Three decades ago, as a result of the Reagan administration’s silence and inaction, we saw HIV grow into a devastating epidemic that cost millions of dollars and hundreds of thousands of American lives. As a young man living in Wisconsin, I watched friends and neighbors die of an illness that my government would hardly acknowledge or mention by name.
Since the early days of the AIDS crisis, we have forged countless successes in the fight against HIV. But now, President Trump and the Republican-led Congress may be on the verge of taking an axe to 30 years of progress.
The latest iteration of the American Health Care Act (AHCA) proposed by the GOP jeopardizes years of advancements and strategies — such as the National HIV/AIDS Strategy and New York State’s pioneering End the Epidemic Blueprint — that have brought us within reach of ending the HIV/AIDS crisis in America.
The Affordable Care Act (ACA) extended health insurance coverage to thousands of people living with HIV by expanding Medicaid, helping them afford their medication and stay in treatment. Adherence to this treatment is essential for HIV-positive people to achieve and maintain an undetectable viral load. It enables them to lead healthier, more productive lives by returning to the workforce and actively contributing to our economy. It also greatly reduces the chance of transmission. As a result of the Medicaid expansion, Medicaid coverage for HIV-positive people rose from 36 percent in 2012 to 42 percent in 2014.
The AHCA proposed Medicaid cuts would be disastrous for the people living with HIV. Prior to the ACA, low-income people living with HIV could only qualify under Medicaid when their HIV infection had advanced so that they were developing AIDS or advanced disease. This was shoddy economics and bad health policy, resulting in far greater costs and suffering than needed to be.
Turning Medicaid into a block grant or per capita cap program, as proposed in GOP plans, would decrease access to health care services for the people who need it the most without addressing the rising cost of care. Once the cap is met, states would be forced to either come up with more money or cut services. And unlike our current Medicaid system, a capped or block granted program can’t be scaled flexibly, without legislative action, to address changing health care needs during crises.
Additionally, the current proposed version of the AHCA gives states the option to opt out of covering essential health benefits and many other critical provisions, including HIV medications. Lack of access to routine preventive care and health screenings means less access to HIV testing and prevention methods such as PrEP (pre-exposure prophylaxis), which is more than 90 percent effective in preventing new infections.
Preventing just one new HIV infection can save upwards of half a million dollars in estimated lifetime medical costs, which are typically paid for by Medicaid and federal programs. At Amida Care, New York’s largest Special Needs Health Plan (SNP) for people with chronic conditions such as HIV, over 75 percent of our HIV-positive members have viral loads that are undetectable, meaning that they require significantly less costly care. This saved New York State more than $110 million between 2008 and 2015.
As a businessman, President Trump should know that an upfront investment can pay dividends for years. By investing now in the comprehensive care needed to keep people living with HIV healthy, the government can save millions of dollars in costly hospitalizations and in-patient care.
HIV doesn’t discriminate and knows no political boundaries. It affects red states like Georgia and Alabama, which face growing epidemics, as much as blue states like New York and California, where many thousands are living with HIV; every state in the nation is affected, including rustbelt states like my home state of Wisconsin or neighboring Minnesota and Michigan where I have relatives and childhood friends.
I’ve seen firsthand how far we’ve come since the darkest days of the AIDS crisis. It’s been extraordinary. Advancements in treatment and prevention can make ending the epidemic a reality, but it won’t happen if we abandon the strategies that have worked.
President Trump can help end our nation’s HIV/AIDS epidemic, save American lives and taxpayer dollars, and avoid the costly mistakes of the past. But like Trump Tower, these efforts need a solid foundation. Decades of tireless work have paved the way. We can’t let it crumble.