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Supreme Court's Ruling on the Affordable Care Act Hailed as Tremendous Win for People Living With HIV/AIDS

June 30, 2015

Millions of Americans will continue to have health insurance, thanks to the historic Supreme Court ruling on the Patient Protection and Affordable Care Act on June 25, 2015.

The court rejected a conservative legal challenge and ruled that Congress clearly intended that the tax subsidies that help millions of low- and moderate-income Americans should be available to everyone in all 50 states -- not only the states that established their own health insurance exchanges. "If the challengers had won, at least 6.4 million people in at least 34 states would have lost subsidies worth an average of $272 per month," reported Reuters. The 6-3 ruling in King v. Burwell -- the decision was written by Chief Justice John Roberts, a conservative appointed by former President George W. Bush -- means that millions of Americans who would not otherwise be able to afford insurance will continue to have access to high quality coverage.

The ruling is especially critical for people living with and at risk for HIV/AIDS, people in the South, African Americans and those with low and moderate incomes.

"It's a tremendous win for the community," said AIDS Foundation of Chicago President and CEO John Peller. "This was a drafting error in the legislation and it shouldn't stand in the way of implementing health care reform for millions of people."


Expanding Coverage

The Affordable Care Act is the signature domestic policy legislation of President Barack Obama's administration. The act was signed into law in 2010 and has been described as "the most far-reaching" overhaul of our health care system since the passage of Medicaid and Medicare in 1965. Less than one in five of the 1.1 million people living with HIV/AIDS in the nation had private insurance when the law was signed. Nearly one in three did not have any coverage.

An estimated 10 million people now have private insurance as a result of so-called Obamacare, CNBC reported in February.

"About one million people in Illinois now have insurance through the Affordable Care Act. That is out of a population of about 12 million," added Peller, who has also led the project, which has prepared the HIV community for health care reform. "People living with HIV now have access to far more comprehensive coverage than they ever did before."

The King v. Burwell ruling also means that states can continue to use Ryan White HIV/AIDS Program funds to pay for premiums, added Carolyn McAllaster, clinical law professor and director of the HIV/AIDS Policy Clinic at Duke University. "People who have these subsidies are able to afford other medications and not only the HIV anti-retroviral drugs. This is very significant for many people, especially in the South. Some of the AIDS Drug Assistance Programs [limit] the drugs that they cover. That is another reason why this decision was so critical."

Potentially millions of people across the South "would have lost their insurance" if the Supreme Court had ruled the other way in King v. Burwell, said McAllaster. Such a ruling could have had "a larger impact on the South than any other region."

Medicaid Expansion and the South

States now have the authority to expand Medicaid income and eligibility requirements. For instance, "people living with HIV no longer need an AIDS diagnosis in order to qualify for Medicaid" in these states, reports "That means they can get into life-extending care and treatment before the disease has significantly damaged their immune system."

Thirty states and the District of Columbia have expanded Medicaid as of June 2015. But there is a critical disconnect on the expansion map: An estimated 43% of people living with HIV/AIDS reside in states that are not expanding Medicaid. Many of these states are disproportionately lower income, have larger concentrations of African Americans and are in the South. The largest increase in new infections is also in the South. Most of these states are conservative and have Republican political leadership. With the exception of Arkansas and Kentucky, none of the states in the South are expanding Medicaid.

"The impact of not extending Medicaid in the South cannot be overestimated," said Kenyon Farrow, the U.S. and global health policy director of the Treatment Action Group.

"Grady Hospital -- Atlanta's public health hospital -- found that half of the people who were diagnosed with HIV in their emergency room already had a clinical AIDS diagnosis. A [significant] number of those will be black gay and bisexual men, as well as black transgender women."

"Contrast this to New York City, which once was the epicenter of the epidemic. New York state has expanded Medicaid and announced an ambitious plan to 'end the epidemic,'" added Farrow, who analyzes public health policy for The Atlantic and RH Reality Check. "If we are serious about ending the epidemic across the country -- and not just on the East Coast and West Coast -- then Medicaid expansion has to be the foundation of that process."

African Americans comprise about 13% of the nation's population, but almost 44% of all new HIV infections. Seroconversions are rising fastest among black men who have sex with men (MSM). Black women, black and Latina transgender women and Latino men also experience significant HIV disparities.

Farrow notes that research has demonstrated that black MSM are not more likely to engage in condomless sex, but are impacted by socioeconomic barriers -- such as poverty, high incarceration rates, "housing and food insecurity, limited access to health insurance and high unemployment rates" -- which are exacerbated by racism, homophobia and stigma.

Challenges Ahead

King v. Burwell becomes the second challenge within three years to the landmark health care law. The first challenge in June 2012 resulted in a 5-4 ruling that upheld the constitutionality of the individual mandate. The ever-growing field of Republican presidential candidates -- there are at least 13 GOP candidates as of June 30 -- has vowed to overturn the legislation. But it will likely remain the law of the land through the near future, according to many analysts.

Insurance discrimination will continue to be a significant challenge that will impact people living with HIV/AIDS. Health insurance companies can no longer refuse to cover because of a pre-existing condition such as HIV. But many insurance companies are limiting access to HIV care and treatment. This includes disproportionately high copays for antiretroviral medications or incomplete coverage for antiretrovirals. Cigna signed a consent order with Florida regulators in November 2014 that agreed to make antiretrovirals more affordable.

Coventry Health Care has also been accused of "placing all of the HIV antiretrovirals on Tier 5 requiring a 40 percent coinsurance after a deductible (of at least $1,000)." That has been rectified as of June 1, according to Peller.

"We need the federal government to step up their implementation and enforce the nondiscrimination provisions to make sure that everyone is truly able to access the care they need," said Peller.

Rod McCullom has written and produced for ABC News and NBC, Scientific American, The Atlantic, The Nation, Ebony, Poz and many others. He will become a Knight Science Journalism Fellow at the Massachusetts Institute of Technology later this summer.

Copyright © 2015 Remedy Health Media, LLC. All rights reserved.

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This article was provided by TheBody.


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