Vol 23, 2014 Annals of Health Law 30
THE ACA AND PEOPLE LIVING WITH HIV/AIDS
than the rest of the population. 15 Moreover, the Department of Health and
Human Services (HHS) has indicated that it plans to cede much of its
regulatory authority in defining what benefits must be included in new
plans to the States, 16 some of whom have already refused to fully enforce
PPACA. 17 PPACA also does not address certain longstanding health care
access problems in the Medicaid program that have resulted from years of
cuts in physician reimbursement rates. 18 In order for PPACA to achieve its
goal of affordable, comprehensive health insurance for not only PLWHA,
but all Americans, it must be implemented in a way that addresses these
Part II of this Note explores the goals of PPACA through the lens of
Congressional statements and the public debate that surrounded its passage.
Part III explains the means by which PPACA expands access to insurance
and health care for PLWHA. Part IV raises the question of what problems
and potential pitfalls lay ahead in the implementation of PPACA. Part V
recommends that ( 1) HHS mandate that its Seven Core Indicators of
Effectiveness be used by HHS funding grantees; ( 2) advocates and medical
experts both influence political actors to expand Medicaid coverage in their
states and ensure that benchmark plans include coverage for medically
necessary treatment for PLWHA; ( 3) HHS require insurance providers to
cover a broader range of HIV care; and ( 4) Congress continue to fully fund
the Ryan White Program in order to meet the health care needs of PLWHA
in need of supplemental coverage. Part VI concludes with a summarization
of the potential and problems moving forward in the implementation of
II. THE PROMISE OF THE PATIENT PROTECTION
AND AFFORDABLE CARE ACT
President Barack Obama signed PPACA into law on March 23, 2010.19
PPACA created an entirely new national health insurance framework and
was the most comprehensive piece of healthcare reform legislation in
decades. 20 Congress enacted PPACA with two primary goals: ( 1) to expand
15. See Crowley & Kates, supra note 4, at 6 (noting that Medicaid is the largest payer of
HIV care in the U.S.).
16. See infra text accompanying notes 108-09.
17. See infra text accompanying notes 193-94.
18. See infra Part IV. B. 2.
19. Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119
(2010) (codified in scattered sections of the U.S. C.).
20. See Abigail R. Moncrieff & Eric Lee, The Positive Case for Centralization in Health
Care Regulation: The Federalism Failures of the ACA, 20 KAN. J.L. & PUB. POL’Y 266, 266