Two years after President Obama signed the Patient Protection and Affordable Care Act (ACA), the Supreme Court is considering the constitutionality of several elements of that law. The fact that the Supreme Court has agreed to hear this case is hardly surprising. The legislation continues to be controversial. But one of the issues that the Supreme Court will consider Wednesday, the law's expansion of the Medicaid program, has made few headlines. What has made even fewer headlines is how critically important this expansion is to our nation's fight to end the HIV/AIDS epidemic.
The ACA includes several provisions that will improve our nation's ability to combat HIV/AIDS, including the minimum coverage requirement, or the individual mandate. In fact, the mandate helps to offset the costs of requiring insurance companies to cover all Americans, regardless of pre-existing conditions like HIV. But while the law's mandate has gotten most of the attention, its Medicaid expansion is perhaps the most powerful tool ever wielded in the fight to bring an end to this 30-year epidemic. As such, the Supreme Court's decision will have implications far beyond the federal government's authority to regulate the insurance market. It could very well determine the fate of our nation's struggle against AIDS.
Current Medicaid eligibility requirements force most low-income individuals living with HIV to wait for an AIDS diagnosis before they can access the program, even if they meet the income threshold. In effect, this blocks access to the very medications that could have prevented or at least delayed that AIDS diagnosis in the first place. From a public health perspective, this policy is absurd. It endangers the lives of the very individuals it's meant to serve. From an economic standpoint, it is disastrous, delaying access to care until the latest and most expensive stage of the disease. Under the ACA, anyone making up to 133 percent of the federal poverty level -- about $14,483 for individuals -- will be eligible for Medicaid, with or with out an AIDS diagnosis.
This is crucial because socioeconomic status is perhaps the most significant factor in determining an individual's vulnerability to HIV infection. A recent study by the Centers for Disease Control and Prevention found that individuals living below the poverty line were twice as likely to be diagnosed with HIV as those with income above that threshold. What's more, these individuals face substantial barriers to accessing care and treatment, resulting in significantly poorer health outcomes. Providing access to health care for low-income Americans is absolutely essential if we are to bring an end to the HIV/AIDS epidemic.
