Ending AIDS In Black America:
Step One: Fully Implement the Affordable Care Act
By Phil Wilson
During the 19th International AIDS Conference in Washington, D.C., last month, there was a lot of talk about the end of AIDS. Now over a month later, I’m fearful that some things have been lost in the sauce or lost in translation.
Let’s be clear: We might be able to end the AIDS epidemic, but we have not done so yet. The AIDS epidemic is not over. And there is no community on the planet for whom that is a truer statement than Black America. The operative word concerning the end of AIDS can be found after the word “epidemic”. That word is “if’. We can only end AIDS, if – and it is a big if – we take appropriate action.
Over the next five weeks, we want to have a conversation with you on what some of the things are that we have to do if we want to fulfill the promise of ending AIDS.
This week I want to focus on the Patient Protection and Affordable Care Act (ACA), informally called Obamacare.
Fully implementing the ACA – including Medicaid expansion and assuring the appropriate essential benefits packages — is the single most important thing that we can do to end the AIDS epidemic in Black communities. The ACA will bring 30 million Americans into health care. Many of them are poor; many of them are Black or Latino; many of them are young; many of them are over 50; and many of them have HIV/AIDS.
Approximately 63 percent of the estimated 1.1 million Americans living with HIV are Black or Latino. Thirty nine percent of new HIV cases in the U.S. are under the age of 25. Fifteen percent are over the age of 50.
Our best bet to end AIDS in Black and Brown communities in America is to help the estimated 693,000 who are Black or Latino living with HIV reach viral suppression.
We know that if we can help people with HIV drive their viral load – the amount of active virus in their bodies – down to undetectable levels (which means that while the virus may still be present, it is present at levels so low we can’t find it), we can reduce transmissibility by 96 percent. That’s huge.
But there is no way that we can reach that goal if we don’t get people into treatment. And we’re not going to get a critical mass of people into treatment if they don’t have access to healthcare. Right now the only way to make that happen in large enough numbers is – through the ACA.
Even with the ACA, the devil is in the details. Two details in particular are critically important to ending AIDS. One is the expansion of Medicaid. A number of governors are doing a lot of political grandstanding around refusing to accept federal support to expand Medicaid. Let’s be clear. for the first few years, the cost of Medicaid expansion is completely budget neutral for state governments. It will have no negative impact on state budgets. All of the governors’ saber rattling is for political purposes only. They are willing to deny millions of people in their states lifesaving healthcare in order to score political points.
Single, childless adults are typically not eligible for Medicaid – a critical failure in an epidemic concentrated among low-income gay men – but under the ACA everyone will have a means to pay for life-saving treatment. Medicaid expansion is crucial in expanding access to healthcare for the most at risk populations on a state level.
The second detail that we have to pay attention to is the Essential Benefits Package. Currently each state gets to regulate the minimum benefits required – called Essential Benefits Packages – for insurance policies offered in that state. If the states’ floor for the Essential Benefits Package is too low, then the coverage will be insufficient to address the needs of people living with HIV or other chronic illnesses. Minimally the Essential Benefits
• an annual physical for everyone,
• an HIV test at every physical (including at least two annually for high-risk individuals),
• twice-a-year viral-load tests for people living with HIV, and
• comprehensive coverage of ARVs, both for treatment and for prevention.
We need to start advocating on a federal and state level immediately to fully implement an ACA containing the components necessary to serve the needs of people living with HIV.
Someone once said, “Elections have consequences.” The fate of the ACA will lie in what we do in November. People running for office at every level are either for it or against it. A candidate’s position on the ACA essentially reveals how the policy they will be in favor of or opposed to will impact ending the AIDS epidemic. We need to make sure that every candidate running for office in November understands how important ending AIDS is to us. And we need to help them understand what policies they need to be supportive of to demonstrate to us that they are serious about ending AIDS as well.
Implementing the ACA is very important, but it is not the only thing we need to do. Next week let’s talk about people with HIV coming out and why that’s important to end AIDS.
Finally, please join the Black AIDS Institute, as we travel around the country in partnership with local AIDS organizations and health departments to host Post-Conference updates, where we share the latest science and other information from AIDS 2012. We look forward to seeing our friends in Birmingham and Chicago on Thursday and Friday, September 6th and 7th. I’ll be in both cities. Please come out and let’s continue this conversation there.
Yours in the struggle,
Phil Wilson