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Long-term Survivors

On ACA's 10th Anniversary, It's More Important Than Ever to Protect It


In the shadow of COVID-19, the significance of the Affordable Care Act has never been more prominent. 

If you’ve seen any news in the last 10 days or so, you haven’t been able to miss that coronavirus, also known as COVID-19, is on track to ravage the U.S. population. The consequences of COVID-19 will depend on our response. If COVID-19’s trajectory to date in China, Italy, and the U.S. has revealed anything, it’s that our individual health is deeply entwined with the health of those around us. When more of our community members are well, when it comes to coronavirus, we as individuals are more likely to be well.

Keeping people well requires strong systems and protections for human rights. Everyone needs to be able to go to the doctor when needed; stay home from work when sick; be able to cover essential bills and feed the family when workplaces close; and manage childcare when schools close. That includes the person ringing us up at the supermarket, sitting behind us on the bus, pressing the elevator button before us, cutting our hair, and making our coffee.

Italy has a highly effective national health care system, contrary to Joe Biden’s suggestion during the most recent Democratic presidential debate. The situation there shows how even strong health care systems can be overwhelmed when societies do not quickly and decisively implement physical distancing to slow down a deadly and highly contagious virus.

Unfortunately, we are already on the same track here in the U.S. And, unlike Italy, the U.S. does not guarantee medical care to all its citizens — nor paid sick leave or subsidized childcare — and has far fewer protections for workers and tenants. As a result, those who cannot work from home, who cannot afford to stay home from work and lose their rent money, or who will lose their jobs if they stay home, face the grim choice between putting themselves and their loved ones at risk or losing their livelihoods. Raids by ICE have continued unabated, and consequently many immigrants are avoiding health departments and interactions with the state. Together, these are a recipe for a public health catastrophe that will almost certainly have calamitous consequences for the most vulnerable among us as well as those working on the frontlines to save lives.

On March 23, 2010, President Obama signed the Affordable Care Act (ACA) into law. The ACA was not perfect. Its main weakness was and continues to be a primary reliance on private insurance companies to meet the needs of individuals and the demands of public health. Keeping people alive and healthy is not compatible with maximizing profits. We wanted more then, and we want more now: Medicare for All.

Still, in many ways, the ACA was the best thing that happened to people living with HIV in the U.S. since antiretrovirals. Between ending discrimination against people with preexisting conditions and expanding Medicaid, hundreds of thousands of people living with HIV gained access to comprehensive health care for the first time since their diagnosis. In Illinois alone, over 12,000 people living with HIV — a full third of those living with HIV in the state — had gained coverage through the ACA by 2016, mostly through Medicaid expansion. Prior to the ACA, some had managed to access HIV care and treatment through Ryan White — but were unable to get care for other physical and mental health conditions, let alone primary or dental care. Thanks to the ACA, they are now able to get the care they need, not just for HIV, but for other needs too — diabetes, hypertension, cancer, depression, anxiety, screening for intimate partner violence, and more.

The coronavirus pandemic has pulled back the curtain and exposed how interconnected we truly are. Positive Women’s Network – USA (PWN), a national network of women and people of trans experience living with HIV, advocates tirelessly for universal health care. PWN members and staff were on the frontlines fighting to protect our gains throughout 2017 as Trump and the Republican-led Congress attempted- three times! — to repeal the ACA. We have pushed elected leaders and candidates to embrace a single payer health care system.

We are not going anywhere, and the current pandemic only strengthens our resolve to make this nation a place where no one is denied the care they need at any time, and where no one avoids or postpones seeking health care out of fear of bankruptcy, being dropped by their insurance, or deportation.

Yet, even as Trump and Congressional Republicans embrace measures that at any other time they would have refused to even get to the Senate floor — direct cash payments, free testing and treatment for the virus, mandatory paid sick leave for all workers — a lawsuit against the ACA supported by the White House still awaits a hearing by the Supreme Court. Texas v. United States would strike down the entire ACA — including protections for preexisting conditions and Medicaid expansion.

In honor of the ACA’s tenth birthday, PWN has collected some stories from women living with HIV whose lives it saved. Thamicha Isaac fled intimate partner violence in her native St. Martin, only to face HIV, depression, unemployment, and homelessness in New York. Today, she is an in-demand public speaker, fierce advocate, and mother of two. She credits her health and stability to Medicaid expansion. Olga Irwin has survived HIV, a heart attack, a stroke, diabetes, kidney disease — and still has put her body on the line, getting arrested at least nine times on Capitol Hill fighting to protect the ACA.

We hope those who read their stories in our Love Letters to the ACA series will understand why the fight to protect and improve upon the ACA is more urgent than ever — and will pledge to be a #HealthCareVoter in 2020.

Jennie Smith-Camejo is communications director at Positive Women's Network-USA, a national membership body of women living with HIV and allies that exists to strengthen the strategic power of all women living with HIV in the United States.

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Jennie Smith-Camejo