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GOP: Don’t Be Penny-Wise and Dollar-Foolish With Our Healthcare

Don’t be penny-wise and dollar-foolish with our Healthcare

An HIV expert examines how repealing the Affordable Care Act without a viable replacement, or reducing Medicaid expansion, makes no fiscal or moral sense.

President Trump promised during his campaign to Make America Great Again. We can debate what “great” means, but I’m sure most would agree that it includes a world where people with infectious diseases – including HIV – have access to high-quality, affordable health care that protects the public’s health.

As a former lobbyist, I’ve analyzed the agenda items of several incoming presidential administrations. But none have had the potential to be as harmful to vulnerable populations, particularly those living with HIV, as the Trump administration’s desire to repeal the Affordable Care Act (ACA) without a proper plan to replace it.

The AIDS Foundation of Chicago estimates more than 12,000 Illinoisans living with HIV gained high-quality, more affordable health care coverage because of the ACA through expansions in either Medicaid or the insurance marketplace. Those 12,000 individuals represent 32 percent of the 37,788-reported people living with HIV in Illinois – that’s nearly one in three individuals living with HIV in our state.

Most, if not all, were likely uninsured before the ACA rolled out. Many couldn’t buy private coverage because it was completely acceptable for insurance companies to refuse to sell policies to people just because they had a pre-existing condition. Low-income people could get Medicaid only if they fit into narrow boxes, like being a pregnant woman, a poor senior, or so sick they were totally disabled. 

Most people living with HIV had to make do with coverage from the Ryan White Care Act, a safety-net program created by Congress in 1990. The Ryan White program is a marvel of coordinated care, meeting the medical needs of people with HIV while helping them navigate the health care system and access social services. 

But there’s a great deal the Ryan White program doesn’t cover, from routine tests to cancer treatment, to unfortunate life occurrences like a broken arm. If an uninsured person with HIV had to be hospitalized for cancer, they had to pay out of pocket or the hospital had to eat the cost.

This is no way to manage an epidemic. In the U.S., we’re still seeing 40,000 new cases of HIV per year. Every new case of HIV costs over $400,000 in lifetime medical care. You do the math – it will cost nearly $680 million to provide a lifetime of medical care to the nearly 1,700 Illinoisans diagnosed with HIV in 2014 alone, and most of that will be paid by the state. 

So, what will happen to the 12,000 people in Illinois with HIV who got coverage through the ACA? Without a clear plan to replace the ACA, we will see interruptions in health care, a lack of coverage for non-HIV conditions, health care costs rising and an increase in new cases of HIV. We also know this will increase health disparities among communities already experiencing significant health inequities and disproportionately impacted by HIV – particularly gay and bisexual Black and Latino men, Black women and transgender women of color. Eliminating health disparities must be a shared national goal and aspiration. If we want to commit to ending health disparities, we must maintain insurance coverage.

Today, we have the knowledge and technology to end AIDS.  We have PrEP, a daily medication that’s nearly 100 percent effective at preventing HIV. We know that people with HIV who are successfully treated early for HIV can live near-normal life spans. Remarkably, we also know they have almost no chance of transmitting HIV to their partners when they are on treatment.

As President Trump and Congress work to make America great, I’ll be measuring their success by the yardstick of how effectively their new health care plan helps people living with HIV to thrive, and how well it works to prevent new cases of HIV.

An America that advances the vision of an AIDS-free generation, in my eyes, is truly great.

John Peller is president and chief executive officer of the AIDS Foundation of Chicago. Learn more at: aidschicago.org

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John Peller

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Ryan is the Digital Director of The Advocate Channel, and a graduate of NYU Tisch's Department of Dramatic Writing. She is also a member of GALECA, the LGBTQ+ society of entertainment critics. While her specialties are television writing and comedy, Ryan is a young member of the LGBTQ+ community passionate about politics and advocating for all.

Ryan is the Digital Director of The Advocate Channel, and a graduate of NYU Tisch's Department of Dramatic Writing. She is also a member of GALECA, the LGBTQ+ society of entertainment critics. While her specialties are television writing and comedy, Ryan is a young member of the LGBTQ+ community passionate about politics and advocating for all.