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HIV Providers and Advocates Call on Congress to Address Uninsured Rates for Those Under the Federal Poverty Line

Twelve states still refuse to expand Medicaid under the Affordable Care Act; advocates say it is time to create a new health insurance option for the two million most affected.


In a letter to members of Congress on Monday, 34 national and community-based organizations sought federal-level action on dangerous disparities in health care coverage. The letter highlights a widening Medicaid “coverage gap,” a term to describe the lack of accessible health care insurance for low-income populations that are barred from Medicaid, yet are also ineligible for subsidies to afford coverage through the private Health Insurance Marketplace. The coalition of signatories highlight policy opportunities for Congress to prevent needless suffering of diseases and disabilities—sometime life-threatening—and close the Medicaid coverage gap.

An estimated two million people in the U.S. fall into the Medicaid coverage gap because 12 states have opted against expanding Medicaid eligibility under the Affordable Care Act. Today’s letter, signed by a coalition of organizations focused on fighting HIV, underscores the individual and public health risks of denying individuals access to health care coverage. The letter points to the federal government’s goal of Ending the HIV Epidemic by 2030 as an acute example of the need to address the uninsured rate.

“People living with HIV can successfully manage their health condition and eliminate transmission to others with regular access to antiretroviral treatment and care. That is the crux of the federal government’s Ending the HIV Epidemic plan,” said Robert Greenwald, Professor of Law at Harvard Law School and Faculty Director of the Center for Health Law and Policy Innovation. “But we simply cannot carry out that plan when access to treatment remains entirely out of reach for the 20% of people living with HIV who live in non-Medicaid-expansion states and are uninsured. It is time for Congress to look beyond state incentives and implement a national solution.”

A recent issue brief by the Center for Health Law and Policy Innovation of Harvard Law School outlines a menu of policy opportunities for Congress and the Administration to fill the Medicaid coverage gap. Those solutions include:

  • Allowing individuals with incomes under 100% of the Federal Poverty Level to purchase heavily subsidized Marketplace coverage;
  • Enact a public health insurance option that is funded by the federal government, available through the Marketplaces, and administered by the Department of Health and Human Services; and
  • Direct the Centers for Medicare and Medicaid Services to develop a federal Medicaid plan for non-Medicaid-expansion states.

“In more than ten years since the Affordable Care Act passed, we have seen incredible gains made in health care access and outcomes in states that have opted to expand Medicaid eligibility. We have also watched 12 states continuously turn down major incentives to expand Medicaid and deny their constituents access to life-saving care and treatment,” said Phil Waters, Staff Attorney for the Center for Health Law and Policy Innovation. “The federal government has waited long enough for state lawmakers to come around. We need federal-level action to relieve the health care needs of millions of people without health insurance, starting with those in the Medicaid coverage gap.”

Today’s letter to Congress was signed by the following organizations: Advocates for Youth, African American Health Alliance, AIDS Alabama, AIDS Alliance for Women, Infants, Children, Youth & Families, AIDS Foundation Chicago, Aliveness Project, American Academy of HIV Medicine, APLA Health, Black AIDS Institute, CAEAR Coalition, Cascade AIDS Project, Center for Health Law and Policy Innovation of Harvard Law School, Cero VIH Puerto Rico, Friends For Life, Georgia AIDS Coalition, HealthHIV, HIV Dental Alliance, HIV Medicine Association, HIV+Hepatitis Policy Institute, Howard Brown Health, International Association of Providers of AIDS Care, John Snow, Inc. (JSI), Latinos Salud, National Working Positive Coalition, Positive Women’s Network-USA, PrEP4ALL, R2H Action , Ryan White Medical Providers Coalition, SisterLove,  Inc., Southern Black Policy and Advocacy Network, Inc., The AIDS Institute, The Well Project, Treatment Action Group, and Treatment Access Expansion Project.

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