I came across this topic by chance, again trying my luck at online dating platforms. A bit of research revealed that the web-fueled dating niche has become rather organized and surprisingly socially-conscious. I was surprised to come across forums like PositiveSingles.com -a place where people diagnosed with STDs or HIV infections are encouraged to interact with like-minded folks. A bit more browsing revealed that not only does the stigma of these diseases persists among regular dating sites, even the government seems not-too-enthusiastic about helping HIV or AIDS survivors. I am going to dwell on the American government’s Affordable Care Act and how it tries to ensure better healthcare for people with HIV.
The General Scenario
The contemporary health insurance system is rather challenging for people with HIV. It is estimated that only 17% or one in five people living with HIV has access to private insurance and more than 30% don’t have any kind of coverage. Yes, people with HIV do have insurance options. This includes public health programs like Medicare, Medicaid and the Ryan White HIV/AIDS Program.
They can also find coverage in the individual market or through employer-sponsored group health plans. However, most HIV patients find little or very expensive health insurance and face a very high denial rate. To address this issue, the Affordable Care Act introduced many reforms, some specific to HIV and some that are transforming the entire healthcare landscape along with bringing more benefits to those with HIV. To understand how ACA affects people with HIV, it is better to start by understanding what existed in pre-ACA era.
What prevailed before ACA?
Some health insurance conventions are challenged in the niche of HIV coverage. For instance, ESI or employer-sponsored coverage is the primary form of health insurance across the nation but this is not the case for people with HIV. Traditionally, Medicaid has been the principal provider of health insurance for low- and middle-income Americans who are HIV positive, followed by Medicare. A significant number of HIV patients are dependent upon Ryan White-often the last resort for HIV patients who often find themselves underinsured or uninsured.
Medicaid too has proven difficult for people with HIV. Despite Medicaid covering medications that prevent the progress of HIV and manage HIV-induced disabilities, many people cannot qualify for Medicaid coverage. Many people don’t meet the income criteria defined by their respective states for Medicaid eligibility. HIV people often exceeded the income level that is critical for getting Medicaid.
Further, they aren’t able to pay the extremely high premiums demanded in the individual market. The federal law excludes all adults from Medicaid who aren’t disabled and without dependent children. This continues to be a standard across most states.
Medicare presents an age-related limitation and for those under 65 years of age and HIV positive, permanently disability needs to be proven. Many HIV positive people cannot get Medicaid despite having HIV-induced disabilities that aren’t permanent in nature. Without Medicare or Medicaid, an HIV person’s options include either buying coverage from the individual market at exaggerated premiums or rely on the Ryan White program.
Prior to ACA, buying health insurance from the individual market was very difficult for HIV positive people as they were considered high-risk individuals, often regarded as “uninsurable” by the payers. HIV was commonly interpreted as a pre-existing condition by insurers and thus, people with HIV were commonly refused coverage.
Transition towards better coverage with ACA
With the onset of ACA reforms, uninsured HIV patients are finding a wider range of coverage options. The ACA started expanding the realm of coverage for HIV positive people in 2010.A temporary program called the Pre-Existing Condition Insurance Plan was started in the private insurance market.
This was done in every state and allowed people with pre-existing medical conditions to purchase affordable coverage in the form of a PCIP Plan. The PCIP is still active and offers insurance to those who have been denied coverage because of a pre-existing condition or have been uninsured for six months or more.
With the ACA removing lifetime dollar limits, people with expensive illnesses like HIV can no longer be eliminated from their health plan or exempted from comprehensive benefits. Children up to the age of 26 years now have a no-limits dependent coverage from the group or individual plans of their family members.
This has increased access to typical HIV care requirements like Antiretroviral Treatment (ART). This treatment is vital for public health benefits too since it can reduce the chances of HIV transmission. Free preventative care introduced as a part of ACA also includes HIV screening tests that are considered imperative for early detection and prevention of HIV. These can be availed by people of all ages without any out-of-pocket expenses.
ACA Helps Overcoming Medicaid and Medicare Limitations
The ACA has also helped HIV people overcome some limitations of Medicaid. For instance, a new state-level Medicaid option has been created where childless adults having household income up to 138% of the Federal Poverty Level are now covered. The Affordable Care Act has been instrumental in eliminating the drawbacks that crept into the Donut Hole of Medicare Part D prescription drug benefit.
The out-of-pocket expenses for such HIV patients have been reduced with ADAP or the AIDS Drug Assistance Program that further discounts drug purchases. Medicare’s HIV beneficiaries receive discounts up to 50% on branded drugs, which is of great significance considering the high price of most HIV/AIDS drugs.
Better, Coordinated Care for HIV Patients
ACA seeks to overhaul the HIV care system with the creation of more medical facilities dedicated for integrated or coordinated HIV care. These patient-focused medical homes will ensure better quality of care for people with complex HIV symptoms and disabilities. More efforts are being directed towards better community and research activities for the prevention of HIV. For instance, the Prevention and Public Health Fund has been allocated more than $30 million.
Reforms Beyond Medical Services
Nearly 50,000 new HIV infections are still reported every year-a major deterrent in checking the spread of HIV is the lack of awareness. ACA seeks to break through the severe gender and racial disparities associated with the menace of HIV. Thus, various initiatives have been adopted that will provide health care providers the cultural competency required to treat and educate regional populations effectively. ACA has increased the funding for community healthcare centers, emphasizing on the recruitment of more healthcare workforce for taking care of low-income minorities and ethnic populations.
The National Health Service Corps is offering scholarships and liberal loans to healthcare providers, nurses and other healthcare professionals to help them understand the dynamics of better, coordinated care.
The Future Seems Promising
ACA has contributed significantly towards improving the quality of care for people with HIV and more benefits are expected to surface in 2014 when State Exchanges start offering enrollment. This would include coverage for preventive services, prescription drugs and chronic disease management. Gradually, denials based upon pre-existing conditions are being eradicated and in 2014, people with HIV can expect more options for comprehensive coverage in the individual and small-group markets.
I would also like to add that apart from the achievements and shortcomings of the American government, people in general need to enlighten themselves about how those diagnosed with STDs or HIV are still human and need affection. I guess insufficient, and somewhat wrong, information drives the general bias. To read more on how STDs get transmitted, prevention strategies, research updates, and answers to common questions, try PositiveSingles.com . People with Syphilis, Herpes, or HPV don’t need our sympathy-a well -informed perception and reason-driven behavior is the bigger demand.