Former members of the Presidential Advisory Council on HIV/AIDS (PACHA) have condemned the Senate's draft version of the Affordable Health Care Act, saying its cuts to Medicaid and defunding of Planned Parenthood would be devastating to people with HIV/AIDS.
"I would say it's at least as bad as the old House one — maybe worse, depending on where it goes from here," Scott Schoettes, Lambda Legal's HIV Project Director, told BuzzFeed News.
"It will kill people — that's not hyperbole. There will be some people who will die from this," he added.
Schoettes was among six members of the council who resigned last week from PACHA, citing their frustrations with working with "a president who simply does not care" about HIV/AIDS.
Gina Brown, another former member of PACHA and a community organizer with the Southern AIDS Coalition, said scaling back essential health benefits like maternal health, mental health, substance abuse treatment, and funding to Planned Parenthood will impact both people with HIV/AIDS and those at risk of contracting the disease.
"Also, expanded Medicaid would be scaled back and because there's no penalty for not having health insurance, a lot of people will not purchase it," Brown said Thursday via email. "I fear we are going backwards, back to a place where people went bankrupt trying to pay for medical emergencies," Brown said Thursday via email.
HIV/AIDS specialists say the impact of cuts to Medicaid under the proposed bill could reverse significant progress made under the Affordable Care Act's Medicaid expansion.
"Within the first year of Medicaid’s expansion, the uninsured rate among people with HIV dropped six percent in expansion states," said Dr. Carlos del Rio, the immediate past chair of the HIV Medicine Association, a group which sent a letter on Thursday morning to senators urging them not to sign the bill. (Unlike the others quoted in this story, del Rio was not a PACHA member).
Currently around 40% of people living with HIV depend on Medicaid for their health care, according to del Rio and Schoettes. "I suspect those patients aren't going to have access to life-saving medications as a result of this bill," Del Rio told BuzzFeedNews.
In the Senate draft bill, cuts to the ACA's Medicaid expansion would be rolled out over a longer period of time—by 2024, instead of 2020 as in the House bill—but payments would be capped at a lower rate, meaning the cuts are deeper.
"Although the Senate bill will make cuts to Medicaid more slowly, it's being reported that over the long term, the Senate bill will result in deeper cuts to Medicaid than even the House bill did," said Ulysses Burley III, former program director for the Evangelical Lutheran Church in America strategy on HIV/AIDS, who also resigned from PACHA last week.
Burley warned of the consequences of forcing the closure of Planned Parenthood clinics for communities that rely on the provider for HIV testing. He referred to Scott County, Indiana, where the Planned Parenthood clinic closed down in 2013. Two years later, the community was hit with an HIV epidemic.
"Over 185 people were infected with HIV and the only clinic in town that provided HIV testing was closed two years earlier because of harmful politics," Burley wrote via email. "These are the consequences of putting party over people and it's where we are headed as a nation if this bill makes it out of the Senate and House."
University of North Carolina at Chapel Hill Professor Adaora Adimora, a PACHA board member who chose not to resign, told BuzzFeed News it was not just lower income Americans who would be affected.
"A number of hospitals in the rural South have had to close because they can’t get paid for uninsured patients," said Adimora, who stressed she was speaking in her personal capacity and not speaking for PACHA. "When this happens it’s a major blow to the local economy: employees lose their jobs, and residents have to travel much, much farther for care."
"This bill will sabotage progress that’s been made in the HIV epidemic — and the public health of America in general," she said.
Schoettes echoed the concern that not providing treatment and testing for HIV would put broader public health at risk. The Centers for Disease Control estimate that around 1.1 million Americans are living with HIV, with black LGBTQ men disproportionately affected by the illness.
Though there's doubt over whether the Senate will pass the bill in its current form, Schoettes thinks the picture will likely only worsen for people with HIV/AIDS.
"Most conservative Republicans who want deeper cuts have already come out against the bill, which means if it's going to move anywhere it's just going to become worse instead of being improved," he said.
"It's really upsetting because I know, having worked in the epidemic, that this is going to affect real people I know living with this disease," he said.