The  AHCA  would  cause  millions  of  Americans  to lose their health care. The Congressional Budget Office estimates that by 2026, 24 million people would lose coverage through the AHCA’s elimination  of  the  individual  mandate,  changes  to the private insurance subsidy structure, and Medicaid  funding  cuts.  In  Medicaid  alone,  14  million beneficiaries would lose coverage by 2026.2 This  would  include  tens  of  thousands  of  people living with HIV who gained insurance through  the  Affordable  Care  Act.  The  Ryan  White Program is a discretionary program that is a  payer  of  last  resort  and  primarily  covers  HIV  care and treatment for low-­‐income individuals. It  is  not  health  insurance.  The  Ryan  White Program  would  be  unable  to  fill  the  gap  that  decimating Medicaid would leave.

The  AHCA  would  eliminate  the  Medicaid  expansion and shift billions of dollars of costs to states. Medicaid is a lifeline to care for 42% of  people  living  with  HIV. 3  The  AHCA  would  threaten the ability of Medicaid to provide care and  treatment  to  this  population  by  putting  in  place a per capita cap funding structure estimated  to  result  in  an  $880  billion  shift  of  Medicaid costs to states over the next decade. State  Medicaid  programs  already  operating  under constrained budgets will simply be unable to continue providing care and treatment to the millions  of  vulnerable  individuals  who  depend  on this program. In addition, eliminating the Medicaid  expansion  means  going  back  to  cruel  pre-­‐ACA rules where people living with HIV must be  diagnosed  with  AIDS  and  thus,  disabled  by  the disease, to be eligible for the program.

The  AHCA  would  make  health  insurance  less  affordable for low-­‐income people, older people,  and  people  living  with  chronic  conditions. The AHCA reduces the amount of premium  tax  credits  people  will  receive  to  purchase private insurance by an average of $1,700.4  This  hardest  hit  are  low-­‐income  and older  individuals.  The  Kairos  Center  estimates  that nearly 48% of Americans live on incomes just  twice  the  federal  poverty  level.    The  CDC  estimates that 40% of people living with HIV have  incomes  at  or  below  the  federal  poverty  level. The AHCA would no longer take income or regional  differences  into  account  in  calculating  eligibility for premium tax credits, meaning that the  people  least  likely  to  be  able  to  afford  insurance costs will now get less help. In addition, the bill would allow insurers to charge older people even more in premiums by relaxing age rating protections.  At  the  same  time,  the  AHCA  eliminates  the  current structure of federal cost-­‐sharing reductions  as  well  as  the  actuarial  value  protections that require plans to pay for a certain percentage of a consumer’s health care costs.  This  means  that  people  living  with  HIV  and other chronic conditions will pay more for a plan  that  covers  less  and  has  higher  consumer  cost sharing. Affordability has been essential to providing  not  only  insurance  coverage  but  also  meaningful access to care and treatment. Failure  to  ensure  that  people  living  with  HIV  have access to the care and treatment they need to stay healthy will result in worse health outcomes, missed opportunities for prevention, and increased health care costs.

The AHCA’s continuous coverage requirements would  disproportionately  harm  people  living  with chronic conditions. Under the AHCA, any person  who  has  a  lapse  in  coverage  of  more  than 63 days will be subject to a 30% premium surcharge.  This  will  make  it  extremely  difficult  for people with pre-­‐existing conditions, who may  have  unavoidable  gaps  in  coverage  as  a  result of these conditions, to re-­‐enter coverage. This requirement may also drive up health care costs by discouraging younger, healthier people from  reentering  the  health  care  market  until  a  change in health status compels them to do so.

The  AHCA  would  erode  benefits  protections  that ensure that coverage meets HIV care and treatment  needs.  The  AHCA  eliminates  the  Essential Health Benefits requirements for Medicaid  expansion  plans.  The  Essential  Health  Benefits, which include prescription drug coverage,  mental  health  and  behavioral  health  services, and preventive services (including routine  HIV  screening),  have  been  vital  to  ensure that Medicaid and private insurance alike provide essential care and treatment.

The  AHCA  would  cut  critical  public  health  funding through elimination of the Prevention and  Public  Health  Fund  and  the  de-­‐funding  of  Planned Parenthood. The Prevention and Public Health Fund has provided significant support to build  local  capacity  to  detect  and  respond  to  infectious diseases, such as hepatitis C and HIV, and other public health threats. Abandoning this critical  investment  will  set  back  public  health  and security. In addition, Planned Parenthood offers  people  of  all  genders  essential  sexual  health services, including STD screening and treatment,  HIV  and  hepatitis  C  testing  and  linkage to care services, and HIV preventative services,  like  HIV  pre-­‐exposure  prophylaxis  (PrEP) and condoms. Planned Parenthood clinics are  the  sole  source  for  HIV  and  hepatitis  C  testing in some rural communities.

Any  changes  to  the  Affordable  Care  Act  and  Medicaid must preserve access to affordable care  and  coverage  for  people  living  with  HIV  and other chronic conditions and ensure continued  consumer  protections  from  discriminatory insurance practices.