Vol 23, 2014 Annals of Health Law 29
THE ACA AND PEOPLE LIVING WITH HIV/AIDS
the workplace, at the doctor’s office, and elsewhere play a part. 5 Perhaps
the biggest reason, however, has been their inability to access
comprehensive and affordable health care coverage. 6 In the private health
insurance market, providers have systematically excluded PLWHA in an
effort to contain costs by categorizing the disease as a “pre-existing
condition.” 7 In doing so, providers have been able to categorically deny
PLWHA health insurance, or in the alternative, simply price it out of reach. 8
Public health plans have also suffered from access issues relating to the cost
of care and comprehensiveness of coverage. 9 These problems have only
been exacerbated in recent years as healthcare costs have grown and
budgets have shrunk, resulting in the institution of stricter managed care
plans by states across the country. 10
In passing the Patient Protection and Affordable Care Act (PPACA),
Congress intended to address these barriers to treatment by including most
Americans in a health insurance market that offers affordable,
comprehensive care. 11 However, the implementation of PPACA comes
with its own significant hurdles. 12 As a result of the Supreme Court’s
decision in National Federation of Independent Business v. Sebelius, 13
PPACA’s Medicaid expansion will likely reach fewer low-income childless
adults than intended. 14 This result will have a disproportionate impact on
PLWHA, who rely on the program for their health needs at higher rates
5. See Jennifer N. Sayles et al., The Association of Stigma with Self-Reported Access to
Medical Care and Antiretroviral Therapy Adherence in Persons Living with HIV/AIDS,
SOC’Y OF GEN. INTERNAL MED. 1101, 1105 (2009) (finding that low rates of self-reported
access to medical care was strongly associated with experiences of HIV stigma among
underserved communities); Lambda Legal, HIV Stigma and Discrimination in the U.S.: An
Evidence-Based Report 1 (Nov. 2010), http://www.lambdalegal.org/sites/default/files/
publications/downloads/fs_hiv-stigma-and-discrimination-in-the-us_ 1.pdf; Press Release,
Am. Civil Liberties Union, ACLU Survey Reveals Massive Civil Rights Violations Against
People with HIV/AIDS: 19-Year-Old HIV-Positive Nebraska Woman Brings Lawsuit
Against Former Employer for Discrimination (Nov. 13, 2003), https://www.aclu.org/lgbt-
(detailing incidents of HIV discrimination across the country).
6. See Crowley & Kates, supra note 4, at 2 (citing studies that suggest access to
healthcare is strongly associated with the availability of insurance).
7. See infra Part III. B.
8. See id.
9. See infra Part IV. B.
10. See id.
11. See infra Part II.
12. See infra Part IV.
13. 132 S. Ct. 2566 (2012).
14. See id. at 2607 (holding that the Spending Clause forbids the federal government
from withdrawing existing Medicaid funds from States that do not implement PPACA’s