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Reports Look at HIV+ and LGBT People Gaining Health Coverage Under Obamacare

Nearly 200,000 people with HIV will be eligible to obtain health coverage through the Affordable Care Act (ACA) -- better know as Obamacare -- which also includes provisions to improve access to care for lesbian, gay, bisexual, and transgender (LGBT) people, according to 2 new Issue Briefs from the Kaiser Family Foundation.

KFF -- a non-profit not affiliated with the Kaiser Permanente health system -- developed its estimates using data from the Centers for Disease Control and Prevention (CDC) Medical Monitoring Project. Since open enrollment in the exchanges only started last October and has been hampered by problems with the Healthcare.gov and some state websites, it is too soon to analyze how many HIV positive and LGBT people have actually signed up.

According to the HIV brief (available online), about one-third or 407,000 of the 1.2 million people living with HIV in the U.S. are currently receiving care. Most of these -- nearly 90% -- have incomes that make them eligible for ACA subsidies (less than 400% of the federal poverty level) and about 40% now receive Medicaid.

KFF estimates that among the 70,000 HIV positive people in care who are not currently insured, nearly 23,000 will be eligible for ACA marketplace plans, in most cases with financial assistance, while about 47,000 would qualify for expanded Medicaid. However, the report notes that half of the states -- including some with high numbers of low-income people with HIV -- have so far refused to expand their Medicaid programs. In addition, some 124,000 of the 700,000 HIV positive individuals who are not now in care stand to gain ACA coverage.

KFF emphasizes that the Ryan White CARE Act -- which includes AIDS Drug Assistance Programs (ADAPs) -- will remain "critical," both to fill gaps in private insurance or Medicaid coverage and to help people who will remain ineligible for coverage under the ACA, such as undocumented immigrants.

Turning to the LGBT brief (also available online), this population will benefit not only from the ACA, but also from the Supreme Court’s recent Defense of Marriage Act (DOMA) ruling and new state same-sex marriage laws, which will give many people access to coverage under their spouses' insurance. (Policy changes that allow gay -- but not yet transgender -- people to serve openly in the military also opens up eligibility for veteran's health benefits.)

In addition to financial coverage, the LGBT brief also looks at other challenges and barriers these populations may face in accessing health care, including stigma, discrimination, violence, rejection by families, inequality in the workplace, substandard care, and outright denial of care due to sexual orientation or gender identity. In addition to HIV, other major health concerns include mental illness, substance use, and sexual and physical violence.

The ACA not only expands financial access to health coverage, but also includes free preventive care and provisions that prohibit health care discrimination and initiatives to improve the health and well-being of LGBT individuals, families, and communities.

1/23/14

References

J Kates, R Garfield, K Young, et al. Assessing the Impact of the Affordable Care Act on Health Insurance Coverage of People with HIV. Kaiser Family Foundation Issue Brief. January 7, 2014.

U Ranji, A Beamesderfer, J Kates, and A Salganicoff. Health and Access to Care and Coverage for Lesbian, Gay, Bisexual, and Transgender Individuals in the U.S. Kaiser Family Foundation Issue Brief. January 8, 2014.