Senate Tax Legislation and Access to Healthcare for People with HIV

 Statement of HIVMA Chair Melanie Thompson, MD:

 The tax reform bill passed by the Senate Finance Committee would harm people with HIV by both threatening their health insurance coverage and putting funding for critical federal programs that support prevention, care, treatment and housing at risk.  The HIV Medicine Association urges Senators to withhold their support from legislation that carries such costs.

 Insurance works when risk is shared across healthy populations and those needing more medical services at a given time. The individual mandate for most Americans to purchase health insurance enables Affordable Care Act insurance reforms that include requiring health plans to cover people with pre-existing conditions and prohibiting higher premiums based on health status. Repealing the individual mandate will destabilize the non-group insurance market, increasing premiums and other health care and treatment costs for those who need the insurance the most, including people with HIV. The Congressional Budget Office estimates that 13 million more Americans will be uninsured and premiums in the non-group market will increase by at least 10 percent annually as a result. 

 We should never forget that successful treatment of HIV requires continuous access to medications and care in order to avert progression to AIDS, costly hospitalizations, and loss of productivity. Moreover, continuity of access to medications and care is required for the durable viral suppression that curtails the HIV epidemic by eliminating new HIV infections and their associated lifelong costs to the healthcare system, both public and private. 

 Increased healthcare costs will be compounded by the significant cuts that will be required in federal funding for discretionary programs and automatic cuts to the Medicare program and the Prevention and Public Health Fund due to a 1.5 trillion dollar increase in the federal deficit. The loss of healthcare coverage coupled with restrictions on critical safety-net programs carry a demonstrated likelihood of increased HIV incidence and of increased illnesses among people living with HIV now. These outcomes are indefensible from a medical and public health perspective and they are wholly avoidable. 

 We urge our senators, as they evaluate this bill, to consider the 1.1 million Americans living with HIV. We also urge senators to support bi-partisan efforts to raise the budget caps and stabilize the non-group insurance market.