The Affordable Care Act Will Improve Access to Health Insurance for People Living with HIV/AIDS

New insurance protections, changes in how AIDS Drug Assistance Program benefits are counted, Medicaid expansion, and other provisions in the law will mean better care for many patients.

During a workshop at the 2013 United States Conference on AIDS, held September 8-11, 2013, in New Orleans, LA, Malinda Ellwood gave a talk on the impact of the Affordable Care Act (ACA) on HIV coverage. Ellwood is a Clinical Fellow with Harvard Law School’s Center for Health Law and Policy Innovation, and is involved with the Treatment Access Expansion Project.

Ellwood began her talk by putting the ACA in perspective. “Where we are now is at an access to care crisis. People with HIV are uninsured at a much higher rate than people in the general population. Under current rules, if you are poor, you also have to have some sort of disability to qualify for Medicaid, and HIV itself is not a qualification,” she said. Many people with HIV with part-time or low-wage jobs cannot get access to health care through their work, and private insurance is too expensive for most people. Additionally, people with HIV have usually been excluded coverage under such plans due to their preexisting condition.

However, under the ACA, several insurance options should open up for people with HIV. Ellwood noted that the ACA also gives states the opportunity to expand Medicaid to cover most low-income people, regardless of disability. “For the first time ever, it gives us an opportunity to truly create a health insurance program for low income people,” she said. The changes also improve reimbursement and services and streamline the application process. These new Medicaid packages must cover certain essential health benefits by law (though many of the details of this are left up to the states).

Individuals in a slightly higher income bracket will also benefit from the law. The ACA will set up substantive federal tax credits for individuals and family members whose income is 100-400% of the poverty line, making it much more affordable. It also offers additional cost-sharing reduction options for people whose income is 100-250% of the poverty line. Private insurance plans will also have to meet certain minimum coverage standards.

Additionally, the ACA will end discriminatory insurance policies. As of 2014, it will not be legal to deny a person insurance coverage for a preexisting condition, including HIV. Health plans will also not be able to drop a person when they get sick, and they cannot make annual or lifetime limits on coverage. The ACA will also allow young adults to stay on their parents’ health insurance plans until they reach the age of 26. The ACA also improves Medicare, making it less expensive for many seniors.

Ellwood talked about how the Supreme Court decision upholding the constitutionality has affected implementation of the ACA. The court ruled that it was legal to require individuals to have health insurance. It also ruled Medicaid expansion was legal, but that the federal government could not withdraw funding from states that don’t comply with the expansion. “Essentially, this makes Medicaid expansion optional for states, which is very very sad,” Ellwood said.

Many states are still in the process of deciding whether to go forward with the Medicaid expansion. Some have opted not to, especially in the South. Unfortunately, this will leave out many people with incomes below the federal poverty line who don’t already qualify for Medicaid, and who also won’t qualify for discounts through the new health insurance exchanges. These individuals may need supplementary help through discretionary funding like the Ryan White program. Ellwood said she is hopeful that these states will eventually comply with Medicaid expansion, since they will have to turn away so many federal dollars if they do not.

The information from this talk, and much more information about the Affordable Care Act, is available at HIV Health Reform.