Do We Still Need the Ryan White HIV/AIDS Program, Now That We Have the Affordable Care Act?

The Ryan White HIV/AIDS Program will continue to play a central role in the national response to HIV, because more and more Americans will become eligible for health insurance under the Patient Protection and Affordable Care Act (ACA), according to Jeffrey Crowley of Georgetown University.

Speaking in a National Center for Innovation in HIV Care (NCIHC) webinar, Crowley, a distinguished scholar and program director of the National HIV/AIDS Initiative at the O'Neill Institute for National and Global Health Law, emphasized the ongoing utility of the program, and identified a range of issues and questions for policy makers to consider in the coming years.

"The Ryan White Program is likely to remain critically important to the HIV response for the foreseeable future," he said during the "The Ryan White Program: What Do We Know and What Don’t We Know?" webinar. "The ACA was not designed to supplant the core functions of Ryan White.

"That said, however, the context in which the Ryan White Program operates is changing, and this creates new opportunities.

"I think we, as an HIV community, need to do work to help policy makers understand the ongoing need for the program to work alongside the Affordable Care Act and other health coverage."

Looking at client data from 2010, Crowley noted only 30% of Ryan White clients were uninsured, while others had some form of health insurance coverage.

So why where they accessing the Ryan White Program?

"They needed the Ryan White Program because insurance -- whether it was Medicaid, Medicare or private insurance -- wasn’t set up to meet all their needs, so they’re turning to Ryan White to supplement this coverage," Crowley said, adding that these gaps in coverage still exist under the ACA. "And as we get more people insurance, there are more people who could be turning to the [Ryan White] Program for supplemental assistance."

The Ryan White HIV/AIDS Program provides critical support to people living with HIV, through services such as HIV testing, outreach to engage people in care, health insurance premium and cost sharing assistance, and non-medical case management, Crowley said.

"These are services that often our insurance system has done less with or has been less willing to cover, but Ryan White covers," he said, "and these things are critical to keeping people engaged in care."

Looking to the future, Crowley suggested policy makers consider how the Ryan White Program can best support people living with HIV at each stage of the treatment cascade -- from diagnosis to viral suppression, build HIV care networks in underserved communities, integrate HIV care expertise into the mainstream health care system, and effectively and fairly allocate Ryan White Program resources.

"Some people may ask us if we still need the Ryan White Program after the ACA has expanded insurance coverage," Crowley said. "That’s a reasonable question, but we also need to unequivocally and convincingly answer 'yes.'

"We’re doing the hard work of changing the program to be nationally effective in this new environment," he added. "So for the future, from my perspective, the Ryan White HIV/AIDS Program is essential to helping us move closer to ending the HIV epidemic in the United States."

The NCIHC will hold a series of webinars for Ryan White-funded AIDS service organizations and community-based organizations over the coming months.

Further information about NCIHC services, including upcoming webinars, is available from its website.

Katherine Moriarty is a consultant and freelance writer, based in Vancouver. She has 10 years of experience in the intersecting fields of public health and community development, with a focus on bloodborne virus policy and programming.