HRC Blog

The following post comes from Robert Greenwald, Clinical Professor at Harvard Law School and Director of the Center for Health Law and Policy Innovation/Treatment Access Expansion Project:

After an absence of more than two decades, our nation’s capital will soon be welcoming the International AIDS Conference (IAC) back to the United States, thanks to President Obama’s lifting of the long-standing HIV travel ban. IAC 2012’s theme is “Turning the Tide Together,” and conference organizers note that we are at a “defining moment”—a time when we have the potential to end the HIV epidemic.

The United States is also at a defining moment as a nation, following the U.S. Supreme Court’s decision upholding, for the most part, the Affordable Care Act. We are on the cusp of expanding access to health insurance to millions of the 50 million currently uninsured Americans. Health reform bears the promise of bringing the U.S. closer to the many countries around the world that guarantee access to health care to their residents. For this promise to be fulfilled, however, we must ensure that our poorest and most vulnerable—including many living with HIV—are not left out.

The Supreme Court’s decision held that the federal government cannot withhold all Medicaid funding from states that do not comply with the ACA requirement to expand eligibility for Medicaid to most people with income up to 133% of the federal poverty level (about $15,000 for an individual; about $31,000 for a household of four). Instead, only new funding for expanded Medicaid may be withheld; noncompliant states will retain their existing federal Medicaid funding.

In practical effect, this part of the Court’s ruling makes Medicaid expansion optional for states.  It undermines a provision of the ACA that would have provided health care coverage to approximately 17% of the non-elderly population nationwide who are now ineligible for Medicaid. Currently, being poor is not enough to qualify for Medicaid—a person must be not only low-income, but also fit a particular eligibility category, such as being pregnant or disabled. In the context of HIV, the Court’s decision means that individuals living with HIV in those states that don’t expand Medicaid will have to wait until they are disabled by AIDS before they are eligible for Medicaid-based care that could have prevented the disease from progressing in the first place. Despite the fact that the federal government will pay for the overwhelming majority of the ACA’s Medicaid expansion costs (at least 90%, indefinitely), some states have indicated that they will not expand eligibility. This raises the possibility that many low income Americans will continue to be denied access to health coverage—an unacceptable outcome.

Health care is a human right. That is the belief that has guided my work for the past 25 years. Today, we are one step closer to making that premise a reality in the United States. To truly turn the tide together, though, and realize the potential to end HIV, we must continue to advocate, push, and fight to bring health care to all. Anything short of this will be a promise broken.

The 19th International AIDS Conference will be held in Washington D.C. from July 22 to 27. Learn more about HRC’s involvement by visiting hrc.org/aids2012.