{"id":984,"date":"2014-03-05T16:51:26","date_gmt":"2014-03-05T16:51:26","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=984"},"modified":"2014-03-05T16:51:26","modified_gmt":"2014-03-05T16:51:26","slug":"hiv-impact-of-obamacare-reduced-by-us-supreme-court-decision","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2014\/03\/05\/hiv-impact-of-obamacare-reduced-by-us-supreme-court-decision\/","title":{"rendered":"HIV impact of ObamaCare reduced by US Supreme Court decision"},"content":{"rendered":"

What impact will the roll-out of the US Affordable Care Act (ACA) – ObamaCare – have on health insurance coverage of people with HIV?\u00a0 A recently published \u201cissue brief\u201d on behalf of the US Centers for Disease Control and Prevention (CDC) offers a first estimate (Kates & Garfield<\/a> (K&G)).<\/p>\n

The ACA includes a provision to expand Medicaid 1. by extending it to non-disabled childless adults (a group at present excluded), and 2. by raising the threshold of eligibility from the present 100% of the Federal Poverty Level (FPL) to 138%.\u00a0 This would have considerable impact on uninsured HIV infected-people, as a large proportion of them are non-disabled childless adults, and relatively poor.\u00a0 Thanks to a recent Supreme Court decision, responsibility for the implementation of this ACA provision rests ultimately with state legislatures.\u00a0 Thus far, only 26 of the 51 states have plans to go ahead with it.\u00a0 The authors of the brief give estimates, firstly for the impact that the ACA would have had but for the Supreme Court ruling, and, secondly, for the impact it will have, assuming implementation by just the 26 states that of stated their intention to go ahead with it.<\/p>\n

In the case of full implementation of Medicaid expansion, say K&G, c.47,000<\/b> of the c.70,000<\/b> uninsured adults retained in HIV care would immediately be brought under Medicaid, while a further c.20,000<\/b> could benefit from the second major ACA provision relevant to the HIV-infected – namely, the subsidized insurance coverage which will be supplied by Health Insurance Marketplaces (HIM).<\/p>\n

But, with just 26 states planning to expand Medicaid provision, only c.26,500<\/b> additional people will be brought under Medicaid.\u00a0 Of the c.20,000 who ought to have qualified, but will now fail to do so, some 5,000<\/b> may be able to gain subsidized cover with HIM (those at between 100% and 138% of FPL), while the remaining c.15,000<\/b> (those under the 100% bar for subsidized coverage by HIM) will remain entirely uninsured.\u00a0 Many people in this situation will seek coverage under the Ryan White HIV\/AIDS program, as they have done in the past.<\/p>\n

So the beneficiaries of ACA among the HIV-infected will, according to this brief, be considerably reduced by the Supreme Court ruling.\u00a0 But does it really matter whether the HIV-infected of the US are treated through an expansion of Medicaid, or through the Ryan White program?<\/p>\n

The authors of the brief seem to be in no doubt that ACA would represent an improvement on the present arrangements – and principally for two reasons.\u00a0 The first has to do the 700,000 HIV-infected (63%) who are undiagnosed, or not linked to – or else not retained in – HIV care.\u00a0 A proportion of these (the authors reckon as many as 124,000), newly eligible for Medicaid under ACA, could have been brought into regular medical care through the program.\u00a0 This is the first opportunity missed.\u00a0 The second has to do with the possibility of addressing the unmet needs of a particularly needy population (i.e. the c.200,000 HIV-infected who are currently uninsured but eligible for cover under ACA) on a more general and ongoing basis than is possible through the Ryan White program.\u00a0 These, according to K&G, are the benefits which will be largely foregone in states that do not to ratify the expansion of Medicaid.<\/p>\n","protected":false},"excerpt":{"rendered":"

What impact will the roll-out of the US Affordable Care Act (ACA) – ObamaCare – have on health insurance coverage of people with HIV?\u00a0 A recently published \u201cissue brief\u201d on behalf of the US Centers for Disease Control and Prevention (CDC) offers a first estimate (Kates & Garfield (K&G)). The ACA includes a provision to […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2042,1613,2793],"tags":[],"class_list":["post-984","post","type-post","status-publish","format-standard","hentry","category-hiv-care","category-sexual-health-services","category-social-inequality"],"yoast_head":"\nHIV impact of ObamaCare reduced by US Supreme Court decision - Sexually Transmitted Infections<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/sti\/2014\/03\/05\/hiv-impact-of-obamacare-reduced-by-us-supreme-court-decision\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"HIV impact of ObamaCare reduced by US Supreme Court decision - Sexually Transmitted Infections\" \/>\n<meta property=\"og:description\" content=\"What impact will the roll-out of the US Affordable Care Act (ACA) – ObamaCare – have on health insurance coverage of people with HIV?\u00a0 A recently published \u201cissue brief\u201d on behalf of the US Centers for Disease Control and Prevention (CDC) offers a first estimate (Kates & Garfield (K&G)). 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