With the nation hurdling towards January 1, 2014, when some important parts of the Affordable Care Act (ACA) kick in, individual states are frantically scrambling to get ready — or digging in their heels in stubbornness that could have serious consequences for their residents. Georgia is one of several states that has refused Medicaid expansion, a decision that represents serious risks to its most low-income, vulnerable residents, especially the population of people living with HIV and AIDS.
In a curious twist, while Georgia may be home to the Centers for Disease Control and Prevention, site of some of the most cutting-edge medical and public health research, the state has the highest rate of new HIV infections in the nation. Those infected with the virus are often low-income with low levels of education, which makes them extremely reliant on government programs intended to help HIV and AIDS patients. That’s a dangerous combination when some of those programs are slated for funding cuts or total dismantling under a changing health care system combined with an economic depression.
These programs are not, of course, streamlined; patients in Georgia struggle to meet the state’s extremely strict Medicaid guidelines while also applying for assistance through Georgia’s AIDS Drug Assistance Program, housing help and other means to help them afford food, medications and a place to live. Simply applying for services can eat up hours of time every week, as can maintaining the documentation necessary to support eligibility claims and stay covered. Living with HIV and AIDS can be a costly proposition and while there are a few innovative AIDS clinics in Georgia working on facilitating patient care, many patients don’t have access to them.
Governor Nathan Deal has taken a hard line on Medicaid expansion as part of his overall commitment to conservative politics, even though it could cost some Georgia residents their lives. At the same time ACA is moving into full swing, many agencies providing health care and outreach services are experiencing substantial cuts because of the sequester, and some of those cuts are especially deep. Federal funders assume that ACA will be able to pick up the slack, while in states like Georgia, that isn’t the case, and patients won’t be able to get the services they need.
Writing for Creative Loafing Atlanta, Cathy Woolard notes that: “Without at least $9 million in unanticipated new funding from either federal or state sources beginning on January 1, we will once again have a waiting list for the AIDS Drug Assistance Program, and see HIV infection rates grow to even more alarming levels.” She predicts a snowball effect as funding shortages disrupt access to medications and housing, making people with HIV infections more likely to transmit the virus to others and creating a situation where the state’s pigheadedness could create a bigger problem than the one it started with in the long term.
This case illustrates what happens when enforcement of comprehensive federal legislation is left to the states, who get to determine on an individual basis how they want to implement it. In many conservative states, there’s considerable resistance to expanding Medicaid and taking other measures to provide coverage for low-income residents, many of whom are more likely to experience disability and disease. In these states, conditions are only going to get worse after 1 January, but the party at fault is not ACA: it’s administrators and political officials who choose not to take full advantage of ACA’s opportunities.
For low-income HIV and AIDS patients in Georgia, political wrangling and discussion provide cold comfort. They need secure and reliable access to services to stay healthy and limit spread of HIV, and it’s seemingly increasingly likely they won’t get that unless Deal experiences a change of heart in time for the state to implement an expanded Medicaid program.
Will the state do the right thing?
Photo credit: Elvert Barnes