Understanding ‘Obamacare’

What the Affordable Care Act means for the LGBT community
by Megan Smith

Obamacare seems to have American opinion split right down the middle. Some have cars plastered with “I [Heart] Obamacare” bumper stickers, while others think the Affordable Care Act will be the demise of the nation. No matter what side of the healthcare reform debate you are on, you have to admit, at over 900 pages, the act is hardly bedside reading. Information on the reform tends to travel like a game of telephone—resulting in a twisted and mangled version of the original. However, the Affordable Care Act has major effects on Texans, including the HIV-positive community. OutSmart is here to untangle, decode, and analyze the truth about Obamacare.

The Facts

HIV and AIDS have not disappeared, especially in the Lone Star State. As of December 2010, over 65,000 people were living with HIV in Texas. These numbers continue to increase about 6 percent per year, according to a 2011 State Healthcare Access Research Project (SHARP) report. The LGBT community continues to be hit hard by these numbers, with men who have sex with men accounting for 61 percent of all new exposures in 2010. Out of all these cases, 36 percent received no medical care in 2008.

Funding for HIV and AIDS treatment is currently a mixture of federal, state, and local contributions. The most prominent AIDS-specific funding in Texas is the Ryan White HIV/AIDS Program, which provides HIV-related services in the United States for those who are uninsured. The program provided over $150 million for AIDS and HIV care in 2009, according to the SHARP report. Although beneficial, this funding only covers care that is related to HIV and AIDS and is not equivalent to the benefits of full health insurance.

Bring on the Expansion

The Affordable Care Act brings big changes to the way HIV and AIDS patients receive care, especially at Houston’s Legacy Community Health Services. The biggest change results from the reform’s Medicaid expansion, which allows most people earning up to 133 percent of the Federal Poverty Level (a yearly income of about $15,000 per year for a single person) to be eligible for health insurance under the Medicaid program. With this expansion, 75 percent of Legacy’s patients that are currently funded under Ryan White would switch over to Medicaid coverage. This switch would provide them with health services that are not specifically related to their HIV-positive status. “This means people would have care not only for their HIV, but full health insurance,” Randall Ellis, senior director of government relations at Legacy Community Health Services, says. “This would give them coverage if they were to get sick with
anything else not related to their HIV, like if they break a hip or get hurt in a car accident.”

The elimination of a disability requirement for Medicaid eligibility is another change impacting the HIV-positive community. Because HIV has evolved into a chronic, manageable disease, very few people living with the virus qualify for disability status. Thanks to improvements in treatment, they can usually remain employed and live longer than before. By doing away with the disability requirement, most people living with HIV and AIDS that live at or below 133 percent of the Federal Poverty Level become eligible for full Medicaid coverage.

The reforms don’t leave the middle class high and dry, either. For a large number of people living at up to 400 percent of the Federal Poverty Level (with an annual income of almost $50,000 a year for a single person), the healthcare reform provides subsidies to assist them in purchasing full health insurance. “Across the board, HIV or not, we have the highest rate of uninsured residents in our state,” Ellis says. “So we stand to gain the most from this law in terms of picking people up under a Medicaid expansion or changing the coverage laws so that people can afford and are able to buy health insurance. So people living with HIV, who currently aren’t able to purchase it because of a pre-existing condition, would be able to buy health insurance.”

Although the Affordable Care Act significantly increases the number of insured people, Ryan White funding is still a necessity to cover those who fall through the cracks, Ellis says. The healthcare reform does not cover a growing population of Texans—undocumented immigrants. “If we call it Ryan White, if we call it something else, there will still be a group of folks who are uninsurable,” Ellis says. “They either choose not to purchase health insurance and pay the penalty instead, or they’re undocumented folks. Ryan White covers people living with HIV regardless of your citizenship status. It’s a communicable disease that we reduce the transmission by treating people. It’s a public-health principle that when you have a disease like that, you treat it, keep it down, and keep it from spreading. That’s the public-health science behind why it’s a good idea to treat everyone, regardless of their citizenship status.”

Did Rick Perry Make Another ‘Oops’?

In a recent decision by the Supreme Court, the Affordable Care Act was upheld. However, the court also ruled that the states have a choice whether or not to participate in the expansion of Medicaid eligibility. Following this decision, Rick Perry released a letter of refusal to participate in the Medicaid expansion. Perry said the expansion would “not result in better ‘patient protection’ or in more ‘affordable care,’” but rather, “make Texas a mere appendage of the federal government when it comes to health care.”

Ellis strongly disagrees with Perry’s statements. “It seems ridiculous that we would turn away federal tax dollars, which we’ve paid already, in order to continue to pay tax dollars to a local county,” Ellis says. “We’d be paying taxes twice instead of paying once and getting that money back.”

Luckily for Obamacare supporters, the matter is not completely up to Perry. The state legislature must also refuse to participate in the Medicaid expansion, which hasn’t happened—yet. How the legislature will vote on the issue is unclear, as Perry did not consult with them before releasing his letter of refusal. Ellis believes the governor is simply revving up anti-Obama sentiment during the election year, while setting Texas up for compromise on the healthcare legislation. “There are legislators on both sides of the aisle that are upset that he has come out and announced this when it is a decision the legislature has to make,” Ellis says. “He announced this without consulting with the legislature, and without discussing and talking about the true benefits of what the program would provide.”

Do Something About It

If you decide to stand by Legacy and Obamacare, there are ways you can help, Ellis emphasizes. Legacy is continually trying to build their grassroots movement within the community. On their website, you can sign up for their advocacy list or to volunteer with the organization. Through the advocacy project, you can help support and promote policies for HIV prevention, treatment, and care for people living with HIV and AIDS and quality healthcare for Texans. “We must not let politics stand in the way of providing cost-effective solutions to our healthcare crisis,” Katy Caldwell, executive director of Legacy says. “We can’t afford to shut out those in need of care.”


Megan Smith

Megan Smith is the Assistant Editor for OutSmart Magazine.

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