Despite having a heated national debate for the past two years about its merits and constitutionality, many people—including healthcare and social workers—don’t really understand what The Obama Administration’s healthcare reform will affect. This is to be expected with a document that’s about 1,000 pages long and is scheduled to be implemented over the course of 10 years. What I’m aiming to do is to put the Affordable Care Act into comprehensible chunks that can be understood by anyone who is both literate and able to spare around 5-10 minutes.

• The main ideological principle behind the Affordable Care Act: all Americans should be able to purchase health care and should be insured. This does not mean that everyone will be insured. An estimated 27 million Americans will remain uninsured–a big drop from the current uninsured population of 60 million, but hardly a panacea for our health system.
  
• Most of the controversy surrounding the Affordable Care Act is about the “individual mandate”, which requires all US citizens to have health insurance or face a tax penalty. However, if you make less than $9,500 a year (individual)/$19,000 (couples), you are exempt from the requirement.
  
• The ACA does a few crucial things for People Living With HIV (PLWH), the first of which is that, as of 1/1/14, the disability requirement for Medicaid will be eliminated and the income requirement will be raised from 100% of the Federal Poverty Level ($11,170) to 133% of the FPL ($15,130).
• To reiterate, every single American who has an income of less than $11,170 per year will be eligible for Medicaid in 2014. With 24% of the HIV+ population in this country being uninsured, primarily due to the high cost of private insurance, the ACA could result in a sizeable portion of the HIV+  population enrolling in Medicaid.
• Another huge breakthrough is that, effective in 2014, the ACA prohibits insurance companies from refusing to sell coverage or renew policies because of an individual’s pre-existing conditions or gender. It doesn’t matter if you’re an HIV+ man with Schizophrenia, a heroin addiction, kidney failure and diabetes; private and public insurance companies are legally barred from denying you coverage.
• Low income families that fall between 133% and 400% of the Federal Poverty Level will receive federal subsidies on a sliding scale if they choose to get insured through a health insurance exchange in their state. The subsidy will come in the form of a refundable tax credit.
• Closing the dreaded Medicare Part D Donut Hole: beginning last year, brand name prescriptions were put at a 50% discount in the donut hole, with both generics and brand name drugs scheduled to be reduced to 25% of their full cost for Part D clients by 2020. Also, AIDS Drug Assistance Program benefits (ADAP) are now considered as contributions toward a Medicare beneficiary’s true Out of Pocket Spending Limit for drug coverage, a huge relief for low-income beneficiaries living with HIV because it helps them move through the “donut hole” more quickly.
• With many healthcare providers the expected increase in coverage might mean a decrease in the level of care due to a widening patient-to-provider ratio and lack of funding. As HIV+ clients begin to shift from Ryan White funded programs to community health centers with less experience working with HIV, there is a chance that the quality of care could drop.
• While the Obama administration has outlined certain services that must be provided in the “Essential Benefits Plan” that will be a mandatory component of all health insurance plans, the interpretations of what  those services look like are at the discretion of the states. With the recent Supreme Court ruling curtailing the extent to which the federal government can expand Medicaid, allowing the states a good deal of wiggle room from the ACA policy. In other words, this is one more reason why living in Mississippi is probably a bad idea unless you have recently struck a geyser of black gold on your property or are related to the governor.

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  The overwhelming majority of Ryan White Clients should become Medicaid-eligible under the Affordable Care Act

  In 2008, among Ryan White clients, 30% were uninsured, 68% had incomes at or below 100% of FPL, 22% of clients had incomes between 101% and 200% of the FPL, 34% were insured through Medicaid, and 12% had private insurance. The majority of these clients will be on Medicaid rather than Ryan White by 2014. This migration of clients from Ryan White funding to Medicaid decreases the perceived need to increase RW funding.

• Ryan White Funding probably will never be what is was in the past: Under President Obama, Ryan White Funding has been increasing at only 40% of the rate it was during the Bush years. This is barely enough of an increase to keep up with inflation, so while the numbers may look slightly bigger each year, the money is actually worth the same amount or less. And, with HIV being treated as a chronic illness that enables patients to live for decades after contracting the virus, you have a growing population being treated with the same amount of cash.

Categories: General Health/Medical, HIV News

Tags: Affordable Care Act, Barack Obama, Essential Benefits Plan, Federal Poverty Level, HIV, individual mandate, Medicaid, Medicare, Medicare Donut Hole, Medicare Part D, PLWA, pre-existing conditions, private insurance, Ryan White Act, tax penalty