Shortly after the 2017 presidential inauguration, the web page for the Office of National AIDS Policy was removed, and terms such as “LGBT,” “Lesbian,” “Gay,” “Bisexual” and “Transgender” were stripped from the new White House website. A few weeks later, the Trump administration lifted federal guidelines that said transgender students should be allowed to use public school bathrooms and locker rooms matching their chosen gender identity. There is still no mention of HIV and AIDS in President Trump’s health care policy. Now the Republican-led U.S. House of Representatives is attempting to fast-track its Obamacare replacement plan. And we have every reason to be frightened and angered by the proposed plan and its potential outcomes.
According to the Department of Health and Human Services, before the Affordable Care Act was passed, 24 percent of people with HIV had no health insurance coverage at all. There are 1.2 million people in the U.S. already living with HIV. Health insurance is vital to keeping viral suppression rates up and infection rates down. The ACA provided critical subsidies for private insurance and expanded Medicaid in 31 states and the District of Columbia, which increased access to medical treatment. It also guaranteed coverage for people with preexisting conditions such as HIV and covered HIV testing. Finally, by funding prevention efforts of HIV and AIDS service organizations, the ACA was playing a big role in keeping the virus from being transmitted to our most vulnerable communities — transgender women of color, and young men of color who have sex with men.
The Centers for Disease Control and Prevention estimates that in the United States, one in two black MSM and one in four Latino MSM will be diagnosed with HIV in their lifetime. The plan that Republican congressional leadership is preparing to fast-track could be particularly problematic for communities at higher risk of HIV infection as well as the entire LGBT community. By gutting Medicaid expansion and other benefits, the proposal could complicate PrEP access and promotion in the states that adopted Medicaid expansion. If passed, the new bill will begin to eliminate money for Medical expansion in 2020, potentially blocking new applicants and access to critical medication. PrEP, a once-a-day dosage of a preventative drug that is 99 percent effective when taken as prescribed, is essential to efforts to end the epidemic nationwide. Reducing access and availability of PrEP has the potential to further spread the virus, as many have come to rely on this strategy to stay negative.
Facets of the Obama administration’s health care policy sought to combat homophobia and stigma, while the current blueprint to replace ACA makes no mention of HIV and AIDS. That coupled with Vice President Pence’s track record when it comes to the epidemic creates a serious cause for concern. As a congressman in 2011, his proposed amendment to defund Planned Parenthood passed the House. In 2013, during his first year as governor of Indiana, Scott County’s only Planned Parenthood (and only HIV testing center) closed, leading to an unprecedented HIV outbreak, which took months to temper due to Pence’s dangerous stance on needle exchanges.
Make no mistake — gutting the Affordable Care Act will have widespread impacts that stretch beyond HIV and AIDS. The repeal and replacement would cause 24 million people to lose health insurance within a decade, according to the nonpartisan Congressional Budget Office. And a report from the Children’s Defense Fund found that more than two million children in New York alone are now at risk of losing coverage or benefits once ACA is repealed.
We must think back to the 1980s, when HIV and AIDS were on the rise and we were losing our friends and loved ones at alarming rates. Over three decades later, and our nation is at a perilous crossroads. If we move forward with a health care plan that causes millions of Americans to lose insurance and doesn’t prioritize HIV and AIDS testing and funding, we could see one of the deadliest epidemics of all time resurface. I urge members of Congress not to make this mistake — do not pass the Trump administration’s replacement plan for the Affordable Care Act.
KELSEY LOUIE, MSW, MBA, is the chief executive officer at Gay Men’s Health Crisis, where he oversees all operational, programmatic, and strategic aspects of the organization. He has over 13 years of professional experience in the fields of HIV and AIDS prevention and care, behavioral health, addiction services, homelessness, LGBTQ issues, and family and children services.