Election 2020: What's at Stake for People Living With HIV

The next administration will be controlling the health care of millions of Americans living with HIV as well as the nearly 40,000 people newly diagnosed each year. Additionally, whoever the next president is will bear the unique challenge of controlling the COVID-19 response. 

Looking to the years ahead post-pandemic, the country’s health care system will leave marginalized people especially vulnerable. Maintaining health insurance protections for preexisting conditions is a top issue for many people living with HIV.

Despite Donald Trump’s promise of ending HIV by 2030, a plan that requires much spending, those living with chronic health conditions will bear heavy repercussions as it pertains to long-term health care coverage.

Republicans ran hard on promises to end the Affordable Care Act, which has given more than 20 million people access to health coverage. When Republicans took control of the House, Senate, and White House in 2017, the Trump administration made it very clear that its intention was to “repeal and replace” the law, with no clear plans for a replacement.

In June of this year, the Trump administration asked the Supreme Court to strike down the ACA (dubbed “Obamacare”), telling the court that “the entire ACA must fall.” This argument came as hundreds of thousands of people are turning to ACA health coverage after becoming unemployed due to the pandemic.

Pandemic aside, repealing Obamacare would leave over 23 million people without health care plans, according to the Center for American Progress.    

Furthermore, 39 states have opted to expand Medicaid — a federal-state health program that covers one in five Americans — largely due to the federal government paying the greatest share of the cost under a provision of the ACA: 100 percent from 2014 to 2016, then dropping gradually before going to 90 percent in 2020 and onward. Still, there are some states, mostly Republican-majority ones, that chose not to. Trump himself opposes the expansion.

In January, the Trump administration offered to let states withdraw from part of the Medicaid funding program and instead receive a fixed annual grant with flexibility in money disbursement. However, much of the new changes negatively impact the poorest populations, especially those living with chronic illnesses.

Though Medicaid has historically covered all federally approved prescription meds, Trump’s plan would allow states to decide which drugs are covered and impose higher co-pays.

Another, rather invisible, consequence of the plan is that in states that opt in, the federal government will have less oversight of the private health insurance companies hired by states to run their programs. Private companies cover nearly two-thirds of those on Medicaid.

In regard to the ACA as a whole, Trump has vowed to protect health coverage for people with preexisting conditions, like HIV, as required by the law. But the administration has not said how this will be accomplished if the ACA is repealed.

Democratic presidential nominee Joe Biden, who advocated for the ACA alongside President Obama, has vowed to continue fighting against discrimination in health care.

“The reason President Obama and I fought so hard for the Affordable Care Act was to make sure that the peace of mind provided by health insurance is a right for all, not a privilege,” Biden said in his 2020 plan for HIV, via a questionnaire by AIDS United. “As president, I will fight to defend and build upon the Affordable Care Act to ensure every American has access to quality, affordable health care.”

“President Trump is trying to walk back this progress,” he continued. “For example, he has proposed to once again allow health care providers and insurance companies to discriminate based on a patient’s gender identity. I will defend the rights of all people — regardless of HIV status, gender, sexual orientation, gender identity — to have access to quality, affordable health care free from discrimination. My plan takes a number of steps to build on Obamacare and achieve universal health care, including allowing Americans who are uninsured or who don’t like their coverage to buy into a Medicare-like public option. My plan also increases premium tax credits so more people will have lower premiums and lower deductibles.”

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