HRC Blog

Making HIV/AIDS Treatments Available to All, Including the Poor and Uninsured

The following post comes from Tim Westmoreland, Visiting Professor of Law and Senior Scholar in Health Law at Georgetown University Law Center:

I have been working on the HIV/AIDS epidemic since before there was a name for it. The Subcommittee on Health and the Environment in the U.S. Congress held its first hearings in April 1982. I was the staff counsel for the hearing titled “Kaposi’s Sarcoma and Related Opportunistic Infections.” Nobody knew that there was something systemic involved, although people had all kinds of hypotheses.

From then until I left Congress in 1994, the subcommittee held almost three dozen hearings on everything from the need for more federal funding for research and prevention to the refusal of the TV networks to allow the word “condom” in ads on the air. There was successful legislation to provide care and treatment services (which came to be the Ryan White program), to create the NIH Office of AIDS Research, and to encourage early intervention for people who are infected. These hearings and bills came from Rep. Henry Waxman (D-CA), and his insight, stamina and courage during those years made him a hero in the fight against the epidemic.

But over the years, the legislation that never passed was the bill to fix the Catch-22 in Medicaid for low-income people with HIV. Medicaid doesn’t cover all poor people. You have to be poor and something else—poor and pregnant, poor and a child, poor and a senior, poor and a person with disabilities, etc. People with AIDS qualify as having disabilities; people with early HIV don’t, no matter how poor they are. And lots of them are uninsured.

So after all the effort for research, treatment and early intervention, we have therapies that will prevent the development of full AIDS but a system that will only insure you after you actually have AIDS. It’s simply cruel. 

The Medicaid legislation came up year after year, and there never was enough support to pass it. Part of it was political inertia and a reluctance to spend the money. And part of it was that a lot of the press coverage and AIDS activism evaporated when people with insurance and money had a treatment to save their lives; the needs of poor people just didn’t draw as much support or coverage.

I regret that the bill never passed. I regret it a lot this month, now that the Supreme Court has limited the requirements in the health-reform law that Medicaid cover exactly these people. There is a line of governors standing up to say that they will not cooperate in fixing the Catch-22 of the Medicaid program, even if the Federal government will give them the money. This policy that they’re proudly announcing includes a whole lot of poor people with HIV staying uninsured. Again, it’s simply cruel.

The early days of the politics of HIV/AIDS were about finding treatments. The fight isn’t over until everyone has access to these treatments. Those of us with insurance and money shouldn’t stop until they do.

Learn more about HRC's involvement in the 19th International AIDS Conference at

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