By: Al Ballesteros
Photo: Affordable Care Act © Designer491 | Dreamstime.com

Before the Affordable Care Act or OBAMA-CARE, getting health insurance coverage to go to a doctor was very difficult for poor and middle-class people. Students, the unemployed, those who worked in jobs that did not offer benefits or those who were self-employed made up most of the uninsured.

Just 14 years ago, the uninsured had little access. They depended on county funded programs, went outside of the United States and paid out of pocket for medical care, medications and other treatment. Many went without care they needed.

The uninsured included hundreds of thousands of LGBTQ+ people as well as tens of thousands of persons living with HIV and AIDS across the United States. People with AIDS who were poor had to depend on the Ryan White program, or county funded medical care almost entirely. And for those who had the ability to purchase insurance on their own, it was very difficult to get if one had a preexisting medical condition. In fact, if one was HIV positive or had AIDS, it was almost impossible to get private medical coverage.

All that changed when the Affordable Care Act or ACA was passed and signed by President Obama. Today, if a person is low-income, below 138% of Federal Poverty, they qualify for Medicaid in the States which offer ACA Medicaid expansion. Under Medicaid in California and in most states providing the ACA, one pays nothing for medical care, dental, mental health, medications, diagnostics, hospital stays and other benefits offered. The ACA also has another component which is the Health Insurance market place. This market place is for those with incomes above 138% of Federal Poverty, where they can buy coverage from low-cost insurance plans. Equally important, plans can’t discriminate against or charge more money to people with pre-existing conditions. Here in California, many of our LGBTQ+ specific health centers are funded by the ACA. They provide targeted and robust care for our community including gay and bi men’s specific care, cancer screenings, transgender services, STI and HIV treatment, Prep and Pep and Doxy-Prep alongside general medical services.

The Medicaid component of the ACA is a federal and state insurance program and for states which expand it the federal government pays 90% and the state 10% of the costs. Unfortunately, there are ten states—Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming—that have not expanded Medicaid eligibility under the ACA to individuals with incomes up to 138% of the federal poverty level. Even though Medicaid would help poor people and be paid mostly by the federal government these largely Republican states have chosen not to provide it. And it’s not because these states can’t afford to provide it, rather, it seems these states politics do not favor providing a benefit to people they feel should not have it.

This is very sad because according to research conducted by the Robert Wood Johnson Foundation, the uninsurance rate in these states would drop by 25% if these 10 states expanded their Medicaid programs. Young adults ages 19 to 24, the age group with the highest uninsured rate, with nearly one in five individuals uninsured (19.9%) would see the greatest decrease in the rate of uninsurance (a drop of 32.4%). 

The ACA has contributed to health and saved lives. Perhaps many of our readers have direct experience with this. However, members of the Republican Party, including former President Donald Trump have tried several times to take this healthcare away. When in office Trump and the Republican Congress almost took this care away and it came down to one vote: The late Senator John McCain of Arizona, a Republican was the only one who voted with the Democrats to protect the ACA. Had McCain voted with the rest of Republican Senators, this benefit would not be here today. 41 million people would have lost access to health care, as we know it today and this includes hundreds of thousands of LGBTQ people.

I can’t understand how taking away health care from people is good public policy for Republicans in the Congress. If people don’t have health care, they don’t have the opportunity to deal with a health problem before it gets worse. Some say it’s about money the government should not be spending. That does not make sense because when people don’t have access to medical care, they get sick and end up with conditions that become more costly and are usually cared for in emergency rooms or hospitals. When care is delivered in emergency rooms or hospitals for the uninsured, it usually is covered by Medicaid. This means the government’s money is spent anyway so why not spend it at the beginning to prevent and make illness better rather than wait for when health conditions get worse.

Other Republicans say the federal government should not “give hand-outs” to poor people, and that they should work and figure out a way to cover their own healthcare. Well, some people can’t do this because of illness, injury or other conditions. Our government should guarantee basic health care coverage for all persons living in the United States, it should be a basic human right. Why should only people with “means” be able to seek medical care in a country that has the ability to provide for all?

Former President Trump says he will get rid of the ACA should he become the president again. Republican members of the Congress are in line with this and will try as soon as they get a president that will sign the law to do away with the ACA, which Trump will for sure.

On March 22, 2024 the U.S. Department of Health and Human Services (HHS) issued four new reports showing that under President Biden’s leadership, over 45 million people have coverage thanks to the Affordable Care Act’s Marketplaces and Medicaid expansion.

• 18.6 million people have coverage thanks to the ACA’s Medicaid expansion.
• Across coverage groups, a total of 45 million Americans are enrolled in coverage related to the ACA, the highest total on record.
• Survey results indicate that all 50 states and the District of Columbia have experienced substantial reductions in their uninsured rates since 2013, the last year before implementation of the ACA.
• Black Americans and Latinos continued to enroll in health coverage through the Marketplace at high rates. An estimated 1.7 million Black people and 3.4 million Latino people enrolled in Marketplace plans in 2023 alone
• Prior to the ACA, health plans also often limited the benefits they covered. In 2011, 62 percent of individual market enrollees did not have coverage for maternity services, 34 percent did not have coverage for substance use disorder services, 18 percent did not have coverage for mental health services, and nine percent of enrollees did not have coverage for prescription drugs.

The LGBTQ+ community’s health care needs are being better met with the ACA. To this end, your ability to vote now means so much. People’s health literally depends on our voting for members of Congress, the Senate and a President that will protect healthcare. Joe Biden and Kamala Harris are steadfast supporters of the ACA. Unfortunately, Donald Trump is not.

If you are registered to vote, vote. If you are not registered to vote, please get registered to vote in the November election.