HIV patients are among those with the most to gain from the Affordable Care Act, as long as new coverage offerings don't come at the expense of existing programs.
There are currently more than 1.1 million people living with HIV in the United States, with only 37 percent receiving regular HIV care. This means almost two-thirds are not, in part as a result of limitations to access and coverage.
The ACA is about to change that by greatly expanding health insurance options for HIV patients.
First, the law prohibits discrimination on the basis of a preexisting condition. "Currently, if you have a preexisting condition like HIV, you're uninsurable," said Jennifer Kates, vice president and director of Global Health and HIV Policy at Kaiser Family Foundation. Under the ACA, insurers cannot deny coverage and cannot charge more for care.
Insurers are also prevented from putting caps on care. This means they cannot limit the amount paid on behalf of the patient annually or over a lifetime — a huge gain, particularly for a condition as expensive to treat as HIV.
Third, Medicaid expansion under the ACA eliminates eligibility requirements outside of income level. Previously, even very poor HIV patients would not be eligible unless their disease progressed to AIDS, at which point they would be considered disabled. Kates calls the pre-ACA Medicaid requirements a catch-22. HIV patients "can't really get on Medicaid to get coverage for their meds until they get really sick because they can't get meds," she said.
Unfortunately, Kaiser estimates that 43 percent of people with HIV live in states that are not currently expanding Medicaid. Although not all would be eligible, individuals with HIV are more likely to be low-income than the overall U.S. population, according to Kates.
These individuals — as well as those who are insured — will continue to rely on HIV/AIDS programs such as the Ryan White Program and the AIDS Drug Assistance Program, which provide services to HIV patients that are not available or affordable otherwise.
However, there has been some concern among advocacy groups that the implementation of the ACA may affect funding for these programs.
"I absolutely share that concern," said John Peller, vice president of policy at the AIDS Foundation of Chicago. "I see the role of HIV programs as working to link people to care and provide supportive services that help people stay in medical care. This also has the benefit of reducing new HIV cases."
These services include things like case management and transportation, which help minimize roadblocks that may be keeping patients from sticking with treatment.
"There is a wide realm of services that are not part of public or private insurance and are not part of the ACA," said Amy Killelea, associate director of health care access at the National Alliance of State and Territorial AIDS Directors. "Insurance coverage is a game changer for people with HIV. But it doesn't replace public health and the Ryan White Program."
Killelea does not see anything happening to destabilize the program in the short term, but thinks the programs will adapt as the health care landscape continues to change. "The Ryan White Program will and should be impacted by the ACA." she said.
According to Health and Human Services' Health Resources and Services Administration, which administers the program, Ryan White isn't going anywhere soon. "Implementation of the Affordable Care Act will help the Ryan White Program reach more individuals and extend the program's ability to provide comprehensive care to individuals living with HIV/AIDS," Martin Kramer, director of communications at HRSA, wrote in an email.
Groups are committed to educating HIV patients about the ACA to ensure they take full advantage. Kaiser released a new web portal yesterday to help those with HIV navigate the health care law.
"We're dealing with restricted funding already," Killelea said. "So there is a tremendous push in every state to maximize enrollment."