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Paul Kawata

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Supreme Court Justices Will Determine the Fate of AIDS in America

Posted: 03/28/2012 3:39 pm

Two years after President Obama signed the Patient Protection and Affordable Care Act (ACA), the Supreme Court is considering the constitutionality of several elements of that law. The fact that the Supreme Court has agreed to hear this case is hardly surprising. The legislation continues to be controversial. But one of the issues that the Supreme Court will consider Wednesday, the law's expansion of the Medicaid program, has made few headlines. What has made even fewer headlines is how critically important this expansion is to our nation's fight to end the HIV/AIDS epidemic.

The ACA includes several provisions that will improve our nation's ability to combat HIV/AIDS, including the minimum coverage requirement, or the individual mandate. In fact, the mandate helps to offset the costs of requiring insurance companies to cover all Americans, regardless of pre-existing conditions like HIV. But while the law's mandate has gotten most of the attention, its Medicaid expansion is perhaps the most powerful tool ever wielded in the fight to bring an end to this 30-year epidemic. As such, the Supreme Court's decision will have implications far beyond the federal government's authority to regulate the insurance market. It could very well determine the fate of our nation's struggle against AIDS.

Current Medicaid eligibility requirements force most low-income individuals living with HIV to wait for an AIDS diagnosis before they can access the program, even if they meet the income threshold. In effect, this blocks access to the very medications that could have prevented or at least delayed that AIDS diagnosis in the first place. From a public health perspective, this policy is absurd. It endangers the lives of the very individuals it's meant to serve. From an economic standpoint, it is disastrous, delaying access to care until the latest and most expensive stage of the disease. Under the ACA, anyone making up to 133 percent of the federal poverty level -- about $14,483 for individuals -- will be eligible for Medicaid, with or with out an AIDS diagnosis.

This is crucial because socioeconomic status is perhaps the most significant factor in determining an individual's vulnerability to HIV infection. A recent study by the Centers for Disease Control and Prevention found that individuals living below the poverty line were twice as likely to be diagnosed with HIV as those with income above that threshold. What's more, these individuals face substantial barriers to accessing care and treatment, resulting in significantly poorer health outcomes. Providing access to health care for low-income Americans is absolutely essential if we are to bring an end to the HIV/AIDS epidemic.

Just last year, research showed that individuals on antiretroviral treatment whose viral loads were undetectable reduced the risk of transmitting HIV to their partner by 96 percent. In effect, if a person is enrolled in drug therapy and remains adherent to that program, it is almost impossible for him or her to pass the virus to another. The Medicaid expansion could potentially extend health care access to tens of thousands of Americans living with HIV. This alone could prevent thousands of new infections. But by providing access to health care, including testing and risk counseling to approximately 16 million additional Americans, the preventative impact of the Medicaid expansion could be colossal.

Last month, the National Minority AIDS Council, along with four other national HIV/AIDS organizations, submitted an amicus brief to the Supreme Court urging it to uphold the ACA's Medicaid expansion, as the 11th Circuit Court of Appeals has already done. Over the last two years, policy and science have aligned like never before, providing America with a clear path forward to ending the HIV/AIDS epidemic. We cannot achieve this goal, however, without ensuring that all Americans, especially those living in poverty, have adequate access to quality health care services. When the Supreme Court hears arguments, I sincerely hope that it will consider the implications of its decision on the lives of Americans living with HIV or AIDS. This case is about much more than legal abstractions or the theoretical limits on congressional authority. It is about whether we as a nation will do what it takes to finally end this epidemic.

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