by Mike Andrew - SGN Staff Writer

As arguments close in the U.S. Supreme Court hearing on the Affordable Care Act and the country awaits the court's decision, the stakes are high for the LGBT community, and particularly for those most in need of health care.

'For many of the approximately 1.2 million people with HIV in this country, the Court's decisions will directly affect access to quality care and life-saving treatment,' NGLTF says in a recent statement.

In fact, NGLTF says, the Affordable Care Act is 'our second most important tool for combating HIV and ending AIDS.'

People living with HIV have been systematically excluded from the health care insurance market because they are considered liabilities for private insurance companies. Antiretroviral medications are expensive, and an insurance company may have to pay out far more for such customers than they would collect in premiums.

Only 17% of people with HIV have private health insurance, compared with 67% of the general U.S. population.

Some of the remaining HIV-positive Americans have insurance through public programs like Medicaid, Medicare, or the VA. But nearly 30% have to depend on benefits funded by so-called Ryan White money, or go without care altogether.

The consequences of this patchwork quilt of health care for people living with HIV can be devastating.

HIV-positive Americans may discover their status late, and therefore have a reduced chance for successful treatment. They may go longer without lifesaving care and treatment and suffer worse complications, and they continue to die at unnecessarily high rates.

These negative consequences are more pronounced and concentrated in already marginalized populations like low-income communities, communities of color, especially the African American community, and the LGBT community.

In contrast, the near-universal access to health care envisioned by the Affordable Care Act would provide definite, measurable benefits to HIV-positive individuals.

Massachusetts, for example, experienced a 37% reduction in new HIV infections from 2005 through 2008, after a very similar reform was enacted in 2006. During the same period, the rest of the country saw an 8% increase in new HIV cases.

In addition, the age-adjusted HIV/AIDS death rate in Massachusetts is about half the national average - 2% as opposed to 3.7% nationally.

Antiretroviral medications that are effective in impeding progression of HIV - especially if the infection is diagnosed early - already exist. For those with access to these medications, and consistent, quality care and treatment, HIV can now be a manageable condition similar to diabetes or high blood pressure.

Effective treatment for patients currently living with HIV will also limit the further spread of HIV. Antiretroviral meds work by reducing the level of virus in the patients' blood to extremely low levels, and the lower the levels of HIV in the blood, the lower the chances of transmitting the disease.

Recent studies show that the risk of contracting HIV through sexual contact is reduced by up to 96% when the patient's viral load is suppressed to undetectable levels.

Not only is near-universal access to quality health care good for people living with HIV, but it is also one of the best prevention tools available.

According to NGLTF, 'the argument for the constitutionality of the [Affordable Care Act's] minimum coverage requirement (or 'individual mandate') is relatively simple,' when taken in the context of treating HIV/AIDS.

Congress has the power to address the exclusion of a particular group - in this case HIV-positive people, but more generally anyone with a pre-existing condition - from a market that operates in interstate commerce.

Because access to anti-retroviral meds and other forms of medical care is absolutely critical for the health of HIV patients, and for society as a whole in the battle against HIV/AIDS, removing exclusions for preexisting conditions is a vital part of any health care reform.

But that will not work without the accompanying individual mandate, which requires every American to become a part of the health care insurance pool regardless of their current health status. This requirement is also necessary to reduce the costs of insurance coverage by distributing the risks over the largest possible population.

'For that reason,' NGLTF says, 'the individual mandate is a necessary and proper means by which Congress uses its clearly constitutional power to regulate an interstate market under the Commerce Clause.'

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