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Stakes high in health debate for HIV+

– For many HIV-positive Americans, and those who advocate on their behalf, these are days of anxious waiting as the Supreme Court ponders President Obama’s health care overhaul.

This loose-knit community – made up of activists, health professionals and an estimated 1.2 million people living with HIV – has invested high hopes in the Affordable Care Act, anticipating that it could dramatically improve access to lifesaving care and treatment.

The act is now in limbo as the high court deliberates on its constitutionality, notably its requirement that most Americans obtain health insurance. A ruling could come in June.

“The HIV treatment community sees the act as a critical step in our fight against the AIDS epidemic,” said Scott Schoettes of Lambda Legal, a national gay-rights advocacy group. “People have been counting on it, making plans based on its implementation, so for it to be pulled out from under their feet at this point would be a tremendous loss.”

Among its many provisions, the health care law has two major benefits for people with HIV: It expands Medicaid so that those with low incomes can get earlier access to treatment, and it eliminates limits on pre-existing conditions that have prevented many people with HIV from obtaining private insurance.

Under current policies, low-income HIV-positive people often do not qualify for Medicaid if they are not yet sick enough to be classified as disabled.

In the view of advocacy groups, this creates a cruel Catch 22 – at a stage when they are still active and productive, these people can’t afford the antiretroviral treatments that could help them stay that way. Only when their condition worsens are they able to qualify for Medicaid and get treatment that might have prevented the deterioration.

The health care act would remove the disability requirement and makes Medicaid available to a broader range of low-income adults.

“It will prolong life potentially by decades for literally hundreds of thousands of persons,” said the National Minority AIDS Council in its Supreme Court brief. “Individuals can continue to work and go about their daily lives as productive members of society.”

According to the Department of Health and Human Services, only about 13 percent of people with HIV have private health insurance and about 24 percent have no coverage at all. As a group, HHS says, these people “have been particularly vulnerable to insurance industry abuses” and face barriers to obtaining care from qualified providers.

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