January 15, 2015
When I smooched my honey at midnight on New Year's Eve, I made five wishes about health care reform for people either living with HIV or vulnerable to contracting the virus. Sure, wishing isn't going to make these Affordable Care Act (ACA) changes come to fruition -- but a heavy dose of advocacy will.
But before we get to the wishes, don't forget that open enrollment for marketplace insurance ends Sunday, Feb. 15. You can get financial help to make coverage more affordable, and there's in-person assistance to help you sign up. Just don't wait until the last minute!
Wish 1: The federal government defines health insurance discrimination. The ACA has strong protections against discrimination. However, the federal government hasn't yet indicated exactly which health insurance practices are discriminatory. Across the country, we are seeing plans put up barriers to enrollment for people with HIV and other chronic diseases, like making HIV medications for treatment and prevention as expensive as possible. Nothing says "don't pick this plan" like the sticker shock of $1,500 a month for medications. Sounds like discrimination against people with expensive health needs to me. If the federal government defined discrimination, we wouldn't have some of these access problems. I'm wishing for this to change in the first part of this year.
Wish 2: The Supreme Court upholds subsidies in federal health insurance marketplaces. The Supreme Court will hear the King v. Burwell case in early March, which challenges the subsidies for health insurance coverage allowed in states that use the federal health insurance marketplace.
I wish that the Supreme Court would uphold the current law and continue to allow the marketplaces to provide subsidies. If the Court rules otherwise, subsidies would end in 36 states and consumers would have to pay full price for coverage, including people with the lowest income levels who are least able to afford coverage but have the highest health care bills because of HIV or another chronic illness. This is one wish where advocacy won't help; it's up to the court.
Wish 3: The new Congress doesn't mess with health care reform. For the first time in eight years, both houses of Congress are controlled by Republicans, some of whom have zealously voted to repeal the ACA over and over. President Obama has pledged to veto any attempt to repeal the ACA, so major provisions of the law may be safe, but Republicans may try to block funding for implementation of the ACA. Making this wish come true will take more than wishing -- it will take good old-fashioned advocacy. Let's not leave anything to chance.
Wish 4: More states expand Medicaid, particularly in the South. The ACA allows states to expand Medicaid to cover low-income adults without children. This is probably the most important provision of the law for people with HIV, but 22 states have not implemented the expansion, although seven have serious discussions underway. In other words, leaders in these 22 states are ignoring the single most important way to improve health care access for people with HIV or vulnerable to HIV. Concerted advocacy is needed in those seven states -- and in the remaining 15 that are not considering implementing Medicaid expansion -- particularly since so many of those states are in the Deep South, where the unmet need for HIV care (and preventive measures like pre-exposure prophylaxis [PrEP]) is the greatest in the nation. Expanding Medicaid is another one that will take more advocacy than wishing, so we need to get to work.
Wish 5: The Ryan White HIV/AIDS Program stays strong. The Ryan White HIV/AIDS Program provides HIV care and supportive services to over half a million people each year. Changes for the program are likely as health care reform is fully implemented over the next few years, but by no means will Ryan White be any less vital. The Obama administration has strongly supported the program, and we need to make sure the Republican Congress does too. My wish for this year is that the program remains fully funded, which will only happen through strong advocacy.
So, those are my wishes for 2015. I have some other ones that involve ending homophobia, transphobia, HIV stigma and the war on drugs (and, oh, yeah, achieving world peace and winning the lottery) but that's for another time.
What can you do to help these wishes come true? Advocate!
John Peller serves as AIDS Foundation of Chicago's president and CEO. He started at AFC in 2005 as the organization's state lobbyist, and became vice president of policy in 2011. In that role, he led the www.HIVHealthReform.org partnership, which helps HIV organizations across the nation implement health care reform.
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