The Affordable Care Act Crystal Ball

The Patient Protection and Affordable Care Act (PPACA), or the Affordable Care Act (ACA) – also known as "Obamacare" – is supposed to see most of the law’s major provisions phased in by January 2014, with other provisions phased in by 2020. The ACA will have numerous implications generally on the United State’s health care delivery system, but more specifically on the supports and services afforded to people living with HIV-infection, or viral Hepatitis. What’s more, ongoing Medicaid expansion and the implementation of insurance exchanges will also impact nearly all healthcare providers, as well as their patients.

President Obama signs the Affordable Care Act into law on March 23, 2010.

As the full implementation of the law fast approaches, it seems to be raising more questions than providing answers. The roll-out hasn't been without its share of bumps, either. Nonetheless, many public health advocates see a lot of "positive" (no pun intended) changes coming with respect to the delivery of health care supports and services for individuals living with HIV/AIDS, as well as Viral Hepatitis.

With so many changes forthcoming under the ACA, there is no crystal ball that will show what is in store for the nation's health care system. For starters, at least pre-existing conditions will no longer prevent people from gaining access to insurance, and thus access to care. Of particular interest to stakeholders advocating for a robust AIDS Drug Assistance Program (ADAP), an ACA provision allows ADAP to count toward the true-out-of-pocket expenses (TrOOP) under the Medicare Part D program is also welcome news.

Antonio J. Carrion, PharmD, MPH, who is an Assistant Professor of Pharmacy Practice at Florida A&M University's College of Pharmacy and Pharmaceutical Services (COPPS), has outlined some of these changes in his recent blog. In fact, Carrion's analysis dispels the myth that the Ryan White CARE Act -- including ADAP -- is going away under the ACA.

The blog reads, in part: "Because of the new health care law, ADAP benefits will be considered as contributions toward Medicare Part D’s True Out of Pocket Spending Limit (TrOOP). What does that mean? ADAP clients who are Medicare Part D enrollees will be able to move more quickly through the “donut hole.” Before the ACA, this transition was very difficult for ADAP enrollees to complete" (Florida/Caribbean AETC, 10/30/13).

Another excellent resource on this topic was made available by the National Alliance of State & Territorial AIDS Directors (NASTAD), which can be downloaded here.

TheBodyPro also recently published an excellent interview with Dr. Michael Saag and Dr. Michael Wong, whereby they each shared their perspective about the upcoming ACA implementation. The article can be viewed online, here.

In the interview when asked if the law was a good or bad thing for HIV patient care, Dr. Saag pretty much summed-up the advocacy community's sentiment: "I think, overall, it's a good thing. Number one, it will put, generally speaking, more people into insurance plans, be it Medicaid or some other kind of plan. And it creates more options. In essence, there's more money flowing to clinics and flowing to cover the costs of medications, so it will give some relief to the Ryan White CARE Plan -- and we'll get back to that, I'm sure, later. But the bottom line is, it's a good thing" (TheBodyPro, 08/22/13).

Unfortunately, one other area that also tends to draw a common theme is the concern over the ACA's uneven implementation nationwide. Whereas some states, like California, Massachusetts, and New York will accept the Medicaid expansion provisions included under the law, other states, such as Alabama -- which has the largest ADAP waiting list creeping up on nearly 200 patients statewide -- plans to decline the Medicaid expansion. The South appears to be disproportionately impacted, again.

Patients, advocates, providers and healthcare professionals alike would be well-advised to obtain the latest information about the ACA, its implementation, and how it might affect the healthcare delivery for individuals living with HIV/AIDS, and/or Viral Hepatitis. One thing is for certain, it remains very fluid.

To that end, the ADAP Advocacy Association (aaa+) -- in partnership with the Community Access National Network (CANN) Great Lakes ADA Center, and HealthHIV -- is hosting an educational webinar on Wednesday, November 6th, 2013. The webinar, themed "Impact of the Affordable Care Act, Medicaid Expansion & Insurance Exchanges on HIV/AIDS and Viral Hepatitis Services," will be open to all HIV/AIDS and Virtal Hepatitis stakeholders nationwide. It is free, so there is no excuse not to participate and learn more about what changes are coming...

Learn More about the Impact of the Affordable Care Act, Medicaid Expansion & Insurance Exchanges on HIV/AIDS and Viral Hepatitis Services

SANDBOX STANDOFF: Day 11

It has now been 11 DAYS since the government closed its doors on the American people because the politicians in Washington, DC are more concerned with scoring political points and posturing on the cable news programs rather than collectively doing their job; in the meantime, people living with HIV/AIDS -- and many other underserved populations -- scramble to make ends meet, including how the shutdown is impacting their daily lives. Some political pundits have described the current partisan rancor on Capitol Hill as nothing less than a bunch of cranky children fighting over a sandbox. The ADAP Advocacy Association (aaa+) agrees.

The negative consequences of the current political stalemate between the President, House Republicans (especially the Tea Party element of the GOP) and Senate Democrats cannot be under-estimated, or maybe even truly comprehended without digging deeper. But recent new reports provide ample evidence that the budget debacle is already raging havoc on the nation's public health system.

The Washington Blade reported that the shutdown will prevent the Health Resources & Services Administration (HRSA) from properly monitoring grants administered under the Ryan White CARE Act -- including the AIDS Drug Assistance Programs. And after the debacle with the Florida ADAP several years ago, there is plenty of reason for advocates to be concerned over the loss of federal oversight. The impasse also will halt the seasonal influenza program. It even means potential delays in Food and Drug Administration (FDA) approvals of new drugs, as well as delays in clinical trials at the National Institutes of Health.

The online publication, Medical Economics, has made available a listing of healthcare agencies being affected by the shutdown.

With so much of the blame being placed at the feet of the Tea Party, it is rather ironic that one of the nation's leading coffee retailers has entered the fray. On October 10th, Starbucks launched its "Come Together" campaign designed "to harness the sentiment many of us are feeling — a growing concern about the lack of progress from our Congressional leadership to work together to resolve the business of the American people." The company is encouraging people to sign an online petition at www.ComeTogetherPetition.com.

All ADAP stakeholders -- especially people living with HIV-infection -- are encouraged to contact their elected federal lawmakers in Washington and urge them to end the government shutdown. Lives are at stake!

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