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

SEPTEMBER 10, 2013
Ruth J. Hickman, MD
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.

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