HIV/AIDS treatment under Obamacare

AIDS awareness and treatment under ObamacareFor people living with HIV/AIDS, the Affordable Care Act brings badly needed help — and some challenges for some of those already receiving care.

Early AIDS fighter U.S. Rep. Henry Waxman says “the Affordable Care Act will take the nation one step further in ensuring that more than 1 million Americans living with HIV/AIDS have access to the services they need.”

There is good news across the board, addressing screening, prevention and care.

In April, the U.S. Preventive Services Task Force recommended that screening for HIV be done on teens beginning at age 15 and on adults up to age 65. The group also recommends that clinicians screen all pregnant women for HIV.

As a result, under the Affordable Care Act, such screenings would be done without additional charge to patients.

“This new screening guideline has significant implications, both in saving lives and in guaranteeing health insurance coverage for testing. This is especially critical for the 20 percent of Americans who are currently unaware of their HIV status,” Waxman wrote. (The task force says the percentage could be as high as 25 percent.)

Previously, there was no clear federal policy regarding HIV testing, health activists say.

The task force finds that “the net benefit of screening for HIV infection in adolescents, adults, and pregnant women is substantial.” The group is composed of independent experts in prevention and “evidence based” medicine.

Dawn Fukuda, who heads the Office of HIV/AIDS for Massachusetts, says of the screening privisions: “Our best chance to make progress in reducing new HIV infections in the country is to ensure that people living with HIV learn their status in a timely manner, access care and treatment, reach viral suppression, and sustain viral suppression long term.”

Waxman, D-California, says he chaired the first congressional hearings “on the mysterious disease now known as HIV/AIDS.”

He cites the following benefits under Obamacare for those with AIDS/HIV — and for those at risk:

  • Patients are entitled to screening services without additional charges. Screening for HIV is included.
  • Health insurers are barred from denying coverage at average rates to those with pre-existing conditions. This includes life-threatening diseases such as AIDS/HIV.
  • Lifetime limits on the amounts insurers have to pay have been eliminated.
  • Insurers have to offer expanded prescription drug coverage as part of the “essential health benefits” mandated by Obamacare. This also addresses the prescription drug “donut hole” under Medicare Part D.

The Kaiser Family Foundation has a detailed list of health system improvements for those with HIV.

These measures will reduce reliance on the Ryan White Care Act, a safety net and “payer of last resort” for care. Those receiving help from the program must have no other option for receiving treatment funding, a situation dramatically changed with the 2014 health care reforms.

“These issues may be more consequential for people with HIV than for some other populations because interruptions in care or delays in treatment could have more harmful effects,” the Kaiser Foundation says.

“Ryan White HIV/AIDS Programs can play an important role in helping people enroll in the coverage that will be available to them,” says the Health Resources and Services Administration, which urges careful coordination of the transitions to state health marketplace coverage and the expanded Medicaid. This is critical “because of the vital role prescription drugs play in the management of and prevention of HIV, as well as the significant financial impact of prescription drugs expenditures on state programs.” The Ryan White program long has had waiting lists for prescription medication help for people with HIV.

The Affordable Care Act also increased funding to the Centers for Disease Control for HIV prevention activities.

In 2010, the Obama administration released a National HIV/AIDS Strategy to fight the domestic epidemic, following up on the Bush administration’s groundbreaking work in the area. “These actions are bringing us closer to an AIDS-free generation at home and abroad — a goal that, while ambitious, is within sight,” President Obama has said.

The White House, however, has come under fire recently for cutting as much as $200 million in AIDS funding in the latest budget plan.

About 50,000 people become infected with HIV each year, and there are more than 1 million Americans living with HIV.

Similar dynamics are in play for those suffering from the hepatitis C virus, which like HIV/AIDS remains incurable. As many as 75 percent of those with the “silent killer” disease do not know they have it, according to a national AIDS group.

The federal Centers for Disease Control has recommended that everyone born from 1945 through 1965 get a blood test for hepatitis C. These tests will be guaranteed under the Affordable Care Act.

More than 3.2 million people in the United States have chronic hepatitis C virus infection, the CDC says, with 75 percent of those members of that baby boomer generation.

While HCV infections have fallen significantly in most population groups, those suffering from HIV are at acute risk. Researchers warn of a “new epidemic” of hepatitis C cases among HIV patients.

New treatments for HCV have surfaced in the past two years, with significantly increased rates of those “clearing” the virus. These medications are quite expensive, and would be covered under plans purchased via the Obamacare health exchanges.

By Glenn Abel

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