Improving Health Equity for Gay Men through the Affordable Care Act

By Amy Killelea July 10, 2013

HIV/AIDS disproportionately impacts gay men and other men who have sex with men (MSM), particularly gay men/MSM of color, in the form of higher infection rates, less likelihood of timely linkage to care, and less likelihood of viral suppression. To make headway against the epidemic and to meet the goals of the National HIV/AIDS Strategy (NHAS), we need tools and strategies that are aimed at improving prevention, access to care, and retention in care for gay men/MSM.

Educating Gay Men about New Coverage and Enrollment Options

The Affordable Care Act (ACA) provides the tools to allow us to address the health care crisis among gay men/MSM; however it will take leadership and vision to ensure that we are using these tools to scale up HIV/AIDS prevention, care, and treatment for this population. The threshold question is: how do we ensure that gay men/MSM are aware of new coverage options through the ACA and apply for and enroll in coverage? The following provides a place to start:

1.   Ensure that community organizations focused on gay men/MSM are part of ACA outreach and enrollment programs.

  • The ACA includes a number of programs and initiatives aimed at making sure that people know what coverage options are available and assisting them in applying for and enrolling in coverage. These programs include funded grant opportunities through the Marketplaces (e.g., Patient Navigators) as well as training and certification opportunities for outreach and enrollment workers (e.g., Certified Application Counselors).
  • Many AIDS Service Organizations and case managers are preparing to undergo ACA outreach and enrollment training to be able to help assist clients into new coverage options. In order to reach gay men/MSM – particularly young gay men/MSM – the community organizations that are already working closely with this population should access these training and funding opportunities.
  • In addition to accessing ACA training and certification programs, community organizations and linkage to care programs focused on gay men/MSM should think innovatively about how to incorporate education around ACA coverage options into their existing programs.

2.   Develop tailored messages and scripts on what the ACA means for gay men/MSM.

 Open enrollment through the Marketplaces begins October 1, 2013. In preparation for open enrollment, health departments, providers, and community organizations are working to develop messages and scripts to ensure that people living and at risk for HIV are aware of new coverage options and the benefits of applying and enrolling in Medicaid or Marketplace coverage. National organizations – such as Enroll America – are already developing templates that may serve as a framework for creating more targeted messages aimed at gay men/MSM.

3.   Continue to address stigma in health care settings.

A closely related issue to education efforts around outreach and enrollment is whether the health care settings and providers that newly insured people will seek care will be equipped to offer culturally competent care. Providers must recognize the effect of racial bias and same-sex stigma on meaningful access to care and develop practices that address these structural barriers to care. NASTAD and the National Coalition of STD Directors (NCSD) have developed a series of tools to help address stigma and improve access to culturally appropriate care. Ensuring that broader health care systems and providers – including community health centers – are able to provide culturally competent care free of stigma is essential to make sure we are maximizing public and private insurance expansions available through the ACA. These tools and practices could be integrated into broader outreach and enrollment efforts as well, such as Patient Navigator and Certified Application Counselor training.

Without outreach and enrollment efforts that are tailored to reach gay men/MSM, we will have built a new system of care and treatment that remains foreclosed to populations who do not know how to enroll, do not know why they should enroll, and do not trust that the system is able to provide care and services that are free of racial bias and stigma. Over the coming weeks and months, new and innovative strategies that coordinate linkage to care efforts with ACA client education, outreach, and enrollment efforts will be necessary to ensure we are using the ACA to truly address health disparities.

What additional strategies could be included to ensure that gay men/MSM understand and enroll in new ACA coverage? Share your suggestions below.