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.