The Affordable Care Act is generally a win for people living with HIV and AIDS, about 30 percent of whom are uninsured. It offers new health insurance options — both private and public — to a group that had been largely locked out of the individual insurance market because of rules about preexisting conditions. In 2010, just 17 percent of people with HIV and AIDS had private insurance, compared to 65 percent of the general U.S. population. Many others are low-income and childless, making them ineligible for Medicaid in most states.
If all states chose to expand Medicaid, nearly 115,000 people with HIV and AIDS would gain coverage, according to a study published in Health Affairs Monday. But nearly 60,000 people with the virus live in states that are not expanding their Medicaid programs and are likely to remain uninsured. More than half live in Florida, Texas and Georgia alone.
“It costs money to run Medicaid, and you have to weight that against the benefits,” says lead study author Julia Thornton Snider, a senior economist at Precision Health Economics, a research and consulting firm in Los Angeles. “Because anti-retroviral therapy is so effective in reducing disability, extending life and improving quality of life, if people with HIV/AIDS don’t have access to it up front, there will be costs down the line.”
Because anti-retroviral therapy, known as ART, also reduces the risk of transmission, Snider explains, making sure people are covered and getting care can also stem the spread of the disease. About 70 percent of the group living in states not expanding Medicaid earn too little to qualify for financial help to buy insurance in the marketplaces created by the health law. The study was based on national HIV surveillance data and data from the National Health Interview Study.
Right now, uninsured Americans with HIV and AIDS can seek treatment under the Ryan White Program, which serves as a payer of last resort and is administered through federal grants. The program is not comprehensive health insurance, however, and it does not cover inpatient care.
Nonetheless, the Ryan White Program is likely to remain critical, says Jennifer Kates, vice president and director of global health and HIV policy at the Kaiser Family Foundation, which released a separate study in January that drew similar conclusions. (Kaiser Health News is an editorially independent program of the foundation.)
“We’re lucky that it’s going to be there,” says Kates, “but will it be there going forward?” The program has limited funding and is dependent on congressional funding. “There’s support for it, but it’s not a guarantee,” she adds.