“As drafted today, it provides less coverage at greater out-of-pocket cost to the insured, and shifts federal benefits from those who need them most, including people living with HIV/AIDS (PLWHA), to high-income Americans,” said a statement from the the Communities Advocating Emergency AIDS Relief (CAEAR) Coalition.
“The AHCA strips the guarantee of essential benefits and patient protections from health insurance, and forces consumers to choose insurance plans at higher costs for less health benefits,” the group says. “Most egregious is the removal of the long established, federal entitlement nature of the Medicaid program that currently guarantees low-income individuals have access to health care and pharmaceuticals, like the expensive HIV/AIDS drugs that people with HIV rely on to stay alive and non-infectious.”
People who are older and poorer would be most seriously affected under the Trump plan. Bloomberg News cites the CBO report as noting that “A 64 year old earning $26,500 a year would have a $19,500 premium for health insurance and get a tax credit of $4,900, leaving them to pay $14,600.... That compares to a $15,300 premium under Obamacare with a $13,600 subsidy, leaving them to pay $1,700.”
The bill as drafted is a violation of the promises of both the Congress and President Trump to provide a better plan with better, lower cost coverage. Specifically:
• The tax credits in the AHCA are far less generous than current subsidies for seniors and young adults, and even when the tax credits are refundable, significantly increase the out-of-pocket cost of premiums, deductibles, and co-pays, creating a set of additional barriers to using health care.
• Lapses in insurance coverage longer than 62 days for those with preexisting conditions would require a 30% increase in the premium charged by the insurance companies for the year after the lapse, which would create severe hardships on a population that already struggles to sustain a quality of life and maintain their health. If enacted, the Ryan White HIV/AIDS Program would once again become the primary source of HIV medical care and drug access for people living with HIV.
• The AHCA would eliminate the ability of states to expand their Medicaid programs in 2020 and raise the eligibility level to enter Medicaid from 133% of the federal poverty level to138% of the federal poverty level, forcing the states to cover the individuals in the program who no longer meet the federal criteria with state funds, putting the poorest Americans at risk for lapses in care, and making the emergency rooms of our public hospitals the primary care site for the poor, as they were before the ACA.
• The AHCA caps the federal contribution to Medicaid, dramatically shifting the cost of the program to states, giving them the flexibility to make the programs less responsive and less accessible. AHCA would roll back the number of people covered by Medicaid, re-establishing categorical eligibility instead of low income for Medicaid starting in 2020. People living with HIV, but not AIDS, would lose Medicaid eligibility, making an AIDS diagnosis the criteria for eligibility. This would undermine the work of public health communities across the U.S. to diagnose HIV early and keep people in care and healthy enough to avoid progression to AIDS.
• Use of the $346 billion Medicare Trust Fund to pay for the AHCA will destabilize Medicare, a crucial health care resource for PLWHA today and increasingly in the future as PLWHA live longer lives as a result of advances in HIV treatment.
The AHCA as currently drafted does not prevent insurers from establishing lifetime and annual caps on services for conditions, a practice that was eliminated in the ACA. For people living with HIV who rely on daily drug regimens, annual or lifetime caps made insurance useless to their ongoing care, forcing them to rely on the Ryan White HIV/AIDS Program to survive.
The AHCA does not continue important requirements for free annual preventive health screenings that are essential for early detection and treatment of life threatening diseases. The removal of this ACA requirement will affect both the individual private health insurance marketplace plans and employer-based insurance, impacting all Americans.
The CAEAR Coalition urges people to call or email representative to express concerns with the AHCA (visit House.gov/representatives to find your representative).
On Tuesday, March 21st, from 5:30 to 7:30 p.m., there will be a community discussion on the potential impact of repeal and replace of the Affordable Care Act, on the lives and health care of people living with HIV/AIDS. The event will be held in Community Meeting Room B145 at the Under Armour House by Living Classrooms (1100 East Fayette Street) in Baltimore.
The Greater Baltimore HIV Health Services Planning Council is hosting the event. The Council helps plan and the distribution of federal HIV/AID funds in the Baltimore and surrounding counties.
A press release from Caear.org contributed to this article.