On Monday, we finally got a look at the American Health Care Act (AHCA), the House Republicans’ plan to replace the Affordable Care Act (ACA, or Obamacare). Responses have been swift and fairly unified across the aisle.

It’s no surprise that Democrats have been critical, but, as The Daily Beast reports, major conservative groups such as Heritage Action, Tea Party Patriots, Americans for Prosperity and Freedom Partners have also come out against the health care overhaul. Dubbing it Obamacare 2.0, Obamacare Lite and RyanCare (after GOP Speaker of the House, Paul Ryan), the conservatives claim the plan still offers too many “entitlements” and that it’ll lead to premium spikes and lower-quality care.

A slew of national organizations and major players have spoken out against the AHCA as well, including the American Association of Retired Persons, the Human Rights Campaign and the American Medical Association, which is the country’s largest group of doctors. What’s more, according to Reuters, seven hospital groups, including the American Hospital Association, America’s Essential Hospitals and the Catholic Health Association of the United States, also voiced opposition to the reform.

But what are the thoughts from AIDS organizations? As POZ mentioned in this news item, the replacement plan doesn’t look good for people with HIV, particularly low-income people or anyone with a lapse in coverage. Below is a roundup of more specific reactions from AIDS groups, which can be summed up in a three-word phrase directed at congressional committees: Please vote NO!

  

AIDS United, which works to end the U.S. epidemic through grant-making, capacity building, policy and advocacy, released a statement in which Ronald Johnson, its vice president of policy and advocacy, said: “This is the biggest attack to the health care system as we know it and the stakes are critical. Millions of people gained access to care through the Affordable Care Act, many for first time, and these gains are at risk. This isn’t an improvement to the Affordable Care Act; it is a hack job that puts tax cuts for wealthy people above the health needs of people.” For specifics on why the group opposes the GOP plan, read the full statement in AIDS United’s POZ blog here.

The HIV Medicine Association (HIVMA), an organization of professionals who practice HIV medicine, released a statement from its chair, Wendy Armstrong, MD, FIDSA, which reads in its entirety:

The HIV Medicine Association is deeply concerned about the impact of the House ACA replacement bill on the health and lives of the 1.2 million Americans living with HIV. The private insurance market elements, such as the requirement for continuous coverage and the insufficient tax credits for lower income individuals, will likely shut the door on coverage in the individual insurance market for most people with HIV. Forty percent of individuals with HIV in care rely on the Medicaid program for their health care coverage. The House proposal to fund Medicaid based on a per capita cap will shift costs to the states and threaten access to health care services and treatment for the hundreds of thousands of individuals with HIV who are covered by the program. If advanced, the ACA replacement bill stands to threaten our progress in diagnosing and treating patients with HIV and increase health care disparities both between states and based on socioeconomic status. These proposals will not only harm individuals with HIV but will compromise our nation’s public health by leaving fewer with access to the antiretroviral treatment that keeps patients healthy and reduces their risk of transmitting HIV to near zero. We strongly urge the committees to reconsider the bill and the accelerated and non-transparent process with which these proposals have been advanced.

The National Black Leadership Commission on AIDS Inc. (NBLCA), a nonprofit that educates, mobilizes and empowers the Black community to fight HIV and other health disparities, also released a statement expressing concerns about the Republican replacement plan. Noting that 41 percent of people living with HIV in the United States are African American, the NBLCA writes, in part:

The lives of women, people of color, poor people and those living with HIV, in particular, would be heavily impacted by a repeal of the ACA and a replacement that will end expanded Medicaid coverage. Medicaid coverage for people in the U.S. with HIV in care rose six percentage points between 2012 to 2014, when the coverage expansions took effect, according to the Kaiser Family Foundation. To us, these percentage points represent precious lives, and they should represent the same to the lawmakers now considering this plan.

 

Other proposed provisions, such as defunding Planned Parenthood and allowing insurers to charge higher premiums for people with preexisting conditions who experience a lapse in coverage, are alarming. Planned Parenthood provides family planning, HIV and STD testing and cancer screenings and other health care services to women who are disproportionately low-income.

The AIDS Institute, a national nonprofit that works to protect health care for people with HIV/AIDS, hepatitis and other chronic illness, sent a letter to the two chairmen of the congressional committees working on the health plan that reads in part:

 

While we agree that improvements can be made to the ACA, including the Medicaid program and the Health Insurance Marketplace, repealing and replacing them with programs that will restrict coverage and offer fewer benefits will not help patients.

 

People with HIV and hepatitis depend on consistent access to medications and cannot risk losing access to their health coverage or a cut in services, not even for a single day.

 

The American Health Care Act reduces access to health care, reduces coverage, and reduces benefits. People living with HIV, hepatitis, and other chronic and serious conditions cannot afford to go backwards by eliminating or destabilizing the health care that the ACA provides.

 

Please vote “NO” on the proposed reconciliation bills to repeal the ACA.

The Black AIDS Institute sent out a statement that breaks the Republican proposal into eight items grouped into three categories: The Good (such as “It continues to prohibit insurers from denying coverage to people with pre-existing conditions”), The Bad (“It increases the premium insurers can charge older Americans”) and The Ugly (“It eliminates the mandate that larger employers provide insurance to their employees or face penalties”).

Phill Wilson, the CEO of Black AIDS Institute, stresses that the stakes are high for people of color, for poor people, LGBT folk and, of course, for anyone living with HIV/AIDS and other chronic illnesses. “If we get this wrong, we stand to lose most if not all of the progress we’ve made on many, many fronts,” Wilson writes. “One thing for sure, we could lose any possibility of ending the HIV/AIDS epidemic anytime soon.”

The American Academy of HIV Medicine (AAHIVM), the nation’s largest group of HIV care providers, also stands against the bill. “This plan would reduce the availability of tax credits to purchase insurance for some of the poorest, while it expanding it to wealthier households who need it less,” stated Margaret Hoffman-Terry, chair of the group’s board of directors, in an AAHIVM press release. “Under this plan, young HIV patients with high health costs and low incomes could be left with less financial assistance than older healthier individuals. A plan for subsidizing insurance costs should be based on financial and medical need, not arbitrary number games.”

The AAHIVM also notes that under the proposed plan, older individuals could be charged up to five times more than younger people for coverage. “The population of older HIV patients,” said Hoffman-Terry, “is growing rapidly in this country and they should be protected from additional costs.” 

All this criticism may lead you to ask, “What, exactly, would a good health care reform plan look like, especially for people with HIV?” You can find the answers in a policy brief just released by The Fenway Institute at Fenway Health, a Boston-based health care provider for the LGBT and HIV communities.

Titled “Essential Elements of a Revised National Health Care Policy for LGBT People and People Living with HIV,” the nine-page document lays out five specific revisions that a new plan must include:

  • Requiring insurance coverage for those with preexisting conditions and eliminating annual and lifetime spending caps.
  • Expanding eligibility criteria for Medicaid and other measures to increase health insurance coverage and health care utilization.
  • Prohibiting anti-LGBT discrimination in health care.
  • Encouraging sexual orientation and gender identity data collection in clinical settings.
  • Encouraging cultural competency training.

“As Congress and the Trump administration debate what will be included in a new, national health care insurance plan, it will be important to include provisions that ensure broad access to health care insurance for LGBT people and people living with HIV,” said Sean Cahill, PhD, of The Fenway Institute at Fenway Health, in a press release about the policy brief. “The most significant of these provisions are preserving the right to insurance coverage for preexisting conditions, continuing the ban on lifetime and annual spending limits on health insurance coverage, and continuing the Medicaid expansion.”

On March 17, the Fenway Institute followed up with a 12-page policy brief that takes a closer look at the bill’s “potentially devastating consequences for low-income LGBT people, people living with HIV, and Black and Latino people.” You can read and download the brief here.