Specifics: Obamacare and HIV

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From Think Progress By Tara Culp-Ressler

new brief from the Kaiser Family Foundation reports that President Obama’s health care reform represents a significant step forward for Americans with HIV, helping to expand health insurance to many HIV-positive individuals who would be “otherwise unable to access affordable and stable health care coverage.” Representing hugely important tactics to continue addressing the HIV/AIDS epidemic, several of Obamacare’s provisions will have a directly positive impact on the estimated 1.1 million Americans who live with the HIV virus:

  • Obamacare will prevent insurance companies from denying HIV-positive Americans coverage simply based on their HIV status. The health care reform law prohibits insurance companies from discriminating based on pre-existing conditions, including HIV. Before Obamacare, Americans living with HIV often struggled to find insurance companies willing to take them on — according to the Kaiser Family Foundation, just 13 percent of HIV-positive individuals were covered under private insurance in 2010.
  • Obamacare’s expansion of the Medicaid program helps low-income Americans with HIV who otherwise wouldn’t qualify for coverage. Over 40 percent of HIV-positive Americans accessed their health insurance through the Medicaid program in 2010, and expanding Medicaid even further will extend additional coverage to this community. Furthermore, under Obamacare, HIV-positive individuals do not have to have to be diagnosed with AIDS as a precursor to qualifying for Medicaid coverage. Although this was an old eligibility requirement for the program, the health reform law ensures the states that accept Obamacare’s Medicaid expansion will not have to impose this restriction on Americans living with the HIV virus.
  • HIV-positive Americans will no longer reach limits on the amount of treatment their insurance companies are willing to cover. Obamacare eliminates lifetime coverage caps and phases out annual limits, which will help all Americans with chronic conditions — including the Americans who rely on treatment for HIV infections — continue to be able to afford the care they need without reaching an arbitrary cut-off set by their insurance companies.
  • HIV testing will likely be covered under Obamacare. This year, the U.S. Preventive Services Task Force is expected to recommend routine HIV screenings as a part of regular preventative care, similar to a routine blood pressure test. Since the health reform law requires insurers to cover the preventive services recommended by the Preventative Services Task Force, a new standard for HIV testing could ensure that it becomes a standard part of annual check-ups. The Centers for Disease Control estimates that about 20 percentof the total population of Americans who are infected with HIV don’t know they have the virus, so regular tests that don’t incur an out-of-pocket expense could help encourage more Americans to learn their status.
  • Since Obamacare helps close the prescription drug coverage gap for Medicare beneficiaries, HIV-positive individuals will be more likely to afford their drug treatments for the virus. By closing the “donut hole,” or the gap in coverage for expensive prescription drugs under the Medicare program, Obamacare will help ensure that older Americans living with HIV aren’t unable to afford any of the 26 antiretroviral drug treatments that can be used to combat HIV infections. Twelve percent of Americans with HIV relied on Medicare for their health coverage in 2010, and that number may rise significantly as the population of HIV-positive Americans continues to age.
  • Obamacare increases resources for HIV research and prevention. The health care reform law allocates $10 billion over ten years for a new fund that focuses on prevention, wellness, and public health activities. In 2010, $30 million from that fund was awarded to the Centers for Disease Control for HIV prevention activities, including new investments in HIV surveillance and testing among high-risk populations.

Medicaid Expansion Likely To Lower Deaths

Medicaid expansion under the Affordable Care Act is contentious- mostly because Republicans don’t want to give President Obama any credit- for anything. But if this study, reported today by the New York Times, is any indication, not going forward could be deadly.

Senate Passes Insurance Industry Aid Bill

Senate Passes Insurance Industry Aid Bill (Photo credit: Mike Licht, NotionsCapital.com)

Into the maelstrom of debate over whether Medicaid should cover more people comes a new study by Harvard researchers who found that when states expanded their Medicaid programs and gave more poor people health insurance, fewer people died.

The study, published online Wednesday in The New England Journal of Medicine, comes as states are deciding whether to expand Medicaid by 2014 under the Affordable Care Act, the Obama administration’s health care law. The Supreme Court ruling on the law last month effectively gave states the option of accepting or rejecting an expansion of Medicaid that had been expected to add 17 million people to the program’s rolls.

Seems fairly reasonable. So why would anyone reject the expansion?

Medicaid expansions are controversial, not just because they cost states money, but also because some critics, primarily conservatives, contend the program does not improve the health of recipients and may even be associated with worse health. Attempts to research that issue have encountered the vexing problem of how to compare people who sign up for Medicaid with those who are eligible but remain uninsured. People who choose to enroll may be sicker, or they may be healthier and simply be more motivated to see doctors.

The New England Journal study reflects a recent effort by researchers to get around that problem and allow policy makers to make “evidence-based decisions,” said Katherine Baicker, an investigator on the study who served on former President George W. Bush’s Council of Economic Advisers.

“I think it’s a very significant study in part because of the paucity of studies that have really looked at health outcomes of insurance coverage,” said Karen Davis, the president of the Commonwealth Fund, a nonpartisan research foundation. “Actual mortality studies are few and far between. This is a well-done study: timely, adds to the evidence base, and certainly should raise concern about the failure to expand Medicaid coverage to people most at risk of not getting the care that they need.”

A Republican-appointed official calling this “evidence based”- will it be enough? Probably not. But the evidence is still there:

“So often you hear, ‘Oh well, poor people just shoot each other, and that’s why they have higher mortality rates,’ ” said Diane Rowland, executive vice president of the Kaiser Family Foundation, a nonprofit group. “In the midst of many claims about what Medicaid does and doesn’t do, it actually shows that it cannot only be beneficial for health, but in preventing some of the premature deaths of the uninsured.”

Janet M. Currie, director of the Center for Health and Well-Being at Princeton, said the new study, combined with the Oregon research, should help transform the Medicaid debate into one about dollars, rather than over whether covering poor people improves health.

“This says, well there is benefit to giving people insurance,” Dr. Currie said. “Maybe you don’t want to pay the cost, but you can’t say there’s no benefit.”