Win-Win: Health care reform law will help HIV patients and providers
More access to providers and drugs
HIV/AIDS providers and others say the Patient Protection and Affordable Care Act (H.R. 3590), which was signed by President Barack Obama on March 23, 2010, contains mostly good news for the HIV/AIDS community.
It will expand access for HIV patients who currently do not qualify for Medicaid, Medicare, or private insurance. It will make it easier for HIV patients to obtain new private health insurance coverage, and it eliminates the life-time caps on how much an insurer will pay for expensive medical issues, including HIV/AIDS.
The expansion of the private insurance pool and the prohibition against denying coverage for pre-existing conditions will make it easier for HIV patients who are healthy enough to work to find jobs that provide insurance coverage, says William E. Arnold, director of Title II CANN — Community Access National Network, founder of the ADAP Working Group, in Washington, DC.
"That will put more HIV patients into the mainstream system, as opposed to the Medicaid system," Arnold says.
Plus the new legislation will create a wellness/prevention fund with $7 billion in funding over 10 years, and some of this money could go toward HIV/AIDS projects, says Michael Ochs, a government relations associate with the Infectious Diseases Society of America in Arlington, VA.
This funding will be distributed through the U.S. Department of Health and Human Services as a discretionary fund, and it will start with $500 million. It's designated to be used for prevention and wellness, Ochs explains.
The health care reform bill will increase access to affordable health care for all Americans, including people living with HIV/AIDS, says Ronald Johnson, deputy executive director of AIDS Action in Washington, DC.
"We are confident this bill could improve health outcomes as having more dependable care is critical to their health," Johnson adds.
The bill's clause that prevents insurers from denying health care coverage to adults because of pre-existing conditions is a very important part of what was passed, but it doesn't go into effect until 2014, Johnson notes.
Everyone in the pool
"In the interim, the bill calls for the establishment of a temporary, high-risk pool, and through that high-risk pool people living with HIV/AIDS can get access to health care coverage within 90 days," he adds.
Another feature that will increase access is the part that raises the Medicaid eligibility to 133% of the federal poverty level.
"This is a very important provision, particularly for people living with AIDS, and it goes into effect in 2014," Johnson says.
Also, the bill's provision to increase Medicaid payments to primary care providers to 100% of Medicare rates is an important feature that hopefully will result in HIV patients who have Medicaid coverage being able to find physicians who will provide them with care, he adds.
"When you're expanding Medicaid coverage, it's important that you don't lose any Medicaid providers," he says.
From the perspective of the AIDS Drug Assistance Program (ADAP), the Medicaid expansion is the single most important benefit, Arnold says.
"The vast majority of ADAP clients are poor," Arnold says. "This will pick up some people who are not picked up right now."
As more HIV patients receive Medicaid coverage, the ADAP roles likely will ease a little, although the help will be none too soon, Arnold notes.
"We have immediate trouble because of states pulling out a lot of their ADAP money and the federal ADAP appropriations being flat for too long," he says. "The Medicaid expansion will definitely be a help, but the issue is how fast it will be phased in."