My entire focus has shifted to the first week of November. In the first days of the 11th month of 2020, two monumental things happen for the HIV community in our state. On Nov. 1, open enrollment begins, and over the subsequent 45 days, anyone can purchase health insurance through the marketplace. And on Nov. 3, the most important election in our lifetime will occur, made even more serious by the passing of Supreme Court Justice Ruth Bader Ginsburg.
The Affordable Care Act, which established the ability of residents across the country to purchase their own health insurance through the marketplace, has been the law of the land for more than a decade. With it came massive changes and benefits to access healthcare for all people in this country, including people living with HIV. The changes, including the ability for young people to stay on their parent’s health insurance, bans on insurance denial because of a pre-existing condition, no lifetime spending caps and increased access to preventative services, have become normalized over the last 10 years. The law has been incredibly resilient, withstanding multiple lawsuits and Supreme Court cases.
This year, there is a major change afoot in North Carolina made possible by the Affordable Care Act. The change has the potential to increase access to health insurance for thousands of people living with HIV, if we can only get the word out.
In 2016, NC AIDS Action Network (NCAAN) led the charge to secure legislative approval for premium assistance for the state’s HIV Medication Assistance Program (HMAP). HMAP is funded by state and federal dollars, and provides financial assistance to low-income individuals for the purchase of HIV medication. Prior to that change, state law didn’t allow North Carolina to cover the costs of health insurance for individuals who bought a plan on the insurance marketplace, a common practice in other states. Over the last several years, the North Carolina Department of Health and Human Services (NCDHHS) has slowly implemented the new program. Unfortunately, income restrictions have been in place that have limited participation in the program. Due to cost neutrality provisions, only those making between 100 percent-300 percent of the poverty level were eligible to enroll.
The program has been a massive success. Those enrolled have had higher viral suppression rates than folks who only receive free medication, and hundreds of people have been able to take advantage of broader access to an array of health services beyond HIV care.
Due to advocacy work done by NCAAN, NCDHHS has lifted the income restrictions for 2021! Starting this year, all U.S. citizens enrolled in HMAP will be eligible to have their premiums and mediation co-payments covered if they purchase insurance on the marketplace. This kind of policy change is one that truly moves us closer to ending the HIV epidemic.
That brings me to Nov. 3, Election Day 2020. This victory is only possible in part because we have sustained a strong and vibrant health insurance marketplace. I remember legislators asking me in 2016 when I walked the halls of the General Assembly if this policy change was even worth making if the Supreme Court was going to invalidate the Affordable Care Act. So many of our victories, from advancments of LGBTQ rights to access to healthcare, were preserved or advanced by Justice Ruth Bader Ginsburg. In her name, it is critical that we turn out and vote in historic rates this year.
No matter who you are, make sure you look into your options to gain health coverage during open enrollment this year. You may qualify for subsidies and might be surprised that affordable health insurance is within your reach. If you are living with HIV and currently on HMAP, talk to your case manager or call the HMAP office directly at 1-877-466-2232 for more information about enrolling in health insurance.
Lee Storrow is the executive director of the NC AIDS Action Network.