The Merriam-Webster dictionary defines “care” as “a feeling of interest or concern.” It is that interest and concern that helped build a nation of equality and compassion. American activist Marian Wright Edelman once said, “You really can change the world if you care enough.”
But truthfully, care is what this country needs to work on the most: health care, child care, Medicare, human care.
While advocating for the care of the people of Illinois and greater United States is among my daily privileges, it is exhausting — especially when there are individuals in politics ready and able to strip health care from those who otherwise would not be able to afford or qualify for it. In fact, it seems like many Republicans these days are aiming to repeal or defund anything that has to do with the word “care.”
The Republicans' proposed American Health Care Act — or as I’d like to call it, Don’t Be Sick, Poor, Disabled or Old Act — will cause millions of people to become uninsured and face higher premiums and out-of-pocket costs. This includes hundreds of thousands of Americans living with HIV who are insured under the Affordable Care Act and Medicaid.
Before the ACA was passed, HIV was essentially an uninsurable condition — more commonly called a “preexisting condition,” in reference to health care coverage. But with a health care system that treats their well-being as a high priority, individuals living with HIV and particularly, low-income people of color, have suddenly become insurable.
Considering how the Republicans' health plan greatly favors the healthy and wealthy while leaving everyone else more vulnerable, one would think that the bill’s authors would reward those taking preventive measures to ensure they remain healthy. Among those preventative measures currently covered under the ACA is PrEP (pre-exposure prophylaxis), a daily HIV prevention pill that is up to 99 percent effective when taken consistently and correctly. Sadly, it probably won’t be covered or affordable under the Republicans replacement plan.
And, for nearly six years, PrEP has been covered by Medicaid and marketplace insurance in most states — contributing to a decrease of new HIV cases each year. Between 2012 and 2015, roughly 80,000 individuals in the U.S. have acquired PrEP prescriptions, estimates Gilead Pharmaceuticals, the manufacturer of PrEP drug Truvada. In Illinois, the number of people diagnosed with HIV decreased by 26 percent over the past decade, and PrEP played a role in that success.
PrEP under the American Health “Care” Act would be harder to get for two reasons:
1. Premiums will go up for marketplace insurance, and subsidies will decrease, making it astronomically harder for people to afford insurance, so they won't get it. 2. The federal government will cap funding for Medicaid at rates that will force states to cut eligibility and benefits, meaning low-income people won't get coverage at all.
PrEP prevents HIV, and today, Medicaid and marketplace plans cover PrEP so people who are vulnerable to HIV can access it. But if any of that changes, we’ll see more cases of HIV. It’s that simple.
The AIDS Foundation of Chicago estimates more than 12,000 Illinoisans living with HIV will lose their health insurance if the ACA is repealed without an adequate replacement. That is one in three individuals living with HIV in the state.
It has also been proven that people living with HIV on successful antiretroviral treatment — meaning their viral load is undetectable for at least six months — cannot transmit HIV sexually to their HIV-negative partners. This newly proposed plan would cut off the recent progress in HIV treatment and prevention at its knees, completely reversing decades of hard work at the expense of innocent lives.
To put this simply: any disruption in health care coverage will lead to the disruption of care. Any disruption of care, such as access to HIV medications for treatment or prevention, will result in more HIV diagnoses. Period.
So again, I ask: Where is the care when addressing public health, especially for the most vulnerable among us?
It is time that all Americans, regardless of their party affiliation, stand together and fight for their fellow citizens and constituents, regardless of their HIV status.
It is time that we stop treating HIV as an uninsurable, taboo, and fatal condition, and advocate for the continued coverage of PrEP and HIV medications under Medicaid and marketplace insurance.
It is time that we call our federal legislators to advocate against the American Health Care Act and be certain that whatever replaces the ACA protects vulnerable groups, such as those living with and vulnerable to HIV.
It is time our health system starts to care.
JOHN PELLER is president and chief executive officer of the AIDS Foundation of Chicago.