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Talking Points


These talking points are intended as a quick-reference for advocates from South Carolina when meeting with Senators, Representatives, and the Governor about the potential impact of repealing the Affordable Care Act (ACA) on people living with HIV

In addition to sharing personal stories, advocates may find it helpful to focus on three main points:

  1. Repealing the ACA is likely to reverse the huge gains in coverage South Carolina has seen since the ACA’s implementation.
  2. Repealing the ACA could jeopardize key consumer reforms and protections that people living with HIV depend on to access health care.
  3. Changing the financial structure of the Medicaid program to a block grant or per capita cap will decimate South Carolina’s budget and result in reduced enrollment and services for low-income South Carolinians.

Coverage Gains in South Carolina Under the ACA

  • Between 2013 and 2015, there has been a 31% reduction in the number of uninsured people in South Carolina.
  • Between 2010 and 2015, 317,000 South Carolinians gained health insurance coverage and stand to lose the robust benefits they currently enjoy if the ACA is repealed.
  • Of those, 35,000 are young people under 26 years of age who gained coverage by staying on their parents’ plans.
  • In 2016, 186,345 South Carolinians received an average of $312 per month in subsidies to purchase coverage. This adds up to $3,744 in savings for each person, each year. Eliminating these subsidies will place an impossible financial burden on these people who will likely not be able to afford insurance on the private market.
  • A repeal of the ACA without a comprehensive, simultaneous replacement plan will leave thousands of South Carolinians uninsured or underinsured. A partial repeal is estimated to leave 353,000 South Carolinians without coverage. 

Key Consumer Reforms that Protect South Carolinians Living with HIV

  • The ACA’s consumer protections made HIV treatment accessible and affordable for many South Carolinians for the first time.
  • The ACA introduced guaranteed issue and banned pre-existing condition exclusions. This was life-changing for people living with HIV. It meant that insurers could no longer refuse to cover them because of their diagnosis. If the ACA is repealed roughly 2 million South Carolinians with pre-existing conditions could be denied coverage, including those living with HIV.
  • The ACA introduced community rating and banned most medical underwriting. This meant that people living with HIV were protected from massive premiums charged by insurers because of their condition. If the ACA is repealed, people living with HIV may once again be charged substantially more by insurers and may not be able to afford premiums.
  • The ACA banned lifetime caps and annual coverage limits. This meant that insurers could not limit the amount of money they would have to pay for care. Roughly 1.5 million South Carolinians saw lifetime limits on coverage disappear due to the ACA. This was especially important for people living with HIV. Previously, the high cost of managing their condition might have left them without coverage either for the rest of the year, or worse, the rest of their life.
  • Similarly, the ACA introduced cost-sharing caps that limit the amount patients are required to pay out-of-pocket during the year. This is especially important to people living with HIV because managing their condition often requires significant out-of-pocket expenses.
  • The ACA introduced a minimum package of services known as the essential health benefits that all insurers must provide. This includes key services that people living with HIV need to manage their condition, such as prescription drug coverage and preventive services without cost-sharing.  If the ACA is repealed and these requirements are lost, it directly threatens the health of people living with HIV.

Impact of a Block Grant or Per Capita Cap on Medicaid

  • Roughly 998,000 South Carolinians rely on Medicaid for access to health care. This includes around 2,800 South Carolinians living with HIV.  These individuals depend on the program to manage their condition and maintain a healthy and productive life.
  • Currently, the Medicaid guarantees coverage for eligible individuals. The federal government matches South Carolina’s spending for care on its most vulnerable residents with no limit.  A block grant would eliminate this entitlement, giving South Carolina a fixed amount of money annually.  Similarly, a per capita grant would give South Carolina a fixed amount per eligible person.  Under either option, Medicaid would not have the funds to meet risings health care costs. 
  • A block grant is estimated to cut the Medicaid program by 33% over 10 years. South Carolinians who currently rely on the program would either see their services slashed or denied altogether.  South Carolina would be forced to reduce enrollment and services, leaving thousands of low-income South Carolinians without vital care.
  • Under the current structure, South Carolina has the flexibility to respond to changing health care needs as necessary. Block grants and per capita caps would lock federal spending to a rate that would not meet rising costs. South Carolina would not be able to respond to unforeseen crises such as unanticipated outbreaks, tough economic times, or natural disasters.
  • If South Carolina does not receive sufficient federal Medicaid funding, we will face a harsh choice: deny coverage to the most vulnerable South Carolinians or cut funding for other state services.

Advocates’ Asks

Using the information above, advocates should ask for specific items from their Senators, Representatives, and Governor, including:

  1. Do not repeal the ACA without first developing a complete replacement plan that provides coverage for at least as many people that are currently insured. A rush to repeal will leave hundreds of thousands of South Carolinians without access to coverage and care.
  2. Ensure that any replacement plan keeps the ACA’s key consumer protections in place, including guaranteed issue for those with pre-existing conditions, no medical underwriting or coverage caps, mandated benefits, and cost-sharing limits. South Carolinians living with HIV need these reforms to make coverage accessible and meaningful.
  3. Preserve premium and cost-sharing subsidies to help purchase health insurance coverage. Without these subsidies tied to income, low- and moderate-income working South Carolinians will have no other way to defray the cost of treatment and care.
  4. Maintain the current funding structure, including the entitlement, of the Medicaid program. Medicaid must be adequately funded to provide comprehensive health services for low-income residents. Any funding cuts will shrink this important safety net and leave South Carolina’s most vulnerable without health care.