According to a brief submitted by Lambda Legal as amici curiae supporting the Minimum Coverage Requirement (MCR) issue of the Affordable Care Act, "When the Patient Protection and Affordable Care Act (“ACA”), Pub. L. No. 111-148, 124 Stat. 119 (2010) (as amended), was enacted, only 17% of Americans with HIV/AIDS had private health insurance, and nearly 30% had neither public nor private insurance". See AIDS.gov, Health Care Reform and HIV/AIDS: How Does the Affordable Care ActImpact People Living with HIV/AIDS? 2 (Jan. 14, 2011) (“Health Care Reform and HIV/AIDS)."

Of the 30% of individuals living with HIV without insurance, many are unable to afford expensive, life-saving medication. Even the 83% of individuals with insurance use either Medicaid, Medicare, VA, or other non-profit based sources of financial assistance--all of which often leave HIV-positive individuals under-insured and financially overwhelmed. These populations tend to be marginalized groups like poor, black, or queer individuals.

Lambda points out that the way our insurance system is currently structured, the HIV-positive under-insured often do not qualify for insurance plans because of a "pre-existing condition." Under the Affordable Care Act, an individual mandate would prohibit health insurance companies from denying coverage for individual conditions--like HIV. Without such a mandate, these marginalized communities are at the mercy of the public assistance, and this often leads to people dying from preventable cases of AIDS. I'm not sure I want to live in a country where someone is sentenced to death because they can't afford to pay for drugs (that would've otherwise been affordable with an insurance plan). Moreover, even more upsetting is the way historically oppressed classes are disproportionately and overwhelmingly impacted by ACA, yet receive little regard because they live on the fringes of society.

The individual mandate provides that everyone must have insurance and denies the banning of coverage for individuals with pre-existing conditions. Sometimes I feel like the Court and lawyers get caught up in a circlejerk of Constitutional theory--and resort to desperate interpretations of the law--and often ignore the more practical implications of legislation. This subgroup of the population desperately needs health care to end senseless, preventable deaths. This mandate has the potential to save many lives; but because these stories come from groups society historically doesn't care about (poor, black, LGBTQ groups), people will be less apt to pay attention and think about the devastating implications for the under-insured living with HIV.

-- AjGarcia - 29 Mar 2012

This issue is immensely important to me and I think that it may also serve as a good example of the concepts of perception and experience that have been lighting up the twiki recently.

To many, HIV and AIDS are distant ailments that peaked in the late 80’s and early 90’s and affected a different demographic. It is pretty safe to assume that many big shot lawyers and judges feel a similar sense of removal, which can also lead to ignorance of the practical implications of some healthcare legislation. However, if they spent a day in the life of a gay man in 2012, their ideas would probably change.

HIV is not gone, and I have seen friends learn this the hard way. The doctor calls them into the office after a routine blood test and breaks the news. An emotional breakdown ensues, after which they become reclusive for a time. They emerge weeks later with a broken spirit, wondering how long they will survive, how to tell their families, and how they will get the medications that will make the disease “manageable.” Coping with alcohol and drugs is common. The word spreads that they are “poz” and they feel like a pariah. The stigma is apparently the hardest part.

The stigma that is attached to HIV is often attributed to the way that the government treats the disease. Legislation enacted in the 1980’s when the “gay cancer” was initially horrifying the world still exists. HIV-positive prisoners are still often separated from others and as recently as 1998 a court deemed HIV-positive saliva a “deadly weapon.”

This shame has been said to lead to a decrease in HIV testing (ignorance is bliss?), which can be largely to blame for the recent increase in diagnoses among young men. If courts and legislators better understood that their decisions regarding the treatment of people with HIV actually play a role in the proliferation of this horrible disease, they would hopefully be more careful. Unfortunately, they haven’t had a chance to walk in my shoes and see the painful effects in person.

I noticed your comment on outdated legislation from the 1980s and 1990s. I encountered one of those outdated laws in the immigration field, when trying to obtain a green card for an HIV-positive client. Though HIV already existed in the United States as an endemic disease and the CDC determined that this change would have little effect on transmission rates, the government did not lift its ban against HIV-positive immigrants until 2010. The surprising delay here, even in a field that tends to move slowly, suggests that efforts to reduce stigma are still live political issues.

-- DavidHirsch- 1 Apr 2012