to as true out of pocket costs or TrOOP, before catastrophic coverage kicks in. Under the new law, ADAP benefits will be considered toward TrOOP so that ADAP, rather than individuals living with HIV, pays the out of pocket expenses.

Private health insurance

Increases access to private health insurance by eliminating discrimination based on health status, and by preventing the practice of charging individuals differently based on their health status and gender.

Increases coverage for a new mandated benefits package that includes prescription drugs, preventative care, chronic disease management, and substance abuse and mental health treatment.

Increases affordability by offering subsidies to individuals and families with incomes between 133-400% of the federal poverty level.

Other key improvements

Invests in prevention and wellness initiatives, including addressing health disparities, and invests in public health infrastructure and the clinical workforce and Community Health Centers serving vulnerable populations.

Invests $75 million in evidence-based sex education programs.

Requires that health insurance plans in the exchange include where available community providers that serve predominately low income, medically underserved individuals.

The Losses

The legislation does not achieve everything HIV and reproductive rights advocates had hoped, and it includes some harmful provisions:

Fails to include a public health insurance option.

Imposes a 5 year waiting period on permanent, legal residents before they are eligible for assistance such as Medicaid, and prohibits undocumented workers from even using their own money to purchase health insurance through an exchange.

Greatly restricts access to abortion coverage. The new law imposes a requirement on insurance plan enrollees who buy coverage that includes abortion care through the health insurance exchanges to write two monthly checks, one for an abortion care rider and one for all other health care. This burdensome system will result in greatly restricting access to, or possibly eliminating, abortion coverage.

Re-authorizes harmful abstinence only until marriage programs, at a cost of $250 million over five years, This defeat comes only one year after these programs had finally been eliminated from the federal budget.

Fails to incorporate ETHA (Early Treatment for HIV Act) into the final legislation. ETHA would have allowed states to immediately expand access to Medicaid to people living with HIV (as opposed to people living with AIDS) until the broader Medicaid expansion goes into effect.

Until we meet again; here's wishing you health, hope, happiness and just enough.

big bear hug,



Daddy Dab