Monday, December 16, 2013

Understanding HIV/AIDS Care and Treatment and Health Care Reform

By Bob Bongiovanni

Back in 2010 when the Affordable Care Act (ACA) was signed into law by the president, people started talking about whether this was “good” for people living with HIV or AIDS (PLWH/A). And the basic conclusion was, “yes, it will be good.”  Since 1990, many uninsured, low income PLWH/A have depended on the Ryan White Care Act to get access to HIV care and treatments because there were no other options.  In 2014, many more PLWH/A will have many more options, thanks to the Affordable Care Act.  For nearly four years, people have been working through all the details on the ACA and trying to maximize the benefits for PLWH/A.  And now it is all coming together.

Change is hard.  It is hard for us as individuals, and it is hard for big systems.  The Ryan White system is no exception.  As I have thought about this, and worked to bring about the ACA changes, what I have come to realize is this:

We have built our whole Ryan White system on a set of assumptions, and those assumptions now have to be challenged.

In the next three blog posts, I am going to talk about those assumptions and how they are changing.  The assumptions boil down to these three:

Assumption 1:  People disproportionately affected by HIV are also “shut out of” the mainstream health care system.

Assumption 2:  Most of the services needed by PLWH/A are not available from Medicaid, Medicare, or commercial health insurance.

Assumption 3: The Ryan White system will continue to operate “as-is” after health care reform is implemented.

Assumption 1

Before ACA, clearly many PLWH/A were shut out of health care.  After ACA is fully in place in 2014, pre-existing conditions like HIV can no longer be used to deny or hike up the costs of coverage there will be streamlined eligibility and enrollment processes. In states like Colorado, it was a safe bet that most PLWH/A coming into our clinics wouldn’t qualify for anything. Now, the opposite is true; most will qualify for Medicaid or some form of private insurance through the new health exchange.

Of course, the ACA is not the perfect solution for PLWH/A.  Some people – like the undocumented – will continue to be denied coverage. Even the streamlined processes are complicated. It’s not clear that there will be enough providers to serve the need, especially primary care providers willing and able to serve PLWH/A.

But even with these concerns, it is time to shake that assumption about PLWH/A being “shut out of” mainstream health care.  They will only continue to be shut out if we do not help them find the right doors and get inside.

Please visit our blog on Wednesday as I address the second assumption that must be challenged in the near future as we seek care and treatment for PLWH/A. Thank you for reading.


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