(The Root) — When the Supreme Court upheld the constitutionality of the Affordable Care Act, the HIV/AIDS community in the United States celebrated: People living with the virus would no longer have to worry about insurance benefits being denied or dropped because of their status. Plus, with its coverage for 30 million additional Americans, the law was a reason to be more optimistic about increases in testing and early treatment — widely seen as keys to stopping the epidemic.
But for women of color, who account for more than 70 percent of new HIV infections in women — black women making up 57 percent, and Latinas making up 16 percent, according to the Centers for Disease Control and Prevention — the real benefits of the ACA will depend on its implementation. That, according to some experts and advocates, hinges in part on a lesser-discussed open question about the legislation: Whether states will take advantage of the piece of the Supreme Court's decision that allows them to opt out of taking federal dollars to expand their Medicaid programs, thereby depriving their citizens of coverage.
On Tuesday at the 19th International AIDS Conference in Washington, D.C., the 30 for 30 Campaign, in collaboration with the Harvard Law School Center for Health Law and Policy Innovation, released a white paper on the impact of the ACA on women living with HIV. It had sobering findings about the Medicaid provision's potential to improve — or fail to improve — health outcomes for women of color.
The Harvard Center's Robert Greenwald, a co-author of the paper, told reporters that for women of color, who are disproportionately poor, uninsured and lacking in resources, "The Affordable Care Act offers tremendous opportunities, but the devil is in the details. Unless implementers on the state and federal level really take the needs of women of color into account, this will be an opportunity lost."
Waheedah Shabazz-El, an HIV-positive woman and HIV counselor representing the Positive Women's Network in Philadelphia, said that her own experience with the health care system convinced her of how critical these details would be for women living with the disease.
HIV has always been an "epidemic compounded by race and gender," and that could get worse, said Dázon Dixon Diallo, the founder and president of SisterLove, and a 30 for 30 representative. The threat, she explained, is that states in the South and Southeast regions of the U.S., which have the highest percentages of African-American and other women of color living with HIV, are the very same ones that are most likely to opt out of the Medicaid expansion.
The ruling giving states the option "when we know that 17 million people stand to be covered by that one provision, and most of them are black and Latino," Rep. Donna Christensen (D-U.S. Virgin Islands), chair of the Congressional Black Caucus Health Braintrust, told reporters. "But," she added, "we knew that the states were going to be a battlefield … We still have time to ensure that African-American women are included."
Jenée Desmond-Harris is The Root's staff writer. Follow her on Twitter.