The ACA's Potential to Transform the AIDS Response
July 9, 2013
The second in a series that examines the Affordable Care Act's impact on people living with HIV/AIDS.
In contrast to our current health-care system, which makes it difficult for PLWHA to obtain the care and treatment they need, the Affordable Care Act (ACA) has the potential to sharply increase health-care access for PLWHA. In 2012 Jeffrey Crowley, former director of the White House Office of National AIDS Policy, and Jen Kates of the Henry J. Kaiser Family Foundation surveyed the ACA's key provisions for PLWHA (pdf). The pair wrote: "The passage of the ACA provided significant, new opportunities for expanding access and coverage to millions of people in the United States, including people with HIV."
The key ACA provisions that Crowley and Kates highlighted include the following:
Medicaid: Beginning in 2014, the exclusion of coverage for single, childless adults will be eliminated, with a new minimum income-eligibility threshold of 138 percent of the federal poverty line to take effect. The ACA increases Medicaid payment rates for primary care and also allows states to permit chronically ill patients to designate a Medicaid provider as their health home.
Medicare: The ACA phases out the Medicare drug-coverage gap, which currently puts chronically ill patients on the hook for thousands of dollars in drug costs. A $250 discount for Medicare recipients who enter the so-called drug doughnut hole is now available, with the discounts to increase over time until the coverage gap is completely eliminated. Until the drug-coverage gap is eliminated, the ACA allows AIDS Drug Assistance Programs around the country to cover HIV-positive Medicare recipients' out-of-pocket costs for HIV-related medicines.
Health insurance: Beginning in 2014, all U.S. citizens and legal residents will be required to have health coverage, with insurance-premium subsidies made available to families with incomes from 100 to 400 percent of the poverty line and cost-sharing subsidies offered to families above 250 percent of that line. Beginning in 2014, both annual coverage limits and exclusions of coverage for pre-existing conditions will be eliminated. Private health insurance marketplaces, or exchanges, will be available in all states (operated either by the state or by the federal government) to enable individuals to purchase affordable health insurance.
Health-care quality: Beginning in 2014, all health plans, including Medicaid, will be required to provide a package of essential health benefits. The ACA mandates that these packages include comprehensive services across 10 service categories. The ACA mandates collection and reporting of data on health disparities.
Prevention: The ACA aims to increase the health-care system's focus on prevention. Priority prevention services are to be covered as part of the essential-benefits package, and the act also created a Prevention and Public Health Fund, which has already provided additional funding for HIV-prevention activities supported by the Centers for Disease Control and Prevention.
Together these provisions are expected to have a significant impact on the ability of PLWHA to access the health-care system.
Next week: Ensuring the ACA's full implementation.
Excerpted from the Black AIDS Institute's 2013 State of AIDS Report, "Light at the End of the Tunnel: Ending AIDS in Black America."
This article was provided by Black AIDS Institute. It is a part of the publication Black AIDS Weekly. Visit Black AIDS Institute's website to find out more about their activities and publications.
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