The Affordable Care Act is generally a win for people living with HIV and AIDS, about 30 percent of whom are uninsured. It offers new health insurance options — both private and public — to a group that had been largely locked out of the individual insurance market because of rules about preexisting conditions.
But nearly 60,000 people with the virus in states not expanding their Medicaid programs are likely to remain uninsured. More than half live in Florida, Texas and Georgia alone, according to a study published in Health AffairsMonday.
If all states chose to expand Medicaid, nearly 115,000 people with HIV and AIDS would gain coverage, the study said. That's significant since on 2010, just 17 percent of people with HIV and AIDS had private insurance, compared to 65 percent of the general U.S. population.
Many others are low-income and childless, making them ineligible for Medicaid in most states.
“It costs money to run Medicaid, and you have to weigh that against the benefits,” says lead study author Julia Thornton Snider, a senior economist at Precision Health Economics, a research and consulting firm in Los Angeles. “Because anti-retroviral therapy is so effective in reducing disability, extending life and improving quality of life, if people with HIV/AIDS don’t have access to it up front, there will be costs down the line.”
Because anti-retroviral therapy, known as ART, also reduces the risk of transmission, Snider explains, making sure people are covered and getting care can also stem the spread of the disease.
About 70 percent of the group living in states not expanding Medicaid earn too little to qualify for financial help to buy insurance in the marketplaces created by the health law. The study was based on national HIV surveillance data and data from the National Health Interview Study.
Florida had 16,528 individuals fitting into that category, more than any other state, the report said.
Right now, uninsured Americans with HIV and AIDS can seek treatment under the Ryan White Program, which serves as a payer of last resort and is administered through federal grants. The program is not comprehensive health insurance, however, and it does not cover inpatient care.
Nonetheless, the Ryan White Program is likely to remain critical, says Jennifer Kates, vice president and director of global health and HIV policy at the Kaiser Family Foundation, which released a separate study in January that drew similar conclusions. (Kaiser Health News is an editorially independent program of the foundation.)
“We’re lucky that it’s going to be there,” says Kates, “but will it be there going forward?” The program has limited funding and is dependent on congressional funding. “There’s support for it, but it’s not a guarantee,” she adds.
Health News Florida reporter Mary Shedden contributed to this report.
Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.