Celebrating 10 Years of the Affordable Care Act
Today, March 23, 2020, is the 10-year anniversary of the Affordable Care Act (ACA), a pivotal health care reform law that was enacted on March 23, 2010 by President Barack Obama. The three primary goals of the ACA are to 1) make affordable health insurance available to more people, 2) expand the Medicaid program to cover all adults with incomes below 138% of the federal poverty level, and 3) support innovative medical care delivery methods designed to lower the costs of health care. Since the ACA’s enactment, it has provided better coverage for all Americans, including those living with and at risk for HIV and hepatitis. It has increased access to high quality affordable health coverage by guaranteeing coverage for pre-existing conditions, prohibiting insurance plans from imposing lifetime and annual caps on covered services, expanding Medicaid eligibility, providing financial assistance for people enrolled in private health insurance plans, ensuring coverage of essential health benefits such as prescription drugs, and lowering Medicare prescription drug costs. The ACA also requires private health plans and public health insurance programs to cover preventive services without cost-sharing, which increases access to preventive care that is critical to ending the HIV and hepatitis epidemics.
In order to end the HIV epidemic, it is imperative that people living with HIV (PLWH) have insurance coverage that allows them to access affordable health care services. Access to health insurance and comprehensive, affordable care improve health outcomes for people living with HIV, and research shows that rates of sustained viral suppression are statistically significantly higher among people with private insurance (65%) and Medicare (69%) compared to those who are uninsured (54%). Additionally, Medicaid is the largest source of insurance coverage for PLWH, estimated to cover 42% of the adult population, compared to just 13% of the adult population overall. Due in large part to the ACA’s Medicaid expansion, the number of Medicaid enrollees living with HIV increased by 33%, since 2013. The ACA also strengthens existing public health efforts to end the HIV epidemic by increasing capacity of the Ryan White HIV/AIDS Program (RWHAP) to serve PLWH. The availability of comprehensive, affordable coverage options under the ACA enables RWHAP Part B and AIDS Drug Assistance Programs (ADAPs) to save money on prescription costs and provide critical support services which are not typically covered by traditional payers, such as case management, transportation, and extended provider visits. Insured PLWH rely on RWHAP to fill gaps in coverage and cover costs associated with HIV care and treatment, and ADAP clients who enroll in ACA-compliant private health insurance plans have higher rates of viral suppression compared to clients who receive traditional full-pay ADAP.
The ACA has impacted the lives of people living with or at risk for viral hepatitis by expanding access to preventive services, care, and treatment. Since the passage of the ACA, uninsured rates have dropped significantly for communities most affected by hepatitis C, including African Americans, veterans, Native Americans, and Latinx individuals. The ACA also has made preventive care for viral hepatitis more accessible by requiring health plans to cover certain preventive services, such as hepatitis A vaccination and hepatitis B and C testing, without charging a deductible or copay.
In addition to expanding access to health coverage and care for people living with or at risk for HIV and hepatitis, the ACA has become an essential part of America’s public health system. It provides opportunities to prepare health systems for public health emergencies by strengthening community-based care, reducing the number of uninsured patients that seek care from emergency departments and safety net hospitals in public health emergencies, increasing the capacity of our health infrastructure to focus on population health management, and improving health care delivery through use of technology.
The ACA has also increased access to health coverage and services for communities that have historically been excluded from the health care system due to discrimination. The ACA’s non-discrimination provision (Section 1557)—the first and only civil rights law in the U.S. that prohibits discrimination on the basis of race, color, national origin, sex, age, and disability in health care programs and services—has increased access to health care for people living with disabilities and chronic health conditions, LGBTQ individuals, women, and individuals living at the intersections of multiple identities. Section 1557 prohibits previously pervasive forms of discrimination in health care programs and settings that made it difficult for marginalized communities to access quality comprehensive and culturally competent health care.
The ACA has made a significant impact on the lives of people living with HIV and hepatitis which is why in order to end these epidemics we must protect the ACA. Rolling back Medicaid access and weakening the ACA’s Medicaid expansion can hinder the Administration’s End the HIV Epidemic initiative. It is imperative that we encourage state policymakers to choose to protect the ACA and Medicaid and the populations these programs serve. Overall, the ACA has created opportunities for America’s most vulnerable communities to receive the prevention, care, and treatment services they need. Today, on the 10th anniversary of the ACA, we recognize the impact the ACA has had in the fight to end the HIV and hepatitis epidemics.