ACA Turns Four: Recognizing Successes and Looking Ahead

By Xavior Robinson March 24, 2014

March 23 marked the fourth anniversary of the Affordable Care Act (ACA). While it is undeniable that the ACA’s inaugural open enrollment period has had its share of challenges, it is important to recognize that the movement to ensure that all Americans have equitable access to health care transcends the technology failures of Over the past four years, state HIV/AIDS programs have worked to adapt and innovate to meet needs of people living with HIV and co-occurring conditions in our evolving health care landscape. Through the use of innovative solutions (see Raising the Bars), support from colleagues and staff, and an enduring commitment to the broader public health imperative presented by HIV, state AIDS directors have leveraged the ACA to achieve remarkable results, including:


1. Overcoming Glitches.

State HIV programs strengthened partnerships and formed new ones to engage eligible clients into coverage. Most HIV programs directly delivered or collaborated with community-based organizations to provide in-person enrollment assistance to clients through the patient navigator program and certified application counselors. In the face of glitches many programs sustained enrollment via mail and telephone.

Looking ahead: Programs will continue enroll eligible clients into Medicaid throughout the year, monitor client eligibility for a special enrollment period, and urge clients that do not have minimum essential coverage to seek an exemption from the individual mandate.

2. Maximizing Insurance Purchasing Programs.

Over the past four years, programs have worked to build and ramp up insurance purchasing programs to assist clients with the costs associated with newly available private insurance coverage. Most recently, HIV advocates (including NASTAD and our members) successfully advocated for a federal regulatory requirement that health insurance companies that offer QHPs accept third-party payments from Ryan White Programs. This victory protects health insurance coverage for tens of thousands of people living with HIV who will rely on Ryan White Program insurance purchasing programs to afford their coverage.

Looking ahead: State HIV/AIDS programs are using lessons learned from the first year of open enrollment to inform activities aimed at increasing access to private insurance coverage for eligible clients in November of 2014, including coordinating across Ryan White Programs to fill remaining affordability gaps and advocating for federal protections to ensure that coverage is affordable. 

2. Facilitating More than 16,000 Enrollments. State HIV programs have facilitated the enrollment of more than 16,000 people living with HIV into Qualified Health Plans and expanded Medicaid and continue to enroll clients as the first open enrollment period comes to a close at the end of March.

Looking ahead: State HIV programs are developing mechanisms to track client eligibility and enrollment into coverage options, monitor QHPs for compliance with the ACA’s consumer protections and market reforms, and report any implementation challenges.

We want to hear from you! Use the comment box below to share your top three ACA-related victories during open enrollment.