Citizens Concerned About ACA Reform Impact on HIV Epidemic in the South
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As a physician working in the New Orleans area my specialty is the prevention and treatment of HIV. I, and the undersigned, have grave concerns about the two recent repeal battles regarding the ACA. We worry that a Republic-led repeal might harm the health and welfare of people in our state and worsen the HIV epidemic in our region. We know ACA reform will come to a vote again and we urge you to reconsider your positions on pre-existing conditions and making drastic cuts to Medicaid and Medicare.
People in Louisiana know that the pre-ACA system was seriously flawed, especially for people living with HIV (PLWH). Many couldn't afford or didn't have access to employer-based insurance. Many more were priced out because their HIV status was listed as a serious "pre-existing condition."Those that did find coverage became part of a "high risk pool" system that segregated them into high premium plans with inadequate coverage and subsidies. As part of ACA-repeal we have heard twice that states could return to the pre-existing condition era and high risk pools with stripped-down subsidies. Is this not a return to a harmful status quo?
Prior to ACA, many PLWH fell into a dangerous health and medical insurance cascade. Many would start out employed but struggling to afford medical insurance until their condition left them with little income or caused significant disability. They would then qualify for Medicaid. For many it meant progressing to AIDS before having any real chance at comprehensive medical services for their HIV. As part of ACA-reform, we have heard twice of deep cuts to Medicaid expansion and placement of per-person caps on benefits. This could be especially dangerous for PLWH as more than 40% now receive medical care through Medicaid according to national statistics. Is this not a return to the same dangerous health and medical insurance cascade?
The losers will not only include PLWH if we return to the failed framework before the ACA. It will include many more Americans in rural and underserved areas. We are at an important crossroads for the health and welfare of people in Louisiana and also the entire nation. We need your help to cut through the politics of the moment and see to it that ACA-reforms put people over partisanship.
Dr. Christopher Garnett MD/MPH
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