The 2013 U.S. Conference on AIDS (USCA) came to a close yesterday with a plenary session on the implementation of the Affordable Care Act, a much discussed topic throughout the four-day conference. Among the observations shared by a diverse panel were:
The healthcare law extends important civil rights protections that can be helpful in addressing the continuing stigma and denials of care in health settings experienced by some people living with HIV (PLWH) across the nation, noted Deborah Reid, JD, Senior Attorney, National Health Law Program (NHeLP). Ms. Reid highlighted that Section 1557 of the law prohibits discrimination on the ground of race, color, national origin, sex (including gender identity and stereotype), age, and disability to any health program/activity receiving federal financial assistance. This includes, she noted, Medicaid, the newly created Health Insurance Marketplaces, and many other federally–supported programs.
PLWH have a vital role to play in ensuring that the potential of the Affordable Care Act is realized for all PLWH, suggested Moisés Agosto, Director of Treatment Education, Adherence and Mobilization at the National Minority AIDS Council (NMAC), which hosted the conference. First, Mr. Agosto observed, PLWH who attended the conference and who are knowledgeable about the new health care law have an important role in informing and engaging other PLWH about the opportunities for access to better health coverage that will soon be available. In addition, he encouraged PLWH to not just help their peers get connected to coverage, but also linked to care, and then supported in ongoing care.
The Affordable Care Act will improve health care opportunities for millions of lesbian, gay, bisexual and transgender (LGBT) Americans, according to Dr. Matt Heinz, from the Office of the Secretary of Health and Human Services. He highlighted, in particular, the importance of the health care law for low-income LGBT individuals, particularly since more than 34 percent of them currently lack health coverage. Concerned that too few of them still know little about the Act and what will be soon be available to them, Dr. Heinz urged the participants to help educate members of the LGBT community about both the availability of coverage through the Marketplace as well as the provisions of the healthcare law that prohibit discrimination against LGBT populations and to engage in efforts to connect uninsured members of the community to coverage in the coming months.
The unfolding changes are transformative for HIV prevention, care, and treatment. Amidst the significant changes unfolding—and, sometimes, associated uncertainty—as we prepare for the Marketplaces to open in less than three weeks, Amy Killelea, JD, Associate Director, Health Care Access, National Alliance of State and Territorial AIDS Directors (NASTAD), suggested it was imperative to bear in mind the bigger picture: that this is an historic moment that will usher in a massive and important transformation for HIV prevention, care, and treatment in the United States. The expanded coverage that will soon be available to many PLWH and persons at risk for HIV coupled with the Ryan White HIV/AIDS Program and other elements of the public health infrastructure will help us make great strides in getting people tested, linked to, and supported and retained in life-extending care.
Affirming the presenters’ observations about the many benefits being brought about by the Affordable Care Act and the importance of working across the HIV/AIDS community in the coming months to ensure that as many people living with and at risk for HIV are enrolled in the new coverage opportunities, a conference participant offered an important closing thought. She reminded the panel and the audience not lose sight of the longer term view: that enrollment isn’t the endgame since jurisdictions with already high rates of health care coverage have taught us that having access to health care alone isn’t sufficient. Thoughtful work needs to be done, she cautioned, to ensure those gaining access to coverage are connected with providers and that those providers and their systems are competent and prepared to serve the HIV, hepatitis C, and other healthcare needs of these populations.