A Win for Coverage, But Can People Still Access HIV Prevention?

While the Supreme Court’s recent decision in Kennedy v Braidwood Management preserved access to preventive services under the Affordable Care Act (ACA), public health advocates warn that proposed funding cuts to the CDC threaten to undermine HIV and hepatitis prevention efforts nationwide, particularly among uninsured and underserved populations.

“We're gonna fight those cuts that has been included in the president's budget because we need, you know, yes, private insurers may cover something, but you need all that outreach,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute in the last part of our interview. “You need all the education. And what about all the people who don't have health insurance? They need help as well with HIV testing, hepatitis testing, and people turn to their health departments.”

Schmid emphasized that although the ACA's preventive coverage mandate supports many privately insured Americans, CDC funding remains a cornerstone of the public health infrastructure. “Yes, it's CDC funding. But like in the case of HIV, I know 88% of that funding goes out in the field and mostly to health departments and community-based organizations,” he said. “To have the coverage will be extremely important. If we lost it... and that we're also facing budget cuts, then we'd really be in trouble. But we still need that federal government funding.”

Pointing to the infectious nature of both HIV and hepatitis, Schmid stressed the importance of continued federal investment. “These are both infectious diseases. These are public health issues and... there is a role for the federal government and state and local health departments,” he said. “For people who have health insurance then the government doesn't have to pay for those.”

Beyond funding concerns, Schmid highlighted the ongoing role of the US Preventive Services Task Force (USPSTF) in guiding clinical practice and combating stigma. “Just to get included on the US Preventive Service Task Force recommended list of preventive services is really a map for providers to review,” he explained. “There's around 40 of them right now, and depending on who the patient is, then a provider should offer these preventive services.”

That list includes routine testing for HIV and hepatitis, as well as offering pre-exposure prophylaxis (PrEP) for those at risk. “In the case of HIV and hepatitis, everyone should be tested at least once in their life. And if they have other risk factors, they should be, uh, tested more frequently,” Schmid said. “And then if they are at risk for HIV, they should be offered PrEP.”

Stigma and provider discomfort remain persistent obstacles, particularly in underserved regions. “We still have a lot of stigma with HIV and people don't talk about their sexual practices with their providers always, and especially if someone is gay and and particularly in the South as well,” Schmid noted. “But I hope this is a roadmap for providers in the South to talk about PrEP to their patients... I hope it will reduce stigma as well. People should be applauded for wanting to get on PrEP and taking the steps to protect themselves and others from HIV.”

Asked whether the Trump administration’s support for ACA preventive services reflects a broader shift in national HIV policy, Schmid described a mixed record. “It's been a mixed bag since day one with the administration—grants being canceled, staff being cut at the CDC,” he said. “The president's budget that came out in a lived elite that said that they would end the HIV Epidemic Initiative.”

While some core programs were preserved, others were gutted. “They're not cutting the Ryan White Program that provides care and treatment to low-income people. That's great news,” Schmid said. “And they also brought back almost all of the CDC HIV division staff except communications.”

That absence of communications capacity has had ripple effects, he argued. “I think they have a conception that communications is like working with the media, but communications does the outreach not only to the community, the public, but the providers as well. And that's all gone and all the grants are canceled. We're working on trying to get that back.”

Recent events have made the gap in federal engagement especially visible. “We just had National HIV Testing Day on June 27th and there was absolutely no campaigns from the federal government, which is really sad,” Schmid said. “The Ending the HIV Epidemic Initiative was in the president's formal budget, but the bad news was they completely eliminated the $800 million for CDC HIV prevention nationwide.”

As new HIV prevention tools become available, Schmid stressed the need for both policy support and insurance coverage. “There's a new drug for HIV prevention called lenacapavir which was just approved by the FDA a couple weeks ago, and that will revolutionize PrEP uptake,” he said. “It's only twice a year. It's an injection. It was approved just before the Supreme Court decision, which is great.”

But approval alone is not enough. “We want to make sure that insurers now cover that drug as well,” he said. “Because as people ask for it, they expect it to be covered and expect no cost sharing. So that's something we're gonna be definitely watching and asking people who are on PrEP to, you know, speak up and make sure their insurers are covering that.”

Reference

Supreme Court upholds preventive services coverage requirements. June 27, 2025. Accessed July 9, 2025. https://hivhep.org/press-releases/supreme-court-upholds-preventive-services-coverage-requirements/