NEW YORK (AP) – For many HIV-positive Americans, and those who advocate on their behalf, these are days of anxious waiting as the Supreme Court ponders the constitutionality of President Barack Obama's health care overhaul, the Patient Protection and Affordable Care Act of 2010 (PPACA).
This loose-knit community – made up of activists, health professionals and an estimated 1.2 million people living with HIV – has invested high hopes in PPACA, anticipating that it could dramatically improve access to lifesaving care and treatment. PPACA is now in limbo as the high court deliberates on its constitutionality, notably its requirement that most Americans obtain health insurance. A ruling could come in June.
"The HIV treatment community sees the act as a critical step in our fight against the AIDS epidemic," said Scott Schoettes of Lambda Legal, a national gay-rights advocacy group. "People have been counting on it, making plans based on its implementation, so for it to be pulled out from under their feet at this point w ould be a tremendous loss."
Among its many provisions, PPACA has two major benefits for HIV-positive people: It expands Medicaid so that those with low incomes can get earlier access to treatment, and it eliminates limits on pre-existing conditions that have prevented many people with HIV from obtaining private insurance.
Under current policies, low-income HIV-positive people often do not qualify for Medicaid if they are not yet sick enough to be classified as disabled.
In the view of advocacy groups, this creates a cruel Catch 22 – at a stage when they are still active and productive, these people can't afford the antiretroviral treatments that could help them stay that way. Only when their condition worsens are they able to qualify for Medicaid and get treatment that might have prevented the deterioration.
The health care act would remove the disability requirement and makes Medicaid available to a broader range of low-income adults.
"It will prolong life potentially by decades for literally hundreds of thousands of persons," said the National Minority AIDS Council in its Supreme Court brief. "Individuals can continue to work and go about their daily lives as productive members of society."
According to the U.S. Department of Health and Human Services (HHS), only about 13% of people with HIV have private health insurance and about 24% have no coverage at all. As a group, HHS says, these people "have been particularly vulnerable to insurance industry abuses" and face barriers to obtaining care from qualified providers.
Under the new law, insurers cannot rescind existing coverage to adults unless there's evidence of fraud. As if 2014, when the law is scheduled for full implementation, insurers will not be allowed to deny coverage to anyone with HIV/AIDS or impose annual limits on coverage.
Schoettes, who is Lambda Legal's HIV Project director and is HIV-positive himself, says this p art of the law would curtail harmful insurance practices.
"Most private insurers have refused to provide affordable coverage to those with HIV," he and other Lambda Legal lawyers wrote in a brief submitted to the Supreme Court in March.
"This market failure has caused serious consequences both for individuals with HIV – who suffer unnecessary illness and premature death – and for society generally in higher overall health care costs and lost productivity," the lawyers wrote. "Virtually all this suffering is avoidable: medical care is available that can turn HIV into a chronic, manageable condition."
America's Health Insurance Plans (AHIP), Washington, which represents major private health insurers, has opposed PPACA. The trade group says it supports expanding coverage to most Americans but believes key provisions in the law are poorly designed and will raise costs and cause disruptions.
The organization's spokesman, Robert Zirkelbach, acknowledged that under the current system, individuals with HIV or AIDS do find it hard to obtain private coverage if they already had the disease. "If people wait until after they're sick, they're often not able to get it," he said.
