A Shifting Healthcare Environment

By: Jacob Smith Yang

Many in the health care community were relieved—even elated—with the news that the Affordable Care Act (ACA) was upheld by the U.S. Supreme Court on June 28th. The law will create coverage for up to 32 million Americans in the coming years and hold great potential to address the inequities vulnerable populations and communities of color have experienced for too long.

This is undoubtedly one of the largest expansions of health care our nation has ever seen, since the signing of the Medicare and Medicaid programs in the 1960s. “By expanding coverage and banning the denial of coverage based on pre-existing conditions, many thousands more people will have access to essential HIV prevention and treatment services,” remarked amfAR (The Foundation for AIDS Research) CEO Kevin Robert Frost. Additionally, the National HIV/AIDS Strategy, unveiled in 2010, calls for expanded access to treatment for people living with HIV and broader delivery of prevention and testing services to those who are especially vulnerable to HIV infection. But as APIAHF’s President and CEO, Kathy Lim Ko points out, “Now comes the hard part of implementing many of the laws most significant provisions – including ensuring that all communities understand the law’s many benefits and working with states to expand Medicaid eligibility for their most vulnerable.” We are in the midst of momentous structural changes to the health care system, but operating in an environment of ongoing budget shortfalls and erosion of the key health care infrastructure.

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In the short term, this means many in the HIV/AIDS community have had to scramble and push to make sure the needs of people living with HIV/AIDs (PLWHA) continue to be met. Over the years, networks of providers across the country have cobbled together safety net systems that effectively meet clients’ needs. As funding sources and program eligibilities and mechanisms shift – moving toward full ACA implementation in 2014 – the cables of the safety net are sometimes unraveling, and PLWHA are at risk of falling. The new healthcare landscape absolutely demands that entities previously unaccustomed to working together overcome turf and silo issues so that true access to HIV prevention and services is maintained.

In the long term, much remains to be seen in how health care reform is implemented, and whether the resources planned to support it actually become available, given the economy. What is clear is that the emphasis on evidence-based programming and demonstrable outcomes is growing and stronger than ever. Community-based organizations (CBOs) are competing for scarcer and scarcer funds, and will need to be able to justify the theoretical and research-based strengths of their interventions. Planning and conducting rigorous systems for monitoring program activities and documenting positive outcomes for clients will also be key to staying competitive. Building strong linkages between prevention programming and HIV testing, clinical and other services are essential, especially in light of the National HIV/AIDS Strategy, and High Impact HIV Prevention, CDC’s approach to reducing HIV infections in the U.S.

The C4H team has worked hard to get the best, most comprehensive information on these initiatives out to the HIV/AIDS prevention community – through its trainings, webinars and one-on-one capacity building assistance. We have deepened our monitoring and evaluation expertise so that we are ready to respond to capacity building requests from providers, as they realize assistance is available to make these changes. CBOs directly funded by the CDC for HIV prevention, in particular, have access to free capacity building services that can strengthen and enhance their programs in this regard. Now that the Supreme Court has given further ACA implementation the green light, it is an opportune time for providers to correspondingly move forward with their planning. C4H is here to help.