Access to health insurance for Americans with HIV is expanding thanks in part to the health care reform law, which has placed a higher emphasis on public programs. Individuals who have HIV/AIDS in America have several health insurance options through government sponsored plans, including Medicaid, Medicare, and the Ryan White HIV/AIDS program, in addition to the option of coverage through an employer. While individual health insurance may be limited to people with HIV or AIDS at the present time, in January 2014, the door will be opened by the Affordable Care Act (ACA).
Medicaid is a primary source of coverage for individuals with HIV/AIDS, covering a significant population of low-income men, women, and children affected by the illness. As the program accommodates those who have any condition of illness, some of our continually disappearing tax dollars are at least supposedly going to serve this group of needy individuals. It is projected that the most insured individuals with HIV in America are covered by Medicaid. A lesser percentage is covered by Medicare or private coverage, and many remain without insurance and use the Ryan White program as their sole source of health care assistance.
As each type of coverage mentioned has its own screening and eligibility process, which includes age, citizenship, income, employment, health status, among other factors to qualify. This leaves people with HIV scattered across the health insurance system, facing difficulties in finding the proper coverage, as well as left to resort to treating their disease without any insurance. However, the ACA will broaden the spectrum for this growing group of Americans, offering more opportunities to get care and be continually insured.
Improving accessibility to care for everyone, especially those with conditions such as HIV is an essential part of health reform. The law is expanding access to all necessary and types of treatment that have proven effective, namely antiretroviral treatment (ART). ART has shown positive results in improving the overall health of individuals with HIV, and recent research also indicates the treatment reduces the risk of the disease’s transmission from an HIV positive to an HIV negative person.
Since the law was passed in 2010, the health insurance system has already begun to make adjustments to provide more coverage for people with HIV. Though the most significant changes will occur in 2014, a gradual increase in much needed insurance or availability of medical services and prescriptions designed to combat the illness. ART treatment has a great overall effect on our public health system by reducing the disease’s potential of spreading to non-infected individuals, as well as helping those with HIV live longer and healthier.
Insurance for HIV before the ACA
Prior to the Affordable Care Act, group coverage (through an employer) was the main source of health insurance for most people who live in this country. However, it was much more limited for workers with HIV. The individual market was even less welcoming, as AIDS is often found on the list of immediately declinable conditions for many private insurers, and HIV, considered an uninsurable, pre-existing condition. The prior knowledge of expensive treatment and medications caused insurers to be wary of individuals with HIV, frequently resulting in rejection of coverage, or vast increase in rates so high the applicant would be unable to afford it.
Due to the challenges brought about by the individual and employer-sponsored market, people with HIV have heavily relied upon the public programs at hand. Medicaid being a primary choice for those with a low-income, a good portion also qualify for the program through being disabled. Most individuals with HIV have been eligible for Medicaid by fulfilling both characteristics. Before the health care law, the federal government made an exclusion for coverage of non-disabled adults without children through Medicaid, unless a state got a waiver or used state-only funds to cover this group.
Clearly not all adults affected by HIV are disabled, which brought hope of coverage to a screeching halt for many individuals who have a low enough income to qualify, but do not have children or a mental or physical disability. This unnecessary discrimination prevented a large population from receiving valuable medications covered by Medicaid for HIV. Though Medicaid, in fact, covers these necessary drugs to prevent HIV-related disability and suppress the life-threatening aspects of the illness.
Another source of coverage before expanding laws to assist people with HIV, again, is quite limited. Medicare is designed for groups of Americans who are age 65 or older, or permanently disabled, which provides coverage for the small window of disabled or elderly individuals with HIV. In other circumstances, if a state has a high-risk pool, people who do not qualify for Medicare or Medicaid would be able to apply for such coverage. However, the high-risk pools have not been known to cover HIV medications and treatments, which leaves the Ryan White program as the primary source of disease-specific care.
During what is referred to as the ACA transition period (between 2010 and 2014), a larger number of options were created, giving greater access to coverage. One of which is the Pre-Existing Condition Insurance Plan (PCIP), a temporary high-risk pool available for purchase on the private market, though a federally and state administered plan. Individuals with HIV will not be discriminated against for having the condition, and no longer are high-risk pools limited only to certain states.
In addition to PCIP, the health reform law also restricted private health plans in both individual and group markets from imposing lifetime maximums. This provision made it possible for people who require costly treatment from running out of coverage, as they easily could have prior to the law. The dependent coverage option is also helpful for young adults with HIV, as they can now stay on their parent’s plans until age 26.
Medicaid was also addressed, offering coverage to adults without children in states who chose to do so, with incomes at or below 138 percent of the Federal Poverty Level. This has been implemented in multiple states already, and in time it will hopefully spread to every state. Despite the expansion in Medicaid and lift on limits, it has remained difficult to get coverage as a person living with HIV. Ultimately, Ryan White still acts as the major source of access to care, because not every state has implemented these provisions. Though slightly more options are available, there has not been enough of an apparent impact made thus far.
Health Insurance in 2014
Once January 1, 2014 rolls around, access to healthcare for people with HIV should improve at a staggering rate. PCIPs will not be effective, as all the private health insurance market will accept individuals with HIV on an equal basis, with no unfair rate-ups or exclusions. Individuals who can afford to pay for an individual health plan will be able to do so without it being such an enormous financial undertaking, and those who cannot afford these plan will receive subsidies to help them meet their premiums and other costs. Many more Americans will be able to receive the care they need with proper coverage, conditions aside, paying the same amount as everyone else.
Though that sounds fairly magical and will hopefully run smoothly and successfully upon implementation, there is also the question of what happens to the low-income. Though the Supreme Court stripped the Medicaid program of its core responsibilities to our nation’s most needy by making expansion optional, the state who do participate will give a larger number of people with HIV the coverage they require. In a country full of predominantly Republican states whose primary concern has never been the poor and sick, this option is dangerous, as many states are flummoxed over how much Medicaid expansion would cost their state.
Hopefully, these statements will be overcome by common sense in government forces and the expansion will take place in as many states as possible. Expanding the Medicaid program would add the group of childless adults with an income of up to 138 percent of FPL, as well as allow in more low-income, disabled individuals with HIV. The most important would certainly be the entry of a larger number of non-disabled adults, the key population affected.