March 6, Republican members of the House of Representatives released proposed legislation to repeal key provisions of the Affordable Care Act (ACA) which would significantly limit access to private insurance and Medicaid for those who need it most. The American Health Care Act would substantially decrease coverage options and increase insurance costs for people living with HIV and decrease STD screening and treatment through reduced insurance access. The plan also reduces federal Medicaid contributions through a per capita cap, which could cause states to make cuts to eligibility, benefits, and important consumer protections and would mean going back to cruel pre-ACA rules where a person must wait to be disabled by HIV in order to be eligible for Medicaid. The legislation also cuts funding for vital services for women’s health and eliminates the Prevention and Public Health Fund, which funds 12% of the Centers for Disease Control and Prevention’s budget.
AIDS United (AU), NASTAD, the National Coalition of STD Directors (NCSD), NMAC, and The AIDS Institute (TAI) believe the American Health Care Act would sharply reverse progress that has been made over the years in reducing new HIV infections and providing access to affordable, high-quality, and life-saving care and treatment for people living with HIV. We strongly urge Congress and the Administration to preserve crucial aspects of the existing Affordable Care Act and Medicaid to continue the progress we have made on HIV and STD prevention, treatment, care, and support and make changes where improvements need to be made. Key elements should include:
- Maintain the current Medicaid funding structure, including expansion of the program, to allow states to respond to current need and increased demand for Medicaid coverage during tough economic times, unanticipated outbreaks or disasters and when there are health innovations, such as the recent curative breakthrough treatments for hepatitis C. This bill eliminates Medicaid expansion in 2020 and drastically changes the funding mechanism for the overall Medicaid program to a per capita calculation, rather than reflecting the actual costs of the Medicaid population.
- Ensure access to an affordable minimum essential benefits package that includes the range of services and treatments that people at risk for and those living with HIV and STDs need to stay healthy, including prescription drug benefits, substance use and mental health treatment, and preventive services without cost-sharing. Though the proposed bill preserves most of the Essential Health Benefits requirements, we are concerned that Congress and the Administration continue to uphold these important protections.
- Keep health care affordable and accessible by maintaining non-discrimination protections and ensuring adequate, up front premium and cost sharing assistance for low income individuals. This includes maintaining the bans on annual and lifetime benefits caps to ensure access to care and coverage when it is needed most. This legislation eliminates actuarial value requirements for health plans and reduces the amount of premium support low-income people will receive, which will disproportionately impact individuals living with chronic conditions.
- Maintain funding for the Prevention and Public Health Fund and Centers for Disease Control and Prevention to ensure that the end of HIV remains a winnable battle within our lifetime. With additional effort and support for evidence-based, cost-effective strategies that we can implement now and a robust healthcare infrastructure throughout our nation, we will have a significant impact on our nation’s health.
“We believe that the proposed legislation would make it much harder, if not impossible, for people living with HIV and other chronic conditions to get the coverage needed to meet their care and treatment needs,” noted NASTAD Executive Director Murray Penner who has been living with HIV since 1986. “We need a system of health coverage that works for everyone, including people with chronic conditions and disabilities and the proposed legislation achieves the exact opposite.”
“We believe there are ways to enhance and stabilize the healthcare system that will not place the burden on individuals most vulnerable, as this bill does. With its emphasis on preventive services, ensuring access to community providers, and assistance for individuals living in poverty, including those newly eligible for expanded Medicaid, the ACA’s provisions are proven as critical for reducing new HIV and STD infections and assisting those living with these conditions to continue living long, productive lives,” commented Jesse Milan, Jr., President & CEO of AIDS United who has been a person living with HIV for over three decades. “Any changes to the health system should keep these fundamentals in place.”
