Charting New Territory

55-7738-crossroads-1382138799Due to negative changes in funding authority under the Ryan White program, the Ohio AIDS Coalition (OAC) will be reorganizing and charting a new chapter in its role as the voice of state policy and advocacy leadership on HIV and AIDS in Ohio. This isn’t the first time in OAC’s long history – and it won’t be its last – that OAC has had to adapt to the financial environment.

Unfortunately, as a result of the changes that limit use of Ryan White funding for programs such as OAC, the services provided by OAC are no longer allowable expenses under the Ryan White Part B program. As such the current program will be funded through March 2017.

Founded in 1986 by a group of individuals, OAC has had a long history of advocacy for Ohio’s HIV-positive community. 2011 brought a changing landscape for the organization, as OAC began to shift its focus from client outreach toward community education, engagement, and leadership. Under the leadership of Kevin Sullivan, the board of directors continued critical discussions about the sustainability of OAC and voted to begin conversations with AIDS Resource Center Ohio (ARC Ohio) as a safeguard for the continued advocacy and education that OAC provides for Ohio’s consumers. In August, 2011 ARC Ohio’s board of directors voted unanimously to carry out a full merger with OAC, with ARC Ohio serving as the continuing legal entity.  The merger of OAC and ARC Ohio brought a stronger voice to the clients and constituents served here in Ohio. As a combined organization, advocacy and fundraising were enhanced, thus permitting continuance of the OAC vision of Hope, Healing, and Empowerment.

OAC’s programs and services continued under the umbrella of ARC Ohio (now Equitas Health), which provided administrative, and program support. Kevin believed that this move would strengthen long-term sustainability and enhance services. His decision has safeguarded the continued advocacy and education that OAC provides for Ohio’s consumers, and mobilized an even stronger advocacy and public policy voice.

OAC has grown tremendously over the years; the impact that OAC has had on lives has reached thousands throughout Ohio communities.

Equitas Health leadership will explore new strategies and structures to continue the advocacy and policy services for Ohioans with HIV.

Please stay tuned for more information.

Patrick Beatty

Director of Ohio AIDS Coalition,
Chief Public Policy & Government Affairs Officer at Equitas Health

(614) 340-6712

Pride

As most of you know, June is Pride month. A time to celebrate the histories, legacy, and lives of queer people. June is about more than remembering the Stonewall pride1Uprising or the Compton Cafeteria Riots. Those brave individuals that stood up for their right to live unburdened by their identities gave us the power to respond to a national epidemic, fight for employment and housing protections, demand access to quality healthcare, and have relationships recognized as legitimate under the law. The LGBTQ community and the HIV epidemic have always been closely linked. Gay and bisexual men and trans women suffer the greatest burden, and their lesbian, bi, and trans brothers and sisters have often cared for them as they shouldered it.

It’s no wonder, then, that there are so many milestones in the epidemic concentrated in Pride month.

  • June 1981 – The publication of the first documented cases of what would come to be known as AIDS. Millions of lives were lost and so many more affected.
  • June 1996 – International AIDS Conference, the world learned about the success of triple combination anti-retroviral therapy; a breakthrough we still use today. Highly active antiretroviral therapy has allowed us to change the game, turning a death-sentence into a manageable chronic condition with near-normal life expectancy and little chance of further transmissions.
  • June 2001 – The United Nations announced the Global Fund to support countries and organizations in fight against HIV by funding prevention, treatment and care, eventually distributing hundreds of millions of dollars in support year-after-year.
  • June 2010 – President Barack Obama released the first National HIV/AIDS Strategy, a roadmap to end the domestic epidemic that included promoting effective prevention strategies such as Treatment as Prevention, and (now) PrEP and PEP.

We must continue to remember and share the histories of LGBTQ people, celebrate our progress, and double-down on our shared principles. Collectively, our organization and our unified voice can impact lives in Ohio through care, prevention, advocacy, empowerment, and hope.

As the festivities, events, and brunches begin, we encourage you to reflect and remember those whom we lost too early thanks to the domestic AIDS epidemic; an entire generation of artists, thinkers, leaders, and activists silenced in a matter of years. And to remember those still here, still fighting, and still writing our histories, now right alongside of us.

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Our Commitment to 2016 (And You!)

Back in 1986 a group of individuals came together in Columbus during the height of the HIV epidemic and formed the Ohio AIDS Coalition. Over the past 30 years, OAC has evolved its advocacy, education, and leadership development strategies while keeping in mind our guiding principles of hope, healing, and empowerment. As we look ahead, we will continue to make strides to serve the needs of people infected and affected by HIV in Ohio in 2016. Here are our resolutions.

Enhanced Consumer Involvement

It is these voices, of those infected and affected by the HIV epidemic, that are most crucial to hear and incorporate when affectively developing projects, programs and initiatives. Who knows the needs of the positive community more than those living positively with HIV? We will strive to elevate those very voices in every aspect of our work. With the calendars turning to 2016, we will be revamp our social media presence to highlight the influence and many great successes of positive individuals.

We will unveil new opportunities for consumers to be seen and to be heard; extinguishing the stigma that often leaves them marginalized and isolated in their families, work places, neighborhoods, and communities. We will continue to engage positive Ohioans to build their leadership skills, help develop their advocacy capabilities, to not only speak for themselves, but to speak for the greater positive community. A way we’ll help individuals demonstrate their growth is assisting in the establishment of consumer-led caucuses across the state.

Ongoing Monitoring of Policy Priorities

OAC will also work tirelessly to elevate consumer voices in the political sphere by providing both opportunities to dialogue with elected representatives, especially at AIDSWatch Ohio 2016, and ongoing leadership and advocacy training. In late 2015 we began this process with our Project HEAL program and commit to continuing these type of programs in 2016. Consumers’ voices, stories, and experiences have power and must be the fuel to our advocacy fire. We will continue our longstanding tradition of advocating, in both public and private sectors, on behalf of all persons affected and infected by HIV & AIDS in Ohio. We will not rest until stigma, discrimination, and disenfranchisement are things of the past.

Commitment to Provider Engagement

During 2016, OAC will continue its commitment to ensuring that Ryan White program care providers maintain and enhance their technical and cultural knowledge when it comes to service delivery for HIV+ consumers, including how providers approach and comprehend the relationship that their specific care has within the HIV care continuum. OAC also commits to examine the level of quality, affordability, and cultural competence of the care that these professionals provide. There is no one “face” when it comes to HIV/AIDS, and as such, it is highly crucial that those that provide care are aware of the diversity and uniqueness present in the individuals that are impacted by their care. Lastly, but certainly not least, OAC recognizes the importance of the provider-client relationship. We will try to break down communication barriers that may exist between consumers and providers, and building new strategies to strengthen and cultivate the clarity and transparency that these relationships require.

2016 and Beyond

This year marks OAC’s 30th anniversary and the HIV epidemic’s 35th year in existence. These milestone years have called on us to reflect upon and evaluate the past and look towards the future. We now have the knowledge and tools to effectively end the HIV epidemic. This cannot be done without collaboration, sound policy, significant investment, removing barriers, and strong leadership. With this in mind, we have developed and released our plan to end HIV in Ohio.

OAC has grown tremendously over the years; the impact that OAC has had on lives has reached thousands throughout Ohio. As OAC evolves, our efforts to elevate HIV positive voices, our attention to policy and direction of advocacy, and building new bridges between providers and their consumers, will continue to remain the forefront as we make strides to serve the needs of people living with and affected by HIV in Ohio.

Throughout this year, OAC will continue to identify gaps in our own services and programs and strive to fill those unmet needs. We must continue to build on our successes and maintain our longstanding traditions while assessing and addressing our disappointments. 2016 will be a year of reflection, renewal, action, and consumer involvement. And, most importantly, we hope that 2016 will be the beginning of the end of the HIV epidemic in Ohio.

In Recognition of National Black HIV/AIDS Awareness Day

In recognition of National Black HIV/AIDS Awareness Day I decided to tell my personal story. Of course I could give statistics and data, which I will do a little of later, but I thought sharing my story 19would be most impactful.

Unfortunately, like many young African American gay males, I was not as educated about HIV as should I have been. This was due to not hearing much about it in school, being heavily involved in the church, and honestly, growing up Black. Being gay was and still is a taboo within the Black community and then to add HIV on top of that was definitely a recipe for disaster.

In the summer of 2009 I started to develop boils in various places of my body and didn’t know why. I decided to go to a local Urgent Care and get some antibiotics. After finishing the medication I got really sick. I started to develop rashes on my body, felt very weak, and could hardly eat. I went to the ER and the nurses and doctors ran multiple tests. Although the results said that I was allergic to the medication that I was taking for the boils, they felt something else was wrong. They asked me if I had ever had an HIV test and I told them that I had only once before, so they tested me.

I was finally released from the hospital but didn’t receive my HIV test results. I waited for a few days and eventually called the hospital and requested them. The nurse informed me over the phone that I was HIV negative. Of course I was excited! It wasn’t until I went to my follow-up appointment with my family physician during my lunch break at work, ON MY BIRTHDAY, that I found out that I was HIV+. Imagine me in his office happy and smiling, excited about my birthday weekend and my doctor coming into the room saying “You seem awfully happy to have heard the news.” I was wondering what he was talking about and then he told me that I wasn’t just diagnosed with HIV but also AIDS. My CD4 count was 2 and my viral load was in the six figures. To this day my doctors still don’t know how I was able to survive.

It turns out I had a strain they had never seen before. Throughout my journey I developed seizures, lost my sight and mobility, weighed 98 pounds, and spent months at a time hospitalized. The fear within my mother’s eyes was something that I had never seen before. I remember that exact moment I told her I was HIV+. We were standing in my grandmother’s yard and I broke down crying and muttered the words, “I have AIDS.” At that moment she grabbed me in her arms and whispered in my ear with tears coming down her face “WE will get through this.” From that point on my mother was at almost every hospital visit and became my rock. I remember laying in the hospital bed crying, not knowing what to do, while my Infectious Disease doctor and nurse were preparing to tell my mother that I was not going to make it. My mother held my hand and sternly said, “You are a fighter, you will not give up. God has a plan and a purpose for you.”

My “lightbulb” moment came the last time I was in the hospital in 2013 when I had my worst seizure to date. I was married at the time and couldn’t remember my husband’s name or even recognize him. I couldn’t speak and lost most of my memory as it relates to that time period. It was after I had finally woken up, after almost a month, that I finally realized that God had a greater purpose for me. All the trials and tribulations that I have been through had been for me to share. I went through what I went through so I can could become a guiding light for others. It was at that moment that I vowed to do what I could in order to decrease the number of new HIV/AIDS infections among young Black gay men, and to this day that vow still lives within me.

I joined a local empowerment group for young African American gay men doing outreach. Shortly after I began working at the Greater Columbus Mpowerment Center (GCMC) as the Outreach Services Specialist. While at GCMC, I became the chair person for both World AIDS Day and the National Black HIV/AIDS Awareness Day committees for the city of Columbus. I soon began working for Columbus Public Health as a Disease Intervention Specialist focusing on young African American gay men. Currently I am the Program Manager at the Ohio AIDS Coalition, an organization that provides hope, healing, and empowerment to all Ohioans affected by HIV/AIDS.

While I believe that I have done great things for my community there is still more work to be done. In Ohio in 2014, African Americans accounted for 52% of all persons diagnosed as HIV+, making them nine times more likely to be diagnosed compared to whites. 44% of all people living with HIV in Ohio are Black/African American. Since African Americans make up about 13% of Ohio’s population, you can see how disproportionately this community is affected by HIV/AIDS.

It is imperative that we not only show support for this community but start and continue to mobilize. Testing is only one piece of the puzzle. Addressing issues around survival sex, homelessness, stigma, poverty, etc. is how were are truly going to be able to reduce new HIV infections among Blacks.

I decided to tell my story to show and prove that despite whatever negative experiences you have, you can and will get through them. February 7th is National Black HIV/AIDS Awareness Day and I implore you to get involved. Take the time to educate yourself about HIV/AIDS and what it is doing to our community. If we do not start equipping ourselves properly and becoming more knowledgeable, we are doing a disservice to ourselves and our brothers and sisters. Martin Luther King Jr. once said “An individual has not started living until he can rise above the narrow confines of his individualistic concerns to the broader concerns of all humanity.” I challenge you to start living.

Yours in the fight,

Adrian Neil Jr.

Taking Control with PrEP

107091581truvadacropThree months ago I started the steps of claiming further control over my health and my life by starting on PrEP (pre-exposure prophylaxis). I had been discussing my interest and intent to start with friends, family, and co-workers for a while. Before calling to schedule my appointment, I was made aware that I could qualify for co-pay assistance through Gilead, via truvada.com. Since I already had insurance I could apply for the HIV Co-pay Assistance Coupon Card, but if I didn’t I could still apply for the U.S. Advancing Access Program.
Scheduling my PrEP intake appointment with the AIDS Resource Center Ohio Medical Center was simple enough. First I met with a PrEP counseling intake specialist, in which I underwent a risk measure assessment. Basically, I covered past medical history, family history, social history (including sexual activity, any drug/alcohol use, etc.), and current medications being taken. I then moved on to meet with the physician who gave me a brief physical and prepared me for the labs I needed to have done. The rest of the visit was listening, answering questions, talking about Truvada and the risks specific to HIV, emphasizing the importance of medication adherence, along with connections to other related services. And then the waiting game for my lab results and medications began. A friend suggested to me to make sure I asked if a 90-day supply was available rather than a standard 30-day supply, as a way to potentially save a couple hundred dollars in the long run.

There’s a lot more to PrEP than just taking one pill of Truvada every day. PrEP would allow me to have sex without fear for the first time in my life. It would remove that month long hangover of psychological anguish after sex, worrying about whether or not I might have put myself at risk of HIV and looking for the slightest sign. If I get a cold or a rash my mind will instantly jump to conclusions because of the anxiety I have around HIV.

I know it’s a completely irrational fear in many ways. Even when I know there’s been no risk and I know the statistics, I should feel comfort but don’t. Even though I use condoms I still have anxiety. For me, wanting to use PrEP isn’t about not wanting to use condoms, it’s about wanting to have that extra layer of security, both physically and psychologically, to not have to worry about it for the next month, which is what I tend to do.

The entire gay community is affected by this kind of anguish and it only fuels the epidemic because when people feel anxious they don’t talk about it. When I try to talk about PrEP, people make assumptions about me and try to turn the conversation into a moral debate about personal responsibility, but doing this won’t stop the HIV epidemic. Empowering people to take control of their HIV risk with a range of tools is what’s going to help.

While condom usage remains the gold standard of HIV prevention, this shouldn’t stop us trying to understand that people might struggle with them. I think a lot of the concern around PrEP comes from the thought that “well you’re taking PrEP to have sex without a condom,” which people see as a problem. But really I think that’s missing the point; you don’t need PrEP to have sex without a condom—people do this all the time. The only reason to take PrEP is to prevent HIV infections. And that’s a pro-health choice at its core.

For anyone on the fence I ask:  If you were a woman would you take birth control pills to prevent pregnancy? If we had a vaccine for HIV, would you take that? You may not be at risk for pregnancy, and we may never have a vaccine, but for now we have an effective bio-medical strategy that reduces risk of HIV by up to 99 percent if taken daily. If you feel it’s for you, talk with your doctor.

-Evan Robinson

Turing Pharmaceuticals Raises Daraprim Price Over 5,000%

Turing Pharmaceuticals paid Impax Laboratories $55 million for the U.S. rights to pyrimethamine, also known as Daraprim, a marketed drug used to treat a parasitic infection called toxoplasmosis and some cases of malaria. This drug is for certain AIDS patients a critical component of their care.

After acquiring the rights to the drug, Turing then raised the price of Daraprim from $13.50 per pill to $750 per pill. That will make acquiring the drug cost prohibitive for some people with HIV/AIDS. In response to the concerns over access, Turning issued a press release indicating that they have resolved any access problems for individuals and hospitals.

OAC will be monitoring this to determine what impact the price change has on managed care and OHDAP formularies.

Turing Pharmaceuticals was just started in February 2015 by a hedge fund operator with a $90 million dollar Series A funding from venture capitalists. One report in xconomy.com stated the following about the startup:

“Turing, a startup with offices in New York City and Zurich, Switzerland, closed a $90 million Series A this morning. The funding was led by Shkreli, Turing’s founder and CEO, and included several other unnamed ‘preeminent institutional equity investors,’ according to a statement. Turing also took on some senior secured debt, though it didn’t specify how much.

Most young biotech startups don’t take on debt; the road to generating the revenue needed to pay off loans in life sciences can be several years long and fraught with failure.” 

This commentary provides an interesting perspective on the impact the pricing has on insurance premiums for everyone. Only time will tell whether the price change was actually for development of new drug therapies, or for stockholders and debt erasure. OAC will be monitoring that as well.

UHCAN Ohio Honors Ohio AIDS Coalition and 5 Other Champions of Health Care

UHCANUHCAN 1Columbus, OH—UHCAN Ohio honored six  champions of health care at its annual event, Lend your Voice—Health Care for All,  held on May 21, 2015, at the historic Lincoln Theatre.  The six honorees were chosen because they enhance the consumer voice in demanding a health care system that delivers quality, affordable health care for all Ohioans.

“Building the consumer voice to make health care work for all Ohioans is our core mission,” said Cathy Levine, Executive Director of UHCAN Ohio. “The individuals and organization we honored have worked tirelessly in their communities to give voice to the voiceless.”

UHCAN Ohio’s organization of the year was the Ohio AIDS Coalition, a division of AIDS Resource Center Ohio (ARC Ohio), which provides education, leadership training, advocacy, and support for Ohio’s HIV/AIDS community. Their purpose is to cultivate and amplify the voices of people living with HIV in Ohio. It is based in Columbus, OH.

“The Ohio AIDS Coalition was honored because of their relentless work ensuring that the services and resources available for people living with HIV/AIDS are provided in a nurturing and respectful manner,” said Levine.

The Ohio AIDS Coalition was introduced by UHCAN Ohio’s Dental Access Now! Director, David Maywhoor, who said of their impact, “The Ohio AIDS Coalition has been a great partner in our work to raise the issue of the lack of dental access in Ohio by hosting events and participating in lobby days. They also help Ohioans with HIV/AIDS choose the right health plans based on the prescriptions they need and shares their members’ experiences on UHCAN Ohio’s monthly calls about issues consumers are having with their insurance coverage.”

Patrick Beatty, Director of the Ohio AIDS Coalition, said “we are honored to receive the award as a recognition of our efforts to maintain that public awareness, and for our advocacy and leadership in helping to bring forward the Affordable Care Act and other resources for the HIV community in Ohio. “

These central Ohio honorees were joined by four other honorees from across Ohio that UHCAN Ohio recognized at their Lend your Voice—Health Care for All annual tribute event. The other honorees included:

  • Semanthie Brooks, Director of Community Advocacy at Benjamin Rose Institute on Aging, Cleveland, OH
  • Susan M. Rogers, Director of COAD/RSVP of the Ohio Valley, Jackson, OH
  • Elizabeth Tronolone, Chair of the Dental Hygiene Program at Owens Community College and the Ohio Dental Hygienists’ Association’s Government Relations Chair, Toledo, OH
  • Judith Warren, CEO of Health Care Access Now, Cincinnati, OH

UHCAN Ohio is a consumer health advocacy organization working to achieve high quality, affordable health care for all Ohioans and building the voice of consumers in health care.

BREAKING THE SILO – BENDING THE CURVE.

This is the year to end rationalizations and isolationism and break out of the silo.

  • The number of new HIV infections in Ohio has gone up over the past ten years.
  • The national conversation about HIV and AIDS has become muted.
  • The age group most impacted by new infections is the younger generation.
  • An HIV positive status has been criminalized for almost two decades.
  • HIV positive Ohioans now have full access to Marketplace and Medicaid managed care plans.
  • Community viral suppression will reduce the rate of new infections.

Let’s put those in perspective. HIV has been in a silo since the start of the epidemic in the 1980s. The Ryan White Care Act was enacted by Congress in 1990 to provide a safety net for individuals living with HIV or AIDS primarily because these persons had no other sources of care or support. For as long as the virus has been around, society spoke about HIV/AIDS separately from other diseases in general, as though it was something to keep apart, and keep isolated. Culturally we became so specialized, so focused on the havoc the human immunodeficiency virus can bring, that we missed the bigger picture.

The advent of highly active antiretroviral therapies changed HIV/AIDS from being a fatal disease to being a chronic disease. It also had a different effect of muting the conversation about the seriousness of the HIV and its impact on the lives of those who contract the virus; isolating both the disease and those with it even further.

The result is not surprising. Society maintained the HIV/AIDS silo, and because of that, the national number of new infections annually has stagnated at 50,000 over the past few years. When it comes to new infections, you don’t want to see stability, you want to see a decline. Individuals under the age of twenty didn’t experience the height of the epidemic in the mid-1980s until the mid-1990s and the muted dialog only served to place the younger generations at greater risk. They are now the age group with the highest rate of new HIV infections, accounting for one in four.

2014 was a watershed moment not only for all Ohioans regardless of HIV status. For the first time in history HIV positive Ohioans can now be covered by some form of insurance with Essential Health Benefits (EHB) whether through employer sponsored insurance, Medicare, Medicaid, or the Marketplace. Access to coordinated comprehensive integrated care means greater opportunities to reduce community viral load and reduce new HIV infections.

2015 will be another watershed year—a year of breaking the silo.

  • We will move forward and recognize that HIV is a disease—not a crime.
  • We will work to fully integrate HIV treatment into mainstream health care.
  • We will promote prevention interventions including pre-exposure phrophylaxis (PrEP).
  • We will work to ensure persons with HIV have fully integrated and equal access to housing and employment.
  • We will promote State Health Education Standards.
  • We will reinitiate the dialog about HIV and AIDS with the public at large.

So, here’s the thing, and there’s really no getting around it. If we’re going to really commit to ending the HIV epidemic, we need to break the silo.

King v. Burwell, Explained

You might have heard about the latest Supreme Court challenge to the Affordable Care Act (ACA), King v. Burwell. Any Supreme Court case can get pretty complicated, so we’re going to try to break it down and simplify it for you since its outcome could drastically effect health insurance for Ohioans.

So what’s the real issue?

Part of the ACA involves offering subsidies to people buying insurance through the exchange as long as their income is below 400% of the federal poverty level. This helps the plans actually become affordable for the average US citizen. Congress gave each state a choice to either set up its own exchange (13 did) or let the federal government run its exchange through the federal Marketplace (the choice of 37 states, including Ohio). At the end of Open Enrollment in 2015, 8,838,291 plans had been selected on the federal exchange (234,507 in Ohio). Some are arguing that the exact language of the ACA is being incorrectly interpreted, questioning whether the ACA allows for subsidies only for state-run exchanges. If it does, over 7.5 million Americans (196,846 Ohioans) could lose their subsidies and have to pay the entire premium for these health insurance plans. The average subsidy for an individual living in Ohio is $247 per month.

Who are the plaintiffs?

There are technically four plaintiffs in this case, David King, Doug Hurst, Rose Luck, and Brenda Levy. These four individuals have pretty different backgrounds. We’ll talk more about them in a bit.

Who are the defendants?

This one’s a little bit simpler! Burwell is Sylvia Matthews Burwell, the United States Secretary of Health and Human Services. The plaintiffs are essentially suing the US government.

Why are the plaintiffs suing?

The plaintiffs are suing the U.S. government because they state that if they do not receive subsidies they would qualify for the hardship exemption and not have to purchase health insurance. With the subsidies, if they did not purchase health insurance they would receive a tax penalty.

Under the federal laws, if the cost of insurance coverage is over 8% of someone’s income, that person would qualify for a hardship exemption to the individual mandate penalty (the fine/tax for not purchasing insurance).  The plaintiffs state that they have incomes that are low enough that they would qualify for the hardship exemption, however, the subsidies reduced the cost of their coverage to below 8% of their income.  The existence of the subsidies causes them be eligible for the hardship exemption and would now have to either purchase health insurance or pay the penalty for not buying insurance.

So you can say the “harm” they show is that the IRS rule results in them having to pay a penalty they would otherwise be exempt from paying.

Do the plaintiffs have standing?

There’s been a lot of talk asking if the plaintiffs actually have standing. That means that a person can demonstrate significant harm from a law or action. When there are multiple plaintiffs, you only need one to have legal standing for the case to continue.

It looks like one or two out of four plaintiffs have standing. Brenda Levy and David King, under the ACA, would be exempt from having to purchase insurance because the premium of the cheapest plan would have been more than 8% of their household income. Rose Luck’s standing is a bit trickier. She listed a motel as her address. Since premiums are determined by where you live, this would effect if she was actually harmed by the legislation. Using that address, the cheapest plan for her would be almost 9% of her income, also exempting her. It all seems to lay on the shoulders of Doug Hurst. It was initially questioned whether, as a Vietnam War veteran, Hurst was eligible for free care through the VA, making him ineligible from purchasing insurance on the Marketplace. But since he only served for 10 months he was ineligible for VA care and forced to buy health insurance on the Marketplace. If he did not, he would receive a tax penalty.

What are some arguments in favor of the plaintiff?

The main argument is based on exactly seven words in the ACA “through an exchange established by the state.” The plaintiffs argue that if taken exactly as written the ACA establishes subsidies only for state exchanges. If a state establishes an insurance exchange they get the subsidies. If they don’t, they miss out.

The plaintiffs can also dispute Congressional intent, arguing that those seven words act as a threat; that by not directly addressing a federal exchange offering subsidies is Congress’s way of saying something to the effect of “if you don’t set up an exchange in your own state you’re going to put your residents at a disadvantage. We really want you to set up your own exchange.”

So what about the defense?

The first thing that might come to mind, if you’re a legal nerd, is Chevron deference. That came out of a 1984 case that decided that if there’s a statute that’s unclear or unreasonable courts should defer to how the administrative agency interprets it. In this case that’s the IRS. In 2012 the IRS released a rule discussing that those enrolling in the federal exchange will still be eligible for subsidies. The question then becomes, is this statute unclear and ambiguous?

Another argument boils down to federalism. In a big picture sense, this case truly becomes about states’ rights. An argument in favor of the plaintiffs touches upon this idea- that if the federal government doesn’t step in an offer these subsidies, well then that’s just plain coercion. This sort of parallels the Supreme Court’s finding in regards to Medicaid expansion in 2012. In that case, the Supreme Court found that it should be up to individual states to choose whether to expand Medicaid or not. Taking a literal reading of the ACA, this might be the same as telling states that either they will create their own exchange, or the US government will send their insurance market into a death spiral.

Lastly the defense can also argue Congressional intent. Historically, the Supreme Court has frequently looked at the entire law and its spirit- not just the literal language. Looking at the ACA in this manner, you can argue that it’s clear that Congress didn’t intend for it to be a threat for the states because they offered a fallback option, they offered protection. They created a federal exchange because in the end, the goal of the ACA was for everyone to have access to affordable health insurance.

The hearing

The Supreme Court heard arguments for King v. Burwell on March 4, 2015. Analysts believe that Justices Scalia and Alito are expected to find in favor of the plaintiffs. Justices Ginsburg, Breyer, Sotomayo, and Kagan are predicted to find in favor of the defendants. Justice Thomas was characteristically quiet during the hearing. It will be interesting to see how Justice Kennedy and Chief Justice Roberts vote. The court is unlikely to issue a decision until June or July. We’ll be sure to keep you updated!

The Ohio AIDS Coalition Recognizes Black History Month

The HIV/AIDS epidemic is now almost 34 years old.  As the epidemic has changed over three decades, so too has the face of HIV.  Blacks represent approximately 12% of Ohio residents yet account for half (49%) of all new HIV infections and 45% of all Ohioans living with HIV.  The rate of new HIV infections among blacks is almost 8 times higher than among whites with more higher rates of new infections among persons 24 years of age and younger.

If the current rate of infection continues, nationally 1 in 4 black gay men will become HIV-positive by the time they are 25 and 1 in 2 black gay men will be living with HIV by the time they are 35.  Overall, 1 in 16 black men will be infected in their lifetime.  For whites, this number is 1 in 102.  We can’t help but ask “why.”  Why are blacks so disproportionately affected by HIV?  Why isn’t the public talking about these overwhelming figures?

It’s a lot more complicated than just statistics and numbers.  HIV/AIDS has never simply been a disease, but has been inseparably tied to historical social injustices, homophobia, misogyny, racism, homelessness, poverty, and transphobia.  And these each singularly, and collectively, have been visited upon members of the HIV community.

The war against HIV is not fought solely in hospitals and bedrooms, but in courtrooms, streets, and the statehouse.  We will not win the war without also addressing the intersectionality between race, poverty, lack of access to healthcare, and how systems perpetuate discrimination and stigma within our communities of color and continue to drive the epidemic.

The Ohio AIDS Coalition (OAC) has a longstanding history of representing the voices of people living with HIV/AIDS (PLWHA) and articulating a united response in the face of threats the HIV community.  From the beginning of the epidemic, people living with HIV have not only been persecuted for the disease they carry, but also for their association with the LGBTQ community, being poor, and being black.

We cannot afford to ignore the threat of HIV/AIDS in the black community.  We need to do better.  We need to increase access to quality, affordable healthcare for communities of color.  We need to increase HIV and STI testing.  Most of all, we need to address ALL aspects of HIV and not just the infection.  We need to promote workforce education and address homelessness.  We need to look to the future, leave our silos, and begin addressing the intersection of HIV and social injustices.  And here at OAC, we’re committed to that fight.