ACA & HCV Care

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Hep Talk by Larry Buhl

Location, Location, Location
How will the Affordable Care Act affect HCV care?
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In October, open enrollment for state-based health insurance marketplaces as part of the Affordable Care Act, or ACA—or Obamacare, as it’s called by its detractors—will begin. Already the ACA has eliminated the discriminatory insurance practice of denying coverage for patients with pre-existing conditions such as viral hepatitis. January is when the affordability part of the ACA kicks in, and in many states the ACA will bring lower treatment costs and free screening. The degree of affordability for viral hepatitis care and screening depends on where you live.

Treatment
First, those who plan to keep their employer-sponsored coverage will likely not see any changes in HCV treatment. For others, there will be options that can be helpful.

In January 2014, health insurance marketplaces, also called “exchanges,” can make treatment more affordable for those who participate. But affordability also depends on Medicaid expansion in each state, and not every state will be equal.

Those who earn more than the federal poverty line but less than four times that amount, and who can’t get coverage through their jobs, can use government subsidies to buy a health plan on the new exchanges. Those who earn less than the poverty line can get insurance via expanded eligibility for Medicaid programs.

When the Supreme Court upheld the individual mandate part of the Affordable Care Act last year, it also said that each state could decide whether to take their share of federal Medicaid dollars, or opt out. More than half of the states—mostly those with Republican governors or Republican-controlled legislatures—have said “no” or are leaning toward “no.” States where Democrats are the majority, have said “yes.”

That means in states that have rejected the Medicaid expansion, low-income people earning between 100 percent and 138 percent of the poverty level can go to the insurance exchanges for subsidized insurance coverage, but those with earnings below the federal poverty level are out of luck. Because the administration and Congress assumed the poorest of the poor would automatically go into the Medicaid system, they did not make a provision to subsidize them through the ACA.

Prevention
As with treatment, coverage for prevention will vary. Those eligible for Medicare, no matter where they live, can opt for HCV screening as part of their annual wellness visit. Others, in states with Medicaid expansion dollars—the “blue states,” generally—can get free viral hepatitis screening if they fall into the risk groups (IV drug users, or, now, those in the Baby Boomer cohort, now aged forty-nine to sixty-nine) if they choose insurance through the state marketplaces.

Some states opting out of Medicaid expansion will have the option of covering HCV screening anyway. In other states, patients will pay out of pocket, or use private insurance (if they have private insurance and if screening is covered).

For Health Providers
The National Alliance of State and Territorial AIDS Directors (NASTAD) has released a primer (Link: http://nastad.org/docs/Primer-ACA-Hepatitis-March-2013.pdf) with action steps to help health providers take advantage of everything the ACA can offer in their states.

There are a lot of moving parts in the ACA. Viral hepatitis advocates and providers, and particularly state health departments, have a role to play, according to Oscar Mairena, Manager of Viral Hepatitis/Policy and Legislative Affairs at NASTAD. “Perhaps the most significant opportunity presented by the ACA is the potential to integrate viral hepatitis services into broader health systems, particularly important given that there is no separate health infrastructure, like the Ryan White Program for those living with HIV, for those infected with viral hepatitis.”

Larry Buhl is a radio news reporter, screenwriter, and novelist living in Los Angeles. His young adult novel, The Genius of Little Things, debuted in January 2013. His comic mystery novel, We’re Here to Help, will be available later in 2013.