What Does AIDS Have to Do With the AHCA? Public Health Watch Report

Opponents of the Medicaid cuts included in the American Health Care Act (AHCA) argue the cuts will significantly impact individuals living with HIV/AIDS as 40% of them depend on the government healthcare program for care.

In cities such as New York and San Francisco, activism on behalf of those with HIV/AIDS dates back to the early 1980s, when the disease was first characterized and diagnosed.

And, believe it or not, Donald Trump was a focus of attention even then, long before he became President of the United States.

As documented in the exhibit “AIDS at Home: Art and Everyday Activism” at the Museum of the City of New York (MCNY), ACT UP, the activist collective formed by author and playwright Larry Kramer, targeted President Trump and, specifically, New York City’s involvement in his real estate activities, as far back as 1989, with protests outside of Trump Tower on Fifth Avenue on Halloween of that year. At issue, at the time, was the perceived inaction on the part of the city government in response to the AIDS crisis. According to ACT UP, the city had just “64 beds” allocated to the more than 10,000 homeless individuals with HIV/AIDS in New York (these figures are from the organization); meanwhile, they noted, the city had given Trump and his businesses hundreds of millions in tax breaks—some $885 million since 1980, per The New York Times—to build luxury apartments such as those found in Trump Tower.

Today, with President Trump now occupying the White House, those same activists might argue that history is repeating itself—on a national scale. As part of the healthcare reform legislation proposed by members of the Republican caucus in the Senate, some 15 million Americans who receive Medicaid will lose their coverage by 2026 should the bill become law. These estimates, from the Congressional Budget Office score released Monday, reflect changes to the Medicaid program resulting from $772 million in funding cuts proposed by the Senate bill—and are significant because some 40% of those living with HIV/AIDS in the United States are covered by Medicaid. Even those who do not have the disease are concerned: A Medicaid recipient told the Guardian this week that the Senate Republicans “are sentencing me to death” with their proposed cuts to the program.

President Trump has urged his Republican colleagues in the Senate to show some “heart” in their healthcare reform package, while still achieving what the GOP sees as vital cost control, given the rise in spending seen under the current law: the Affordable Care Act (ACA). According to Centers for Medicare and Medicaid Services (CMS) statistics, Medicaid expenditures grew 9.7% to $545.1 billion in 2015, the last year for which data is available, and Medicaid now accounts for 17% of the national healthcare expenditure. Those who support the Senate bill also note that private healthcare spending (private insurance and out-of-pocket expenditures) increased 7.2% to $1,072.1 billion in 2015 (based on CMS figures).

CMS expects both Medicaid and private healthcare spending to increase in the coming decade, albeit more slowly, assuming the ACA remains in place.

Which, for now at least, is looking more and more likely. As of today, the Senate GOP leaders have decided to put off voting on the bill until after the Fourth of July holiday.

Next to images of ACT UP’s Trump protests in MCNY’s “AIDS at Home” exhibit were heart-rending portraits—by the likes of painter Hugh Steers—of AIDS patients, circa 1985-1990, receiving care at home from friends, partners, and loved ones. Certainly, heading into this week, there was some concern these works would be once again relevant (beyond their role in documenting history) in the near future. However, such is the nature of the US political system that major change is no small feat.

And, to the activists whose stories are portrayed at MCNY, and their contemporary counterparts, perhaps thankfully so. However, the fight is far from over. Healthcare costs are still rising, and how best to manage them remains up for debate. And as long as people continue to get sick (or, in other words, for the rest of time), that’s not likely to change.

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.