After a three and a half year wait – and several near-death experiences along the way – open enrollment under the Affordable Care Act (ACA) is finally here. On October 1st, 2013 the Marketplaces officially open for business, and millions of people will begin to apply for new public and private insurance coverage options. At this point, we all know the incredible opportunities to expand HIV and viral hepatitis prevention, care, and treatment that are at stake. Now is where the rubber meets the road as federal, state, and local advocates, providers, and programs roll up their sleeves and prepare for full implementation. Below are four action items the HIV and viral hepatitis community should be focusing on as we leap into open enrollment and beyond:
1. Be ACA messengers
The entire HIV and viral hepatitis community – including health departments, AIDS Service Organizations (ASOs), medical providers, case managers, and people living with HIV – are going to be on the front lines of making sure people living with and at risk for HIV know about and enter into new ACA coverage options through the Medicaid expansion and through Marketplace coverage. We can build the very best public and private insurance system in the world, but if people don’t know about it or how to get into it, or why it will benefit them, the ACA will not progress past being a very good idea that looked pretty good on the thousands of pieces of paper it was written on. This is particularly true for populations who already experience significant disparities in accessing care and treatment – including young gay and other men who have sex with men (MSM) of color – because of stigma, discrimination, and other barriers. 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 and reach every community.
2. Serve as an early warning system as the ACA transition unfolds
As much as the ACA law and regulations envision a consumer- friendly, simple and smooth enrollment process and as much as I firmly believe we will eventually get there, there are going to be bumps in the road. And that is to be expected. No massive policy shift of the size and scale of the ACA could ever be implemented entirely without challenges. As program staff, case managers, and outreach and enrollment counselors on the frontlines of ACA transition and expanded access to public and private insurance for tens of thousands of people living with HIV, we all must prepare to act as an early warning system for how well new systems are working and for what we need to fix along the way. This includes assessing cost, provider networks, and scope of coverage as soon as detailed plan information becomes available on October 1st and identifying and reporting plan discrimination, enrollment challenges, and barriers to meaningful to access to care.
3. Continue to advocate for Medicaid expansion in every state
The Medicaid expansion is the single most significant piece of reform for people living with HIV and viral hepatitis, and in states not yet expanding Medicaid the advocacy battle in state legislatures and governors’ offices is far from over. The tide has already turned in many states whose policymakers have recognized the individual health, public health, and economic reasons to expand Medicaid, and over the coming months and years, diverse advocacy coalitions will continue to push their states to expand Medicaid.
4. Be innovators
We are at an incredible time of change in our health care system with significant implications for the future of HIV/AIDS programs, services, and models of care. The HIV community knows intuitively that insurance coverage – while absolutely essential – does not replace public health, does not replace the Ryan White Program, and does not replace prevention and care programs and infrastructure that have demonstrated success in preventing new infections and linking and retaining people living with HIV and viral hepatitis in care. But, we have to make that case. At every opportunity. Over the coming years, the HIV community will be charged with re-envisioning the Ryan White Program amidst this massive change. This conversation goes beyond Ryan White Program reauthorization – instead, at its core, it is a conversation about the future of HIV/AIDS prevention, care, and treatment in this country moving forward. Already, state AIDS Drug Assistance Programs (ADAPs), linkage to care programs, and ASOs are launching innovative programs to maximize new ACA public and private insurance coverage options and demonstrate the one/two punch of insurance coverage with vital public health programs and services. Programs will continue to innovate in line with scientific advances, policy shifts, and funding shifts and share best practices to inform large scale changes.
There will be many more action items over the coming months and years. During this incredible time of change and uncertainty, it may be easy to get lost in the challenges and the complexity – but even with the challenges, we as a nation are at an historical moment in terms of the opportunity to transform our health care system and to expand access to care for people living with HIV and viral hepatitis.
As HIV/AIDS and viral hepatitis programs prepare for open enrollment, here are relevant resources NASTAD has compiled: NASTAD Health Reform Alert - September 30, 2013: Open Enrollment Resources.