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Today, House Republicans approved the Affordable Health Care Act (aka. AHCA or Trumpcare 2.0) in a vote of 217 – 213, partially fulfilling President Donald Trump’s campaign promise to repeal and replace the 2010 Affordable Care Act (Obamacare). To be clear, the AHCA still faces a Senate vote. Without a doubt, though, its changes to the American health care system will affect an estimated 1.1 million Americans living with HIV. Here’s how:
1. The AHCA’s amendments will increase costs for HIV-positive people.
The AHCA’s MacArthur Amendment, named after New Jersey Representative Tom MacArthur, allows states to decide what benefits insurers have to offer.
Under Obamacare, every insurer had to offer “Essential Health Benefits” which guaranteed coverage for basic services like prescription drugs, mental health and substance abuse treatment. Under the MacArthur Amendment, states could let insurers drop these services or charge more for them.
The MacArthur Amendment also lets insurers charge different prices based on a person’s ”health status.” Although the Amendment explicitly states that insurers cannot “limit access to health coverage for individuals with pre-existing conditions,” people with HIV (especially older ones in their 50s and 60s) could still get charged more for health care because the mechanism to stop this from happening is insufficient.
That mechanism is called the Upton-Long Amendment, and it moves people with costly pre-existing conditions (like HIV) into “high-risk pools” and helps reduce their increased health care costs with $1.6 billion in subsidies every year for the next five years. The problem is that this amount will only cover 76,000 of the 130 million Americans currently living with pre-existing conditions, leaving many with no way to pay for their increased costs.
As the American Medical Association said in its letter opposing the AHCA, no one knows whether the AHCA “will be sufficient to provide for affordable health insurance or prevent discrimination against individuals with certain high-cost medical conditions.”
2. Cuts to Medicaid will hurt lower-income and HIV-positive LGBTQ people.
Obamacare helped provide health insurance coverage to thousands of HIV-positive people by expanding Medicaid, “a jointly funded, federal-state health insurance program for low-income and needy people.”
Obamacare’s Medicaid expansion increased the number of insured HIV-positive people from 36% to 42% in just two years and helped expand Medicaid to 386,000 uninsured low-income LGBT people in the 26 states that expanded it.
That expansion also helped lower-income LGBTQ people access PrEP, the pre-exposure prophylactic medication that helps reduce HIV transmission by up to 99%.
Although the AHCA allows Medicaid expansion to continue until 2020, after that the expanded enrollment will cease. This means that Medicaid will go back to its pre-Obamacare enrollment criteria: In addition to being poor, enrollees would also need to have kids or be disabled to qualify (that is, LGBTQ people would either need to have procreative heterosexual intercourse or get so sick that they qualify for disability just to get coverage).
The AHCA’s new system of financing Medicaid will also cut an estimated $116 billion of federal funding from Medicaid over 10 years, forcing states to reduce their range of Medicaid services, including PrEP and any others related to HIV.
3. Eliminating the individual mandate will leave millions uninsured.
Obamacare required every American over the age of 18 to buy health insurance under the economic reasoning that younger, healthier Americans could help finance the health care costs of older and sicker citizens. But the AHCA gets rid of the individual mandate and replaces it with a system that allows insurers to tack on a one-year, 30% surcharge to anyone who goes more than 63 days without health insurance.
The surcharge will discourage younger, healthier, uninsured people from seeking coverage and will also make it more financially difficult for older, sicker uninsured people to get coverage. Ultimately, it will result in higher costs for those who need insurance most and millions of uninsured Americans nationwide.
According to an analysis by Fenway Health — an LGBT health care, research and advocacy organization in Boston, Massachusetts — the AHCA will result in 24 million Americans losing health insurance by 2026.
Reuters reports that “nearly every major medical group, including the American Medical Association and the American Hospital Association, and the AARP advocacy group for older Americans,” strongly opposes Trumpcare, as do most major American HIV and AIDS organizations.