The So-Called American “Health Care” Act Would Put Americans’ Health At Risk

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March 17, 2017
Photo by: Gage Skidmore
Paul Ryan, Speaker of the House

Now that Congressional Republicans are being forced to slow down and consider the real world effects of the GOP’s so-called “replacement" for Obamacare, otherwise known as the American Health Care Act (AHCA, or “Trumpcare”), they have no excuse for ignoring its ramifications for the health of our country.

Twenty-four million. That’s how many people it is estimated would lose coverage under Trumpcare.

And while many communities would face obstacles to coverage and care as described by the Congressional Budget Office (CBO) report this week, the truth is that the AHCA’s effects on people living with or at higher risk for HIV could be devastating. And for those for whom multiple systemic oppressions intersect, the AHCA could be deadly.

HIV has risen among young gay and bisexual men over the past decade, particularly young men of color.

New CDC data shows a slight improvement in the rate of new cases among young Black gay and bisexual men, but an alarming rise in cases among young Latinx gay and bisexual men. Additionally, although HIV prevalence among transgender men is relatively low, studies suggest that transgender men who have sex with men are at substantial risk for HIV.

No one plans for an HIV diagnosis, and young people often find it difficult to fit health care insurance into their budgets – and must prioritize spending limited income on other things.

By making coverage optional and allowing insurance companies to penalize those trying to re-enter the market with a 30% premium increase, the AHCA is a recipe for more young gay and bisexual men with HIV, but without access to care.

We still don’t have much data on exactly how many transgender women are living with HIV, but this we know: the percentage is very high.

Approximately 28% of transgender women in the U.S. – and over half of Black transgender women — are living with HIV. In other words, Black trans women have the country’s highest HIV rates.

It’s no secret (though it is appalling) that transgender people, particularly trans women of color, face tremendous income inequalityRacism and discrimination in seeking employment are real. This and other hurdles, such as a lack of family support, educational opportunities and stable housing, make securing the kind of full-time employment that would come with employer-based health care insurance all the more difficult. And even for transgender people able to personally overcome these barriers to employment, the AHCA would make it easier for employers to provide inadequate coverage.

All of these challenges and less affordable care under the AHCA add up to more transgender women – especially trans women of color – with HIV, but without access to care.

When HIV intersects with the oppressions that come with race, sexual orientation, gender identity, income level and age it is very likely that the AHCA will be deadly.

More than 40% of people living with HIV who are receiving medical care receive that care through Medicaid.

And the percentage of all people living with HIV who are Medicaid-eligible, including those who are not yet diagnosed and those who are not in care, is likely higher.

By block granting Medicaid and imposing a per-person cap on Medicaid spending in order to give tax cuts to the rich, the AHCA will contract Medicaid eligibility and make it much harder and less likely that states will provide even adequate coverage to people living with HIV, especially those living with co-morbidities such as hepatitis C, diabetes or heart disease.

The AHCA’s cuts mean significantly more members of our community with lower income and with HIV, but without access to care.

It is estimated that over 40% of people living with HIV in the U.S. are over age 50.

Because more significant health conditions come with age, as a person grows older, health care takes up an ever-larger percentage of their budget. When HIV is one of those conditions, health care can bust that budget.

By allowing insurers to charge older people five times what they charge younger people, the AHCA would move health insurance beyond the reach of more people over 50. Between increased premiums and high out-of-pocket costs for co-pays, co-insurance and deductibles, older people living with HIV will be pushed right out of the market.

Shifting health care costs from younger people to older people under the AHCA will result in more older people with HIV, but without access to care.

Photo by: LaDawna Howard

An increase in people living with HIV, but without access to care — and the treatment that makes it nearly impossible for HIV transmission to occur — means more new cases of HIV.

As Lambda Legal has argued in two amicus briefs to the Supreme Court regarding the validity of the Patient Protection and Affordable Care Act (Obamacare), providing everyone with access to affordable quality care not only makes sense in the name of protecting our basic human rights, but also safeguards public health. The AHCA does neither.

When HIV intersects with the oppressions that come with race, sexual orientation, gender identity, income level and age it is very likely that the AHCA will be deadly.

If we want to continue to reduce the number of new HIV cases (spoiler alert: they are actually going down right now) and end AIDS in this country, we must stay the course to truly universal health care.

Take action now to let your members of Congress know that you don’t want #TrumpDONTCare.

We do not come even close to describing all the many ways in which the AHCA would be bad for the health of this country (reproductive and women’s healthcare would also be devastated, for instance), but the bottom line is this: Trumpcare would halt – or possibly reverse – the tenuous gains we’ve made in the fight against HIV/AIDS.

Click here to contact your Senators or Representatives. Call and tell them this:

The American Health Care Act would be dangerous for people living with or at higher risk for HIV. It would be destructive to the LGBT community, harmful to people of color, bad for the health of people with low income, an unacceptable substitute for older people and seniors and wildly unhealthy for the health of all Americans.

We won’t go back. #WeObject to health care for only some, and not all.