Many people in the United States who are living with HIV rely on some form of federal assistance, whether it's Medicaid or Medicare, Housing Opportunities for People With AIDS (HOPWA), the AIDS Drug Assistance Program (ADAP) and other components of the Ryan White AIDS Program, or insurance through the Affordable Care Act (ACA). When Republicans take control of both halves of the U.S. Congress in 2015, what might this mean for HIV treatment access? TheBody.com spoke to Brandon Macsata, a Washington insider who is a Republican with HIV, to get his thoughts on the 114th Congress.
"In terms of Ryan White and HOPWA, I don't think there's any real threat to the funding. Those two programs specifically still enjoy broad bipartisan support," predicts Macsata, who is CEO of the ADAP Advocacy Association (aaa+) and managing partner of The Macsata-Kornegay Group, Inc., a national political consulting firm specializing in grassroots campaigns, social media messaging and fundraising.
He's not so optimistic about other ways in which the care of people with HIV will be affected, explaining that "when you get into the more contentious issues of the Affordable Care Act [ACA], specifically the subsidies and Medicaid expansion, I think it's anyone's guess as to what's going to happen."
In addition to funding issues, Macsata points out that it can be difficult to find providers who accept Medicaid and Medicare patients, a problem rarely discussed in the debate over the ACA's Medicaid expansion.
"All you need to do is look at the reports that Medicare and Medicaid each have to do every year to see that the number of doctors are getting fewer and fewer because the Medicaid reimbursement is so ridiculous and the paperwork that comes along with it -- why bother?" he says. "Until we address that, it's one of those pie-in-the-sky pipe dreams that Obamacare is going to fix this."
Macsata also expects to see more people looking to ADAPs for their medications because of the ACA policies pricing HIV drugs on the top tier or instituting high copays. "It's not only people who are uninsured, but it's happening to people who have insurance and still can't afford it."
Regarding the incoming freshman class, Macsata believes that without "antagonistic" legislators (like Minnesota's Michele Bachmann), House Speaker John Boehner and Senate Majority Leader Mitch McConnell will have more flexibility to strike deals and get things done, which they were both known for before the tea party wave in 2010. "If you look at the caliber of the Republicans who won, they're not the Christine O'Donnells or the Ken Bucks," Macsata says. "They're more old school. Overall, the level of Republican extremists has dwindled."
HIV antiretroviral access has long been a bipartisan issue. Macsata explains that forging alliances across party lines is not just important, but necessary: "You put your personal shit aside and get the job done!"
Sue Saltmarsh has worked in the HIV/AIDS field for over 20 years, the first 10 as an herbalist and energy therapist at Project Vida, the last six as a writer and copy editor for Positively Aware magazine. She is now a freelance writer and editor and is also able to devote more time to her passion as founder and director of the Drive for Universal Healthcare (DUH).