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C. Virginia Fields

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What's Right And Wrong With the Supreme Court Ruling on Obamacare

Posted: 07/05/2012 9:22 am

For millions of Americans living with HIV and AIDS, the U.S. Supreme Court's ruling on the Patient Protection and Affordable Care Act (ACA) is a silver cloud -- but it's a cloud with a dark lining. While the ACA will be a godsend for so many people who currently don't have access to health care, including many living with HIV and AIDS, millions of other Americans who would stand to benefit from state-level expansion of Medicaid may be faced with no reasonable health care alternatives as a result of the ruling.

Currently, HIV and AIDS are considered pre-existing conditions. While 13% of people living with AIDS have private health insurance, 24% have no insurance coverage at all -- in some cases because of cost but often because coverage is denied by insurance companies. Thanks to the Affordable Care Act, private insurance companies will soon be prevented from denying care because of pre-existing conditions and imposing lifetime caps on benefits that disproportionately affect people living with AIDS. Thanks to the Supreme Court's ruling, the Affordable Care Act -- including these vital provisions -- will soon go into effect and improve access to care for millions. And in the interim, people living with AIDS can access a special insurance pool for those with pre-existing conditions.

Yet, because HIV/AIDS strikes low-income black communities far worse than any other, we must consider the negative impact of the Supreme Court's ruling on the Medicaid provision of health care reform. When Congress passed the Affordable Care Act, it expanded access to Medicaid from families at or below 63% of the poverty line to include families that make up to 133% of the official poverty threshold (or about $30,000 per year in income for a family of four). Yet the Supreme Court ostensibly ruled that the federal government cannot compel states to expand their Medicaid coverage. As many as 17 million Americans may have benefited from the Medicaid expansion. Their ability to obtain coverage is now, once again, in jeopardy.

While blacks make up only 12% of the American population, we comprise close to 50% of reported HIV and AIDS cases. In 2010, blacks accounted for almost 50% of new AIDS diagnoses. Even more disturbing, while blacks are only 17% of the teenaged population in the United States, black teens account for 70% of new AIDS diagnoses in that age group. AIDS cuts across all demographic groups, but in America today, its impact on racial minorities is grave and unparalleled.

Why? A major factor is access to affordable, quality health care. While about 11% of white Americans lack health insurance, 20% of black Americans have no health coverage. Not unsurprisingly, because of the intersection of race and poverty in America, a quarter of black Americans who do have insurance coverage get their care through Medicaid. So while expanding Medicaid has clear benefits to black people living with AIDS and black Americans in general, Medicaid cuts will have a biased impact on us as well. Even worse, in its ruling the Supreme Court opened the door for states to unilaterally deny even current benefit levels under Medicaid.

We all know that testing and early treatment are key to preventing the spread of HIV and AIDS in America and helping those who are infected to live healthy lives. This is why insurance coverage and access to affordable, quality care are so vital. Yet the Supreme Court's ruling protects the Affordable Care Act's private market provisions while jeopardizing expanded coverage for low-income Americans. Yes, we should rejoice at the overall ruling, but we must also remain vigilant and advocate for measures that will provide access to the health care and treatment options our communities so desperately need.

At the national level, as the fight to repeal the ACA ramps up, we must insist that our leaders finally put partisan politics aside in the interest of safeguarding the health and well-being of all of our citizens. But what about the fight at the grassroots level, where the states will soon debate whether to provide more care and coverage for the poor or strip away support?

The storm clouds of that battle are just beginning to gather.
 
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