Now that key provisions to the Affordable Care Act, or Obamacare, have been upheld, pundits and politicians are debating the impact and affects. Locally, the law could have large implications for the queer community, particularly for those that are HIV positive.
The individual mandate portion of the law, that was upheld in a 5-4 decision, requires every American citizen to have health insurance or be fined. This requirement was necessary to require insurance companies to accept all applicants, regardless of pre-existing conditions, including HIV status. With a larger pool mitigating costs, covering everyone would become more affordable, according to the proposal by the Obama administration.
More than 1.2 million people are living with HIV/AIDS in the United States. More than 30 percent of those are not covered by an insurance provider who can currently deny coverage based on pre-existing conditions. Also, without regulations provided by the ACA, insurance companies are free to charge whatever they want. Insurance companies routinely extort huge premiums from applicants with HIV and many companies simply say no to all HIV-positive applicants. Also, benefits are often capped and insurance providers can stop paying for life-saving procedures when costs are too high.
While there are various public programs that help thousands, the benefits vary and depend on other factors, such private and public donations. Navigating the existing system can be difficult and the ACA provides a way for all HIV-positive Americans to receive the care they need, said Scott Schoettes, HIV project director for Lambda Legal.
“The Affordable Care Act will finally allow people living with HIV to access medical advancements made years ago but that have so far remained out of reach to many. With continuing prevention education, early detection, and quality care for everyone living with HIV, we have the power to stem the HIV/AIDS epidemic,” Schoettes said.
However, the Supreme Court ruled against the provision to the law that requires states to expand Medicaid coverage to low-income applicants. While it’s speculated most governors will expand their states’ Medicaid coverage to take advantage of federal benefits, it’s possible that some governors take an ideological stance against the law.
Without the expanded coverage, those that cannot afford private health insurance may still be unable to acquire coverage, Schoettes said.
“This is not a complete victory, because the decision allows states to opt out of the Medicaid expansion that would provide insurance coverage for many low-income people who cannot otherwise afford it. Our continuing challenge will be to make sure that states opt to expand Medicaid so that more low-income people, and particularly those with HIV, can get the health care they urgently need,” he said.
Despite the Medicaid decision, the ACA also advances queer equality, said Human Rights Campaign President Chad Griffin. Along with improved protection for HIV-positive Americans, the ACA enacts nondiscrimination policies protecting against bias based on sexual orientation and gender identity by private insurance companies. Also, information regarding health of queer Americans will be gathered and studied under the ACA.
“The Supreme Court’s decision means millions of Americans – including many lesbian, gay, bisexual and transgender people and their families – will be better served by our nation’s health-care system. The Affordable Care Act addresses a number of the barriers LGBT people face in obtaining health insurance, from financial barriers to obtaining affordable coverage to discrimination by insurance carriers and health-care providers. While there is a great deal more that must be done to ensure that the health needs of all LGBT people are fully met throughout the healthcare system, today’s decision is an important victory in the fight for health-care equality,” Griffin said in a statement.
Nearly all the queer rights groups that spoke about the ruling agreed it was a momentous moment and an advance in queer equality. National Gay and Lesbian Task Force Executive Director Rea Carey called the ruling a victory for LGBT families and said, “It is about making sure everyone has access to affordable health care when faced with injury and illness. It is based on the premise that no one get hung out to dry — to literally die in some cases — because they were denied affordable health care in one of the richest countries in the world.”