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Posted by on Dec 24, 2016 in Blog | 0 comments

Recommendations for future health care reforms impacting the Affordable Care Act (ACA) and Medicaid.

Recommendations for future health care reforms impacting the Affordable Care Act (ACA) and Medicaid.

Letter to Governor Haley


The Honorable Nikki R. Haley
Governor of South Carolina
1205 Pendleton Street
Columbia, South Carolina 29201

Nikki Haley

Nikki Haley

Dear Governor Haley:

We are writing on behalf of the South Carolina HIV Task Force (SCHTF), a non-partisan advocacy coalition of individuals, non-profit organizations, and allies from across South Carolina committed to improving the response to the HIV/AIDS epidemic in our state. As you know, Congressional leadership has asked each Governor for their recommendations for future health care reforms impacting the Affordable Care Act (ACA) and Medicaid. We strongly urge you to tell Congress not to repeal the Affordable Care Act, in part or in whole, without an adequate replacement. We also urge you to oppose changes to the financing and coverage guarantees of the Medicaid program.

We have made remarkable progress in addressing the HIV epidemic in the United States. Treatment advances have transformed what was once a fatal diagnosis into a chronic disease for many people living with HIV (PLHIV), and landmark scientific research has given us the tools to drastically reduce the rate of new HIV infections. Furthermore, the ACA has expanded access to care for millions of Americans, including many PLHIV who now have private insurance or Medicaid that gives them access to these breakthrough treatments. For the first time in our history, we can envision ending the HIV epidemic. To do so, however, requires that individuals at risk for HIV and those living with the disease have affordable, reliable access to comprehensive health coverage.
We are deeply concerned that efforts to quickly repeal the ACA, without simultaneously providing meaningful health coverage alternatives, will leave thousands of South Carolinians uninsured or underinsured. People living with HIV and other chronic conditions cannot afford to be stripped of their health insurance coverage. In providing recommendations to Congress, we strongly urge you to consider the key reform principles listed below:

• Maintain critical reforms that address unfair or discriminatory insurer practices, including laws that prohibit insurers from denying coverage based on pre-existing conditions or charging individuals more based on health status or gender, or excluding coverage of treatments for specific conditions. Prior to the ACA, South Carolinians living with HIV were largely shut out of the private insurance market by rules that allow plans to deny coverage to individuals with higher-cost conditions, or place coverage out of reach due to high premiums or cost sharing. Without the private insurance market reforms of the ACA, 353,000 South Carolinians are predicted to lose coverage in 2019 , and 822,000 South Carolinians (nearly one-third of non-elderly adults) could be left uninsurable due to pre-existing conditions.

• Maintain consumer protections in the private insurance market such as mandated benefits and a prohibition on lifetime and annual coverage caps. Lifetime and annual caps, before the ACA, often resulted in PLHIV and other chronic conditions exhausting their coverage and getting cut off from health care when they needed it the most. Roughly 1.5 million South Carolinians saw lifetime limits on coverage disappear as a result of the ACA. Insurers often try to avoid covering key services and medications for chronic conditions as a method of deterring high cost enrollees, such as those living with HIV, from selecting their plans. PLHIV need a minimum essential benefits package that includes the range of services and treatments needed to manage their conditions, including prescription drug benefits, substance use and mental health treatments, and preventive services without cost sharing.

• Maintain financial assistance that helps moderate-income working families in South Carolina to pay their premiums and cost-sharing for insurance purchased in the marketplace. The financial supports of the ACA helped the uninsured rates among working South Carolinians drop 28% between 2013 and 2015. In 2016, South Carolinians who enrolled in marketplace coverage received an average advance premium tax credit of $309, which covers 76% of the total monthly premium for comprehensive care. Without this financial assistance, 186,345 South Carolinians would lose more than $697 million in annual premium tax credits in 2019. Further, we prefer subsidies that support access to care over high risk pools. In over 30 years of state and federal high risk pool experience, these programs are often expensive to administer, expensive for consumers to purchase, and are severely limited in enrollment capacity and coverage of enrollees.

• Maintain incentives to expand Medicaid to nearly all non-elderly adults with incomes at or below 138% of the federal poverty level. Historically, most Medicaid beneficiaries with HIV (68% in 2011) qualified through a disability pathway, and this remains the case in South Carolina and other states that did not elect the expansion option under the ACA. Even without expansion, South Carolina would lose $88 million in federal Medicaid funding in 2019 as eligible people fall off the program.

• Maintain the current funding structure, including the entitlement, of the Medicaid program, our state’s most essential safety net, covering older adults, pregnant women and children in poverty, and persons with disabilities, including 2,800 South Carolinians living with HIV. Without the current funding structure, South Carolina will not be able to respond to current need and increased demand for coverage during tough economic times, unanticipated outbreaks or disasters, and when there are health innovations, such as the recent curative breakthrough treatments for hepatitis C. The alternative proposed Medicaid funding structure, block granting, will save money for the federal government while shifting those costs to the states. We believe the goal of state flexibility within the Medicaid program can be better achieved through waivers rather than block granting.

We hope that we can count on you to consider the health care and socioeconomic needs of South Carolinians living with HIV and others who now rely on the marketplace and Medicaid for access to their care and treatment. While the ACA is by no means perfect, it has made a major impact on our ability to contain and end the AIDS epidemic in South Carolina and across the country. Any future health care reform efforts should reflect the lessons learned from the ACA by preserving critical consumer protections, programs, and funding structures to maintain strong, comprehensive access to care for PLHIV. We urge you to tell Congress not to repeal the ACA without simultaneous replacement that reflects the principles outlined in our letter. We also urge you to protect the Medicaid program as an important safety net that is already cost effective, innovative, and provides flexibility to the states.

If you have any questions or need additional information, please contact Kendall Brooks, SCHTF Executive Director, at

Respectfully Submitted on behalf of the South Carolina HIV Task Force,

Kendall Brooks
Executive Director