April 26, 2013
HIV and the Patient Protection and Affordable Care Act (ACA) was the focus of the 51st meeting of the Presidential Advisory Council on HIV/AIDS (PACHA). The unique town hall-style format of the meeting allowed for interactive and informative discussions with guest speakers, panelists and PACHA members.
Some of the most pressing concerns that have emerged during the transition into full implementation of the ACA include the role of the Ryan White Program, Medicaid expansion and the functionality of state health insurance marketplaces (which will allow individuals to purchase insurance from qualified health plans, all of which must provide a core set of benefits, known as Essential Health Benefits). The first panel featured department of health officials from Massachusetts and Michigan who highlighted efforts in their own states to ensure continuity of care for people living with HIV/AIDS as they adapt to certain aspects of health care reform. Massachusetts, for example, has been living in a post-health care reform environment for years now, having already expanded Medicaid and enacted health care reform. However, it took many years to transition low-income HIV-positive individuals into the Medicaid system. H. Dawn Fukuda, Director of the Office of HIV/AIDS, Bureau of Infectious Disease at the Massachusetts Department of Public Health, warned that full implementation of ACA will be a long process requiring extensive outreach and communication with providers and HIV-positive individuals. She also stressed the need for the Ryan White Program to be as flexible as possible, which will allow it to adapt and provide the necessary supplemental support to coverage provided by the ACA and Medicaid expansion. The second panel provided detailed information regarding state health insurance marketplaces and Medicaid expansion, including those Essential Health Benefits that must be provided by qualified health plans.
The final panel featured community and stakeholder input including Center for Budget and Policy Priorities Vice President for Health Policy, Judy Solomon. Solomon emphasized it was not likely that the new electronic Medicaid system for determining Medicaid eligibility vs. health insurance marketplaces would be up and running. As a result, many decisions about where and how to enroll would continue to be made by hand. Solomon suggested that HIV organizations and advocates should become involved with eligibility decisions at the ground level. She urged the community to be engaged, review multiple sources of information and establish expertise in practical ways, including education about the new healthcare system, monitoring the system and advocating for change. Andrew Baskin, National Medical Director for Aetna Insurance, noted Aetna had many tools that might be particularly helpful in getting people to adhere to medical care. Dr. Michael Saag of the University of Alabama at Birmingham provided new data about the financing of a Ryan White Part C funded clinic and showed how funding shortfalls were at least in part a result of funding disparities even within the same city. Finally, Jeff Crowley from Georgetown Law School spoke about the need to make changes in the next few years as coverage needs and gaps emerged with the implementation of the ACA.
This interactive town hall-style meeting allowed the community to engage with officials working directly on ACA implementation and helped provide valuable information regarding HIV-positive individuals and possible issues that may arise as the major ACA transition begins. AIDS United will continue to update you on issues associated with ACA implementation as more information becomes available.