Imagine a man named Andre. He is an HIV-positive, 30-year-old African-American man living in DeKalb County. He primarily has sex with other men. He suffers from shame and depression about his HIV status and is conflicted about his sexual identity.
Andre graduated from high school but wasn't adequately prepared to enter a competitive work environment. He works a variety of hourly jobs, none of which provide insurance or a wage that pulls him out of poverty. Most years he earns between $12,000 and $15,000.
If you met Andre, you might not see that he struggles to keep a roof over his head, find reliable transportation, eat meals somewhere besides the closest fast-food joint, and follow a daily course of expensive, necessary prescriptions that keep his viral load at low to undetectable levels. In short, Andre is a pretty typical person with an HIV-positive diagnosis in Georgia.
Because Georgia has very restrictive requirements for state Medicaid eligibility and because of his income and HIV status, Andre can't find medical insurance. His medical care and prescriptions are paid for by a complex combination of federal, state and local funding woven together over the course of 32 years, since HIV/AIDS was first diagnosed. He also has access to a case manager who can help connect him with medical care, housing assistance, and mental-health counseling. It's not easy for Andre, but he works hard to manage his situation.
Andre doesn't realize it but, come January, things will change. That's when the Affordable Care Act, President Obama's overhaul of the health care system, kicks in. And Georgia's not prepared.
Georgia has one of the highest rates of new HIV infection in the country. According to the state Department of Public Health, 3,623 Georgians were newly diagnosed in 2011. And the number is growing. We spend roughly $117 million each year to provide medical care and prescriptions to about half of the 50,000 Georgians already living with HIV/AIDS. The others are not receiving medical care at all.
We live in one of a handful of states that won't be participating in the expansion of Medicaid anticipated in the ACA. Our state is also far behind other states in understanding how to use health insurance exchange networks to get 2 million uninsured Georgians into an appropriate health care plan.
For every person like Andre who is uninsured and lives with a chronic and/or communicable disease, there is a tapestry of public funding that tries to prevent him from landing in the emergency room of your local hospital where you, the taxpayer, will also pay for his critical care needs. It is an expensive and redundant system that is dismantling as we speak.
In most states — but not Georgia — people will find their way into the new health care system. Like any sort of change, it will be messy, but the system will adapt and new efficiencies will be found.
Meanwhile, organizations that receive federal funding to help manage health care for uninsured and uninsurable Georgians have already received notice of up to 5 percent budget cuts this year due to sequestration. Most agencies will figure out how they can bridge a gap.
But more troubling are the calls and letters from various levels of government delivering bigger shocks as entire line items for health care disappear with the view that everyone will have access to some kind of insurance under the ACA to cover their needs next year. For example, agencies that help people secure and stay in housing have already seen 20 percent cuts in funding — with more likely on the way.
There's speculation that Gov. Nathan Deal will opt in to the Medicaid expansion after the gubernatorial primary in July 2014. Let's hope so. The repercussions of holding off from full participation in health care reform, especially fully federally funded expansion of Medicaid, between January and that time will result in more people falling through the cracks of an evolving system of care that anticipates full insurance coverage for people like Andre.
Andre will likely find that there will be no funds available to pay for his visits to the doctor or for prescription drugs. The services that help Andre fight scenarios that can lead to transmission of the disease are unraveling. People who achieve viral suppression due to uninterrupted access to medical care and anti-HIV fighting drugs are 96 percent less likely to transmit HIV to others. Without at least $9 million in unanticipated new funding from either federal or state sources beginning on January 1, we will once again have a waiting list for the AIDS Drug Assistance Program, and see HIV infection rates grow to even more alarming levels.
This public health disaster could be avoided by Deal expanding Medicaid now for all of those Georgians who will fall through the cracks between private insurance and our current limited Medicaid program.
The cost to Georgia for not participating in the Medicaid expansion or implementing changes that other states have been pursuing for several years — supplemented by tax dollars you paid to help them do it — will be tabulated as early as next year. The cost to Andre and millions of other Georgians could very well be their lives.
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