Donald Trump and the Republican Party assumed power of the United States executive and congressional branches in January, promising to "repeal" the Affordable Care Act (ACA), aka Obamacare -- though "repeal" quickly morphed into "reform" as they began the actual process of seeking to undo a program that has delivered health insurance and care to about 20 million people.
On March 6, House Republicans released the American Health Care Act (AHCA) to show how they propose to fulfill this promise. Major groups such as the American Medical Association (AMA) and the American Association of Retired People (AARP) are not loving it, to say the least.
And the reviews from the HIV community? Well, yeah, also not good.
Hack Job, Says AIDS United
"AIDS United Opposes the American Health Care Act," reads the headline of the press release from the nation's central HIV policy, capacity-building and grant-making group.
"This is the biggest attack to health care system as we know it and the stakes are critical," says the organization's vice president of policy and advocacy Ronald Johnson in the release. "Millions of people gained access to [health] care through the Affordable Care Act, many for first time, and these gains are at risk. This isn't an improvement to the Affordable Care Act, it is a hack job that puts tax cuts for wealthy people above the health needs of people."
The press release explains:
The replacement of premium subsidies with refundable tax credits will hurt the ability of low income people, including people living with HIV, to afford up-front payment of health plan premiums. Under this system thousands of people will lose coverage.
These people will then be subject to a 30 percent penalty in their future cost of coverage because of continuous coverage requirements. These same requirements will hurt people who lose their jobs and will also make it more difficult for people to change jobs or move across the country.
The bill also places a higher cost burden on older Americans by allowing higher premium as people age. This will result in much higher costs and lower access to care for lower income people.
Finally, the bill effectively repeals Medicaid expansion in under three years at the end of 2019. Such a repeal will result in a loss of health coverage for millions of Americans, including people living with HIV and other chronic conditions.
Shutting the Door on HIV Coverage, Says the HIV Medical Association
The HIV Medicine Association (HIVMA), which represents more than 5,000 health care professionals, expresses deep concern about how the bill would affect the 1.2 million people living with HIV in the country. In its statement, chair Wendy Armstrong, M.D., FIDSA, explains:
The private insurance market elements, such as the requirement for continuous coverage and the insufficient tax credits for lower income individuals, will likely shut the door on coverage in the individual insurance market for most people with HIV. Forty percent of individuals with HIV in care rely on the Medicaid program for their healthcare coverage.
The House proposal to fund Medicaid based on a per capita cap will shift costs to the states and threaten access to healthcare services and treatment for the hundreds of thousands of individuals with HIV who are covered by the program.
HIVMA urges the House committees not only to reconsider the bill's contents but also to consider the "accelerated and non-transparent process with which these proposals have been advanced."
Reducing Care to the Most Vulnerable, Says the American Academy of HIV Medicine
The American Academy of HIV Medicine, a professional organization that supports HIV practitioners in the United States, says that the AHCA would "ultimately reduce access to health care for the most vulnerable populations."
"The population of older HIV patients is growing rapidly in this country and they should be protected from additional costs," emphasizes Margaret Hoffman-Terry, M.D., FACP, AAHIVS, chair of the AAHIVM Board of Directors, in reference to the AHCA proposal allowing insurers to charge significantly higher rates as people age.
In addition, AAHIVM urges the House to keep the ACA provision forbidding insurers to reject people with pre-existing conditions such as HIV:
"For too many years, people living with HIV were denied access to insurance until it was made available through the ACA," says James Friedman, the organization's executive director. "We are pleased to see this benefit retained in the new plan. However, we cannot support a proposal that would reduce overall access to medical care and medical treatment for patients with long-term life-threatening medical conditions."
Trumpcare Could "Make HIV AIDS Again," Says Community Advocate
Community educator and advocate Raul Robles, who leads a Spanish-language HIV long-term survivors' support group in San Diego, started circulating a graphic on Facebook as the AHCA emerged from Congress, reading "Trumpcare: Make HIV AIDS Again."
Robles' slogan reflects the widespread concern in the HIV community that the AHCA could inhibit or roll back progress made in expanding access to HIV care and treatment, leaving people with HIV vulnerable to risk of illness, worsening health, loss of life or an AIDS diagnosis.
"People living with HIV, hepatitis, and other chronic and serious conditions cannot afford to go backwards by eliminating or destabilizing the health care that the ACA provides," insists the AIDS Institute in a letter to members of the House committees considering the bill, in which it urges them to vote "no" on the measure.
"If advanced, the ACA replacement bill stands to threaten our progress in diagnosing and treating patients with HIV and increase healthcare disparities both between states and based on socioeconomic status. These proposals will not only harm individuals with HIV but will compromise our nation's public health by leaving fewer with access to the antiretroviral treatment that keeps patients healthy and reduces their risk of transmitting HIV to near zero," notes HIVMA in its statement.
A Call for Action
"The serious changes contemplated by this Act will directly undermine the goals of providing treatment and care for people living with HIV as well as the goal of ending the epidemic," AIDS United writes in its statement, adding a call to action for advocates to contact the House Ways and Means Committee and House Energy and Commerce Committee.
Here's how to do it, says AIDS United:
To reach the House Ways and Means Committee please call (202) 225-3625. The Members of the House Ways and Means Committee here. To reach the House Energy and Commerce Committee please call (202) 225-2927. The Members of the House Energy and Commerce Committee here. You can find out who your Member of Congress is here.
JD Davids is the managing editor for TheBody.com and TheBodyPRO.com.