The passage of the Affordable Care Act (ACA), also known as ObamaCare, brought significant changes to the health care industry. While there was — and is — much controversy about the law, many of the changes ObamaCare brought were favorable to Americans dealing with chronic illnesses, such as HIV/AIDS.
Those with HIV/AIDS have struggled for decades to receive appropriate care. In addition to living with a disease that is universally feared and almost as universally misunderstood, these Americans also lived with fear of being isolated from others due to a lack of information surrounding their health condition. Fortunately, extensive public education has allayed some of the fear surrounding HIV/AIDS, but health care remained expensive and sometimes unattainable for those with the disease.
HIV/AIDS Treatment Before the ACA
Before the Affordable Care Act, an HIV or AIDS diagnosis was considered a pre-existing condition when applying for health insurance. This meant that, unless a person had existing insurance coverage in place at the time of diagnosis, health insurance was difficult to obtain. Because the treatments and medications for HIV/AIDS are expensive, this left many suffering Americans in a terrible situation – sell everything for treatment, or give up treatment and suffer painful and life-threatening complications.
Many of those struggling with HIV or AIDS fell into a lower-earning group and some did not have insurance through their place of employment. Because of this, they either had no coverage at all or they had to rely on assistance from programs like Medicaid or the Ryan White HIV/AIDS Program. Even for those with coverage, yearly and lifetime benefit limits often restricted the amount of needed care that they could receive. As a result, almost two-thirds of Americans living with HIV or AIDS did not have regular care.
The ACA’s Effect on HIV and AIDS Care
There are many provisions of the ACA that are important to Americans living with HIV or AIDS, but two of the most impactful are the expansion of Medicaid and the creation of the health insurance Marketplace. Although not all states have chosen to expand Medicaid, many states have broadened the program’s eligibility requirements, allowing millions of lower-income Americans access to health coverage. This will allow many of those living with HIV or AIDS who have been unable to receive treatment in the past to be able to obtain care and stabilize their condition.
The creation of the health insurance Marketplace allows Americans greater access to private insurance. To make this coverage more attainable, financial assistance is available for Americans earning between 100% – 400% of the federal poverty level, with special assistance for those earning between 100% – 250% of the federal poverty level. This puts private health insurance within reach for millions of uninsured Americans, including those who live with HIV or AIDS.
Another key provision of the ACA that helps those with HIV/AIDS is the requirement that companies provide coverage to Americans with pre-existing conditions. Health insurance companies can no longer exclude coverage for HIV/AIDS from their insurance plans just because an individual suffered from the disease before purchasing a policy. Health insurers may no longer deny coverage to anyone, and must provide insurance to anyone who applies and pays their premiums. This is known as “guaranteed issue” and, under the ACA, was another boon to Americans with chronic diseases like HIV/AIDS.
ObamaCare also limits the factors that health insurance companies may use to vary premiums. As a result, having a chronic illness is no longer a rating factor. The fact that an individual may need significant health care is no longer an allowable reason for the company to charge extra for coverage. This brings health insurance within reach for the first time for many Americans living with HIV/AIDS.
Finally, the ACA doesn’t allow insurance companies to put yearly or lifetime limits on the dollar value of benefits, meaning that those Americans who need extensive care will be able to receive the help they need every year throughout their illness. This is a great relief to those with HIV/AIDS, especially since the therapies can be costly and limits were often quickly exceeded.
Americans with HIV/AIDS have much to gain as the implementation of the ACA continues. Many states have expanded Medicaid and now offer coverage to previously ineligible lower-income citizens. The Marketplace gives new access to private health insurance plans. Health insurance companies can’t refuse to cover a pre-existing condition, can’t charge people extra for being sick, and can’t cap yearly or lifetime benefits. For a long time, Americans facing HIV/AIDS have needed help getting the required care and treatment to help stabilize their condition. That help is now available as a result of the ACA.