To End HIV, Embrace Medicaid

It didn’t take long for President Donald Trump to undermine his pledge to end new HIV transmissions in the United States by 2030 — an initiative that would save lives and taxpayer dollars. The promises made during the State of the Union are being undercut by the Trump administration’s budget, which includes a draconian $1.5 trillion cut to Medicaid — the largest source of insurance coverage for Americans with HIV — and the Justice Department’s support to invalidate the Affordable Care Act in court.

In the two years since Trump was inaugurated, his administration has taken a number of steps that have jeopardized efforts to end the HIV/AIDS epidemic, including the administration’s relentless assault on the ACA and Medicaid. Prior to the passing of the ACA, many people living with HIV couldn’t get insurance coverage due to pre-existing conditions, cost barriers and Medicaid eligibility limitations. The ACA removed these barriers, and as a result, Medicaid coverage of people with HIV increased significantly nationwide.

Today, thanks to the ACA, Medicaid covers over 40 percent of Americans with HIV. Access to treatment means that individuals with HIV can become virally suppressed so they can live longer, healthier lives and are unable to transmit the virus.

Preventing one new HIV infection saves nearly half a million dollars in lifetime medical costs. For every 2,700 new infections we prevent, we save close to $1 billion in future medical costs.

Medicaid has been key to much of the recent progress we’ve made in the fight against HIV and should be the centerpiece of any national strategy to end the epidemic. Instead of cutting it, we should expand Medicaid in every state that hasn’t already done so. The increase in Medicaid coverage for people with HIV was driven by states that opted to expand Medicaid access.

In addition to proposed cuts, the Trump administration has also allowed states to make it harder — or nearly impossible — for many to stay enrolled in Medicaid by enabling states to create work requirements for Medicaid. Work requirements violate Medicaid’s core mission and have already led to thousands of vulnerable Americans losing their health coverage.

Medicaid is the backbone of coverage for millions of working Americans; almost 60 percent of adults with Medicaid coverage are already working, mostly earning low wages or working for small businesses that don’t provide insurance. Those who aren’t working are either too sick to work, or they are taking care of a child, elderly, or sick loved one. The Trump administration budget doubles down on this flawed approach and could potentially take coverage away from an additional 4 million Americans.  

Trump should look to his home state for a winning strategy. New York has a plan to end the prevalence of the HIV/AIDS epidemic by the year 2020 that has significantly reduced new infections by helping people living with or at higher risk for HIV get the right kind of care — largely through Medicaid. At the height of the HIV/AIDS epidemic in New York, over 10,000 people were newly diagnosed with HIV every year. By 2017, that number dropped to 2,769 new HIV diagnoses.

In addition to embracing Medicaid expansion, New York has HIV Special Needs Plans, which are specifically designed for people living with or at higher risk for HIV. These plans connect New Yorkers to care that helps them become virally suppressed. And to help HIV negative people stay negative, New York is working to make testing widely accessible and ensure access to prevention methods such as pre-exposure prophylaxis, which has proven to be 90 percent effective in preventing HIV transmissions.

Attacking Medicaid isn’t the only way the Trump administration is undermining his own stated efforts to end the AIDS epidemic. From his previous move to dismantle the Presidential Advisory Council on HIV/AIDS to proposing hundreds of millions of dollars of cuts to global programs that target HIV/AIDS, the Trump administration’s actions don’t indicate a commitment to end the epidemic.

Ending the HIV/AIDS epidemic nationally is well within our reach, but only with the right approach. If Trump’s intentions are genuine, he needs to stop undermining and attacking Medicaid and ensure all Americans have access to quality, affordable health care.


Doug Wirth is the president and CEO of Amida Care, New York’s largest Medicaid Special Needs Health Plan.

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