Ask Lambda Legal: The Affordable Care Act and HIV

By Scott Schoettes

Originally printed 3/15/2012 (Issue 2011 - Between The Lines News)

Q: I recently tested positive for HIV, and a friend told me that I might have a hard time keeping health insurance if I changed jobs. What kind of insurance is available for me?

A: In 2012, a positive HIV test result is the beginning of a new health regimen - from regular check-ups, to better nutrition, to daily medications - and these new health habits often become a substantial financial adjustment. For many people living with HIV, obtaining quality, affordable health care is of great concern.

In March of 2010, the Patient Protection and Affordable Care Act, commonly referred to as the ACA, was signed into law. The law reforms aspects of the private health insurance industry and expands access to health insurance for millions of Americans. The ACA's interconnected reforms include expanded Medicaid coverage, elimination of pre-existing condition exclusions, and a minimum coverage requirement (or "individual mandate"). These reforms are essential to expanding care and prevention strategies in the fight against the HIV/AIDS epidemic.

In June, the U.S. Supreme Court likely will decide the constitutionality of the Affordable Care Act. Lambda Legal united national HIV advocates in support of the ACA when we filed a friend-of-the-court brief in the case Dept of HHS V. Florida. (Read about our brief here: http://lambdalegal.org/in-court/cases/dept-of-hhs-v-florida)

When the ACA was enacted, only 17 percent of Americans with HIV had private health insurance. In the individual insurance market, people living with HIV are generally considered "uninsurable" and are routinely rejected when they apply for coverage because they have a pre-existing condition. Even when these individuals find an insurance company to cover them, most states have no rating limits, allowing insurers to charge prohibitively expensive premiums.

Currently, Medicaid provides health insurance programs for the very poor and people with disabilities, but in most states, a disability determination based on HIV requires an AIDS diagnosis. This has created a catch-22: only once a person's HIV progresses to AIDS does s/he become eligible for the medications that would have prevented AIDS from developing. While the federal government provides funding for some HIV-related services through the Ryan White program, this overburdened system is increasingly unable to provide necessary care to people living with HIV.

The ACA is designed to address this problem by eliminating pre-existing condition exclusions and requiring that everyone acquire health insurance. We've already seen the benefits of a minimum coverage requirement for people living with HIV. In 2006, Massachusetts enacted health care reform legislation similar to the ACA, and between 2005 and 2008, Massachusetts had a 37 percent decrease in HIV infections while the nation had an 8 percent increase.

All of us care about and need affordable health care - especially those who have pre-existing conditions and often fall through the cracks of our current broken system - like people with HIV. It is for that reason all eyes are on the nation's high court as it reviews this historic piece of legislation this term.

Scott Schoettes is the HIV Project Director for Lambda Legal. If you are living with HIV, and are looking for resources in your state, call Lambda Legal's Help Desk at 1-866-542-8336, or visit http://lambdalegal.org/help