Win-Win: Health care reform law will help HIV patients and providers

More access to providers and drugs

HIV/AIDS providers and others say the Patient Protection and Affordable Care Act (H.R. 3590), which was signed by President Barack Obama on March 23, 2010, contains mostly good news for the HIV/AIDS community.

It will expand access for HIV patients who currently do not qualify for Medicaid, Medicare, or private insurance. It will make it easier for HIV patients to obtain new private health insurance coverage, and it eliminates the life-time caps on how much an insurer will pay for expensive medical issues, including HIV/AIDS.

The expansion of the private insurance pool and the prohibition against denying coverage for pre-existing conditions will make it easier for HIV patients who are healthy enough to work to find jobs that provide insurance coverage, says William E. Arnold, director of Title II CANN — Community Access National Network, founder of the ADAP Working Group, in Washington, DC.

"That will put more HIV patients into the mainstream system, as opposed to the Medicaid system," Arnold says.

Plus the new legislation will create a wellness/prevention fund with $7 billion in funding over 10 years, and some of this money could go toward HIV/AIDS projects, says Michael Ochs, a government relations associate with the Infectious Diseases Society of America in Arlington, VA.

This funding will be distributed through the U.S. Department of Health and Human Services as a discretionary fund, and it will start with $500 million. It's designated to be used for prevention and wellness, Ochs explains.

The health care reform bill will increase access to affordable health care for all Americans, including people living with HIV/AIDS, says Ronald Johnson, deputy executive director of AIDS Action in Washington, DC.

"We are confident this bill could improve health outcomes as having more dependable care is critical to their health," Johnson adds.

The bill's clause that prevents insurers from denying health care coverage to adults because of pre-existing conditions is a very important part of what was passed, but it doesn't go into effect until 2014, Johnson notes.

Everyone in the pool

"In the interim, the bill calls for the establishment of a temporary, high-risk pool, and through that high-risk pool people living with HIV/AIDS can get access to health care coverage within 90 days," he adds.

Another feature that will increase access is the part that raises the Medicaid eligibility to 133% of the federal poverty level.

"This is a very important provision, particularly for people living with AIDS, and it goes into effect in 2014," Johnson says.

Also, the bill's provision to increase Medicaid payments to primary care providers to 100% of Medicare rates is an important feature that hopefully will result in HIV patients who have Medicaid coverage being able to find physicians who will provide them with care, he adds.

"When you're expanding Medicaid coverage, it's important that you don't lose any Medicaid providers," he says.

From the perspective of the AIDS Drug Assistance Program (ADAP), the Medicaid expansion is the single most important benefit, Arnold says.

"The vast majority of ADAP clients are poor," Arnold says. "This will pick up some people who are not picked up right now."

As more HIV patients receive Medicaid coverage, the ADAP roles likely will ease a little, although the help will be none too soon, Arnold notes.

"We have immediate trouble because of states pulling out a lot of their ADAP money and the federal ADAP appropriations being flat for too long," he says. "The Medicaid expansion will definitely be a help, but the issue is how fast it will be phased in."

ADAPs now have 800 people on waiting lists to receive antiretroviral medications, and it's possible this number will double or triple in the next few years, he says.

Plus, some of the states with the highest number of HIV/AIDS patients also have high numbers of undocumented workers who have no insurance coverage and who are not eligible for Medicaid, Arnold notes.

"They still receive help from ADAP," he says.

The bill's Medicare Part D "donut hole" fix also could benefit ADAPs. It's a long-term fix, although this year Medicare beneficiaries who reach the Part D coverage gap will receive a $250 rebate. Gradually, this gap will be eliminated by 2020.

Also, the bill allows ADAP drug payments to count toward patients' out-of-pocket costs when they are in the coverage gap of Medicare Part D, says Kristina E. Lunner, vice president of government affairs for the American Pharmacists Association in Washington, DC.

"Previously, Medicare Part D prescription drug benefit did not count drugs provided through ADAP programs, and this law would change it so they do count," Lunner says. "Before, even if ADAPs had helped people it didn't go toward the patient's out-of-pocket costs, although different states have assistance programs, and those payments counted toward it, but ADAPs didn't."

Now the ADAP funds will count and help patients bridge the Medicare Part D doughnut hole gap.

"If more money goes to cover the doughnut hole, then potentially ADAPs will keep more money to cover their clients," Arnold says.

But it will take some time before anyone can predict how the Medicare Part D changes might benefit ADAPs financially, Arnold says.

"It's clearly good news down the road and will clearly help when you look at the national picture, but you'll have to see how it is played out in the states," he adds.

One part of the health care reform bill that AIDS advocates don't like is a provision inserted by Orrin Hatch (R-Utah) to provide more than $250 million for Title V abstinence-only-until-marriage programs.

AIDS advocates had pressed the Obama administration to eliminate funding for abstinence-only education which had been one of the only HIV prevention funding areas to be increased over the Bush administration's eight years. The research that came out of those years of funding clearly did not show any public health benefits to abstinence-only education.

"We will continue to speak out against abstinence-only funding, and it's unfortunate that money was stuck in the bill," Johnson says.