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How States Refusing To Expand Medicaid Are Undermining The Fight Against HIV
by Sy Mukherjee
January 7, 2014

The Affordable Care Act will expand insurance coverage for nearly 200,000 Americans with HIV — but states refusing the law’s optional Medicaid expansion will leave about 19,000 uninsured Americans with the virus without new coverage options, according to a new report by the Kaiser Family Foundation.

About 1.1 million Americans above the age of 13 are living with HIV, according to the Centers for Disease Control (CDC), and approximately 407,000 HIV-positive people between the ages of 19 and 64 are actively receiving care. Over 40 percent of them are covered by Medicaid, the single largest provider for people with the virus, while another 30 percent have private health insurance. Around 17 percent of the HIV-positive Americans getting treatment remain uninsured, and could benefit greatly from the law’s coverage expansion.

But many of them won’t. Over four in ten of uninsured HIV-positive Americans won’t be eligible for Medicaid in the 24 GOP-led states opposed to the health law’s optional expansion of the program.

Obamacare represents a step forward despite the ongoing opposition to Medicaid expansion.

The KFF report estimates that about 27,000 Americans with HIV will become eligible for Medicaid in the 26 pro-expansion states and another 25,000 people will qualify subsidized private insurance coverage through Obamacare’s statewide marketplaces. And that’s just the people actively pursuing treatment — the study authors write that “an additional 124,000 people with HIV not receiving regular medical care could be newly eligible for coverage either through Medicaid or in the Marketplace,” bringing “the total estimated number of people with HIV who could gain new coverage to close to 200,000″ under Obamacare.

Fortunately, the HIV-positive Americans who won’t qualify for Medicaid or subsidized private insurance in the states refusing expansion will have at least some resources available to them. The Ryan White HIV/AIDS Program, the largest such program for people with HIV/AIDS, will still assist low-income and under-insured individuals afford treatment (although they may have to get particularly sick before that coverage kicks in). But the fact remains that 96 percent of uninsured Americans with HIV would be able to get either subsidized Obamacare plans or Medicaid coverage if all states expanded the program.

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