April 27, 2012
HIV/AIDS advocates and patients are closely monitoring the Supreme Court's review of the Affordable Care Act. President Obama's health care overhaul includes two key benefits for HIV-positive people: It expands Medicaid to more low-income adults, paving the way for earlier access to treatment, and it eliminates limits on pre-existing conditions that prevent many from obtaining private health insurance. But the act is in limbo as the high court considers its constitutionality, particularly the requirement that most Americans carry health insurance.
"The HIV treatment community sees the act as a critical step in our fight against the AIDS epidemic," said Scott Schoettes of the gay-rights group Lambda Legal. "People have been counting on it, making plans based on its implementation, so for it to be pulled out from under their feet at this point would be a tremendous loss."
Data from the US Department of Health and Human Services indicate just 13 percent of HIV-positive Americans have private insurance, and around 24 percent have no coverage at all. Many who are eligible rely on public programs like Medicaid and Medicare, while those who meet low-income criteria seek assistance through the federal Ryan White Care Act. Advocates say this patchwork of coverage makes it difficult to effectively address the US epidemic.
"Once on treatment, transmission of HIV is cut to almost zero, but where do these people get treatment?" asked Dr. Michael Saag, an HIV expert at the University of Alabama-Birmingham.
"HIV is a disease of poverty," said Saag, past chair of the HIV Medicine Association, which represents more than 4,800 health care researchers and providers. "That's why the health care law is critically important."