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Monday, March 24, 2014

How Medicaid Expansion Benefits Women with HIV/AIDS

Kathleen Stoll

Director of Health Policy

42% of HIV-positive women do not get needed treatment and drugs

March is National Women’s History Month. As part of this month of honoring women’s strength, resilience, and leadership, March 10 was designated as National Women and HIV/AIDS Awareness Day, a day historically focused on testing and prevention of the infection. With the Affordable Care Act affording many low- and middle-income HIV-positive people quality, affordable health coverage for the first time, this year’s National Women and HIV/AIDS Awareness Day took one step further and also focused on the proper care and treatment for women who are HIV-positive. 

Under the Affordable Care Act, a woman with a pre-existing condition such as HIV/AIDS can no longer be denied an offer of insurance because of her health status, or be charged much higher premiums. In addition, women with low and middle incomes may be eligible for Medicaid or premium subsidies that will help them afford quality coverage purchased through state health insurance marketplaces.

According to the CDC, about 275,700 American women are living with HIV/AIDS in the nation. Only about 42 percent of HIV-positive women receive the treatment necessary to achieve viral suppression. Many of these women are uninsured, don’t see a doctor regularly, and don’t get the ongoing care and treatment they need to control the virus and remain healthy. With Medicaid coverage, more HIV-positive women will see a doctor and be able to afford antiretroviral drug therapy (ART) that can help a woman to manage HIV, stay out of the hospital, and stay healthy. And many women at risk of exposure to HIV can also receive HIV education, testing, and preventive counseling from a doctor who they see regularly. 

State Medicaid expansion: Federal dollars for HIV prevention and treatment for 115,000 people

The March 14, 2014 issue of Health Affairs addresses how the ACA can improve health care for two groups of often overlooked and underserved populations: the 1.1 million Americans who are living with HIV/AIDS and the 11.6 million people who cycle through the nation’s 3,300 local and county jails every year. 

One of the articles in the March Health Affairs estimates that there are nearly 115,000 uninsured people with HIV/AIDS who would be eligible for Medicaid if all the states moved forward to expand the program under the Affordable Care Act. It is unfortunate fact that nearly 60,000 uninsured and low-income people with HIV/AIDS (with incomes below 138 percent of the federal poverty level who fall into what is known as the “coverage gap”) could be left behind if more states do not make the choice to take the federal funds on the table to expand Medicaid. Among these states, the largest uninsured HIV-positive populations are in Florida (16,528), Texas (11,193), and Georgia (5,890). 

When a state chooses to expand Medicaid, it can save millions of dollars by preventing HIV infection. And the state can replace state spending with federal dollars to pay for what would otherwise be uncompensated care spending on low-income HIV-positive people who eventually do seek care – when their condition is more difficult and costly to treat. Programs like the federal Ryan White Care Act and AIDS Drug Assistance Program only serve as an inadequate backstop to insurance coverage. 

HIV/AIDS at the intersection of race and gender health disparities

Combating HIV/AIDS is a critical step toward ending gender and race health disparities:

  • African Americans are 9 times more likely than whites to be newly diagnosed with HIV.1
  • African American women are 15 times more likely than white women to die from HIV.2
  • Hispanics are over 2.5 times more likely than whites to be diagnosed with HIV or AIDS.3
  • Hispanic women are almost three times as likely as white women to die.4

Women’s History Month honors women leaders across our country. We challenge women state legislators – regardless of party affiliation – to step forward and support a Medicaid expansion that will save women’s lives and save state dollars.


http://www.cdc.gov/hiv/surveillance/resources/reports/2011report/pdf/2011_HIV_Surveillance_Report_vol_23.pdf table 1a.
http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_04.pdf table 16 (age-adjusted)
http://www.cdc.gov/hiv/surveillance/resources/reports/2011report/pdf/2011_HIV_Surveillance_Report_vol_23.pdf table 1a.
http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_04.pdf table 17 (age-adjusted)