AS New Year’s Eve celebrations wind down in the early morning hours of January 1, 2014, Americans will also be welcoming in a new national healthcare plan. The Affordable Care Act (ACA), otherwise known as Obamacare, will be fully implemented on January 1, 2014. The ACA is expected to have many unpredictable effects within the healthcare system, especially for those affected by hiv/aids. The ACA is also poised to impose new insurance criteria for those receiving treatments through the Ryan White Care Act (rwca).
The rwca, which was enacted in August of 1990, just four months after White’s death, was designed to improve the availability of hiv/aids care to low-income, uninsured, and underinsured individuals and families, as well as to provide support services and healthcare training to state agencies and medical providers throughout the U.S. It is estimated that the rwca supports some 2,500 medical providers and offers life-prolonging treatments to over 500,000 individuals each year. Only seventeen percent of people with hiv/aids currently have private health insurance, and thirty percent have no medical coverage at all. For many of them, the rwca has been the sole means of support for their medical, psychological, and psychosocial needs. However, with the passing of the ACA, these individuals will see potentially drastic and counterproductive changes in the means by which they receive treatment.
One of the most controversial components of the ACA is the state-optional expansion of Medicaid eligibility and coverage. Not only is the actual buy-in of Medicaid expansion up to each state’s discretion, the exact components of services provided under the expansion are up for grabs as well, making any sort of prediction of medical coverage effects nearly impossible. This expansion could potentially provide insurance coverage for some, but not all, services currently provided by the rwca. Since the latter is a “payer of last resort,” services not provided under Medicaid may still be available. But there is concern in the medical community that some individuals with hiv/aids will fall by the wayside in the transition and enrollment periods and will not have the ease of access that they once had.
Many with hiv/aids already encounter barriers to receiving treatment and find it difficult to navigate the systems of care that are available to them. These difficulties can be caused by lack of access to medical care, provider discrimination, stigma, and misinformation, all of which continue to surround the epidemic. A completely new system of eligibility, enrollment, and coverage with the ACA has the potential to trip up both patients and medical providers. As medication adherence is essential in hiv/aids treatment, every effort must be made to avoid lapses in coverage. To this end, providers and healthcare professionals will need to be well-versed and educated in the new enrollment policies and procedures well before 2014.
The good news is that the ACA is looking to the lessons learned in hiv/aids treatment and efforts pioneered by the rwca, including the models developed to continue funding of patient-centered medical homes and other facilities. These homes are particularly effective for those with hiv/aids and other co-occurring conditions such as heart disease, diabetes, and mental health disorders.
No matter how smooth the transition or how many hiv/aids patients will ultimately be treated under expanded Medicaid, there will certainly be a period of trial, error, and discouragement for some providers and patients trying to navigate the new systems and standards. Only time will tell the scope, size, and significance of these changes upon the rwca. As standards and coverage will vary from state to state, both medical providers and patients must take equal responsibility to educate themselves on the steps required to continue life prolonging treatments.
Anthony Armstrong is the development manager the Center For Drug-Free Living, an AIDS service organization in Florida.