Vol 23, 2014 Annals of Health Law 39
THE ACA AND PEOPLE LIVING WITH HIV/AIDS
2. The Ryan White Program
Congress created the Ryan White Program in 1990 with the goal of
supporting health care programs for people with HIV/AIDS. 82 Congress
designed the program as a “payer of last resort,” meaning that it only
provides coverage for those who have no other source of coverage or face
coverage limits. 83 Nevertheless, the Ryan White Program is the single
largest HIV-specific, grant program in the U.S., and the third largest source
of public funding for HIV care after Medicaid and Medicare. 84 Congress
reauthorized the program four times with a sunset provision, automatically
ending the program unless Congress reauthorized it by a certain date. 85 The
most recent renewal deadline passed on September 30, 2013, without any
action from Congress. 86 Nevertheless, as long as Congress has appropriated
funds to the Ryan White Program it will continue to function, for now. 87
Congress has probably not reauthorized Ryan White because once
PPACA is fully implemented, many people who once received funding for
care through Ryan White will begin to get it from other sources, including
Medicaid, the Pre-Existing Condition Insurance Plan (PCIP), and the state
insurance exchanges. 88 Consequently, some commentators have questioned
whether the program should be funded at previous levels, or is even
necessary at all. 89 The fact that PPACA will result in more insured
PLWHA, however, does not obviate the need for this vital supplemental
82. Am. Acad. HIV Med., Ryan White, http://www.aahivm.org/ryanwhite (last visited
Nov. 21, 2013).
84. See Jeffrey S. Crowley & Jen Kates, Kaiser Family Found., Updating the Ryan
White HIV/Aids Program for a New Era: Key Issues and Questions for the Future 1, 4 (Apr.
85. Id. at 1.
86. Jennifer Kates, Implications of the Affordable Care Act for People with HIV
Infection and the Ryan White HIV/AIDS Program: What Does the Future Hold?, 21 TOPICS
IN ANTIVIRAL MED. 141 (2013), available at https://www.iasusa.org/sites/default/files/
tam/21-4-138.pdf. Advocates for the HIV/AIDS community have been divided over
whether to seek reauthorization before PPACA is fully implemented on January 1, 2013.
Nat’l Alliance of State & Territorial AIDS Dirs., Update: Ryan White Program Current
Status (Sept. 23, 2013), http://blog.nastad.org/2013/09/update-ryan-white-program-current-
status/ (noting that while their organization has advocated for delaying reauthorization, other
members of the HIV/AIDS community supported reauthorization in 2013). Some advocates
have supported seeking reauthorization after January 1st because of the uncertainties
surrounding how PPACA will affect the Ryan White Program. Crowley & Kates, supra note
87. Crowley & Kates, supra note 4.
88. Id. at 6.