The most recent iteration of the American Health Care Act would be a disaster for people living with HIV, health care experts and AIDS non-profits warn. Not only would it axe funding for programs like the National HIV / AIDS Strategy and New York’s End the Epidemic Blueprint, but it would also fail those who rely on the government to subsidize their anti-retroviral medication.
“No matter which way you spin it, a repeal would be devastating,” Noël Gordon Jr., a senior program specialist for HIV prevention & health equity at the Human Rights Campaign, told TIME magazine. “It would not only halt the progress we’ve made, but it has the potential to turn the tide the other direction, where we could potentially see the spread of HIV.”
As a result of the Medicaid expansion under the ACA, coverage for HIV-positive people rose from 36 percent in 2012 to 42 percent in 2014. In Illinois, one in three people with HIV gained coverage through Medicaid expansion or the new individual insurance plans created under the ACA, according to an analysis compiled for Reuters by the AIDS Foundation of Chicago. The new bill would cut Medicaid by $800 billion over ten years.
While the Republican plan, like the ACA, mandates that insurers offer coverage to people no matter how sick they are, insurance companies would now be able to make such coverage prohibitively expensive. More than a quarter of adult Americans under 65 have a pre-existing condition, according to the Kaiser Family Foundation.
The bill would likely cause prices to skyrocket for Truveda, a pre-exposure prophylaxis that lowers the risk of contracting HIV. The ACA’s Medicaid expansion provided access to PrEP for low-income Americans in 31 states, plus the District of Columbia, but the per-capita grants that AHCA proposes would cut funding to these programs.
Before the Affordable Care Act, low-income people with HIV could only qualify under Medicaid when their HIV infection had advanced to the point where they were developing AIDS.
The problem with AHCA is that it provides states with a loophole, allowing them to let insurers charge higher premiums to sick people if they let their insurance lapse and if the state has set up a “high-risk pool” for sicker patients. Those with pre-existing conditions are the most likely to have gaps in their insurance, because if they become too sick, they may lose coverage through their employer.
Many believe these risk pools will be underfunded, even with the $8 billion added last-minute to the bill.
A repeal of the ACA would also affect HIV screenings, which were previously bundled into all plans offered through the marketplace. Under the AHCA, millions of people could be prevented from receiving the HIV tests critical to understanding their status.
And if even a small percentage of the people currently receiving subsidized antiretrovirals decides to stop taking them because of skyrocketing costs, HIV cases could go up.
“The evidence is iron-clad that when people with HIV are treated and their viral load is suppressed, their likelihood of transmitting HIV goes down to almost zero,” John Peller of the AIDS Foundation of Chicago, told Reuters. “So, any kind of interruption in care is going to result in more cases of HIV.”