The Latest Assault on the Affordable Care Act: An HIV-Positive, 34-Year-Old Man's Perspective

03/31/2015 11:54 am ET | Updated Feb 02, 2016
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It has now been almost eight years since I have been diagnosed with HIV. In today's day and age, HIV is a manageable chronic disease much like diabetes. We have come a long way since the onset of the HIV/AIDS epidemic in the early 1980s. The havoc it wreaked within the NYC gay community left many casualties behind. I think often of how my fate could have been so different if I was born in 1961 as opposed to 1981.

I can still remember the heroes of my youth who fought this disease so valiantly. The young, brave Ryan White taking on a society's discrimination with all his courage. The handsome and inspiring Pedro Zamora of The Real World who helped me to not only put a face on HIV, but a face on what it meant to be gay and living a life of dignity and truth. The charismatic Maurizio, the partner of my older cousin Sandy, who had been an Italian model in his younger years, gracing the pages of magazines. In 2000, he passed away from an HIV-related complication. Another life lost on a pile of so many before. The ultimate devastation for Sandy, whose photo album of friends was a graveyard of men long gone.

About a year into being diagnosed it was necessary for me to start taking medication. My T-Cells were getting lower and lower. At the time I was unemployed and receiving government assistance. If I didn't have Medicaid my life would have been in jeopardy. And this is where the latest assault on the Affordable Care Act ("Obamacare") and the Supreme Court of the United States come in. This is where I must make a resounding call for a single payer health care system. In today's day and age in the most industrialized country in the world, no one should be dying because of lack of quality care and access to that care.

For the approximately 1.2 million Americans living with HIV in the United States, HIV should now be a manageable condition with access to life-saving medications and quality care. However, a report published by the Kaiser Family Foundation in the beginning of 2014 found that over 700,000 people between the ages of 19-64 were still uninsured. The authors of the report estimate that this number would be reduced by 200,000 as a direct result of the ACA. Though the ACA is of great importance to this segment of the population, an estimated half a million people remain uninsured.

Single payer health care is the final answer. In a nutshell, single payer is universal health care. Giving everyone access to state funded health care, health care would be recognized as a basic human right rather than a commodity.

It is important that we understand what is at stake right now and make sure that we don't go backwards. We must solidify what we have in place in order to move forward. The same folks with the same right-wing agenda who brought you the 2012 Supreme Court ACA battle (National Federation of Independent Business v. Sebelius) are it again! Part II features the same cast of characters, including Michael Carvin, the plaintiff's attorney, who once again is trying with all his might to cripple the ACA. United States Solicitor General, Donald Verrilli, is being forced to defend the government's position for the second time.

2012's NFIB v. Sebelius case hinged upon the individual mandate and Medicaid expansion. With some exceptions (religious objectors, undocumented immigrants and incarcerated individuals), the individual mandate part of the ACA requires everyone to maintain a minimum level of health insurance for themselves and their tax dependents. Those who do not satisfy the individual mandate will face a financial penalty, also known as the shared responsibility payment. The individual mandate of the ACA was upheld by a slim 5-4 Supreme Court decision, where, in a surprise twist to many, Justice Roberts sided with the four liberal justices of the court (Ginsburg, Breyer, Sotomayor and Kagan).

The ACA also expands Medicaid eligibility. Funded by both the state and federal governments Medicaid provides health insurance to people with very little income. Though this program is a voluntary system for states, at this time all states participate in the program. Under the ACA expansion, Medicaid would now cover all people under 65 with household incomes at or below 133 percent of the federal poverty level (FPL). In 2012 this was $14,856 per year for an individual and $30,657 per year for a family of four. Pre-ACA Medicaid coverage by and large excluded non-disabled, non-pregnant adults without dependent children, unless states got waivers to cover them. Unfortunately, Medicaid expansion was limited by the Supreme Court when they allowed states to choose whether or not they wanted to expand Medicaid enrollment. Only Justices Ginsburg and Sotomayor found Medicaid expansion to be constitutional. Currently 28 states plus D.C. have expanded their Medicaid coverage, five States are considering expanding, and 19 states have decided against expansion.

The Carvin case now before the Supreme Court, is the right's latest effort to take down the ACA. Carvin argues that the law holds that Federal subsidies will be given to states with exchanges that were "established by the State." With only 14 states setting up their own exchanges so far, the Federal Government has had to set up the exchanges for most of the remaining states and in some cases partner up with them. Carvin seeks to create chaos and unravel the ACA by applying a phrase of four words in the most literal of ways, in an effort to make the case that people in those states with federal exchanges should not be given subsidies, because they were not set up by the State. People in those states who are making use of the exchanges are by and large dependent upon federal subsidies. The ACA would be in serious jeopardy with so many people removed from the health insurance program. Costs for those remaining on the program would skyrocket, resulting in a crushing blow to the ACA, from which the program and the new law might never recover. Essentially right-wing ideology would triumph at the cost of people's lives.

The ACA has been the biggest health care expansion since 1965, when Medicare and Medicaid became law. To all the critics of the ACA, we can agree with its shortcomings while understanding that it lays a foundation for us to build upon. I recently attended a health care panel where one man reminded everyone in the room of what President Obama had to go through to get this law enacted. Obama, he said, came out of this period of time with arrows coming out of his back. I am grateful for this law, because I clearly understand that it is means for the poorest people in this country. I would not be here today if it wasn't for the free, quality health care I was given in the form of Medicaid. As we know, even with government assistance, many Americans are saddled with high health care costs and are forced to navigate an often complex system.

I support the ACA and I advocate for a single payer national health insurance system. With this system in place, all medically necessary services for every United States resident would be covered. For-profit healthcare would disappear. Patients wouldn't be burdened with obstacles to care such as premiums, deductibles and co-pays. The Expanded and Improved Medicare for All Act (H.R. 676) seeks to create a single payer system here in the United States. This is what HIV+ people, LGBT people, people of color and those who are living in poverty desperately need. This is what we all need in order to be a society in which our ideals are realized rather than sold off.

We can't go backwards, there's just too much at stake.