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

07/05/2012 09:24 am ET | Updated Sep 04, 2012

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


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.