The Affordable Care Act in the United States and HIV Disease: Past, Present, and Future.

From its beginning, the AIDS epidemic crystallized some of the major flaws of the American health care system. Most private health insurance was associated with employment, and job loss meant insurance loss. Private insurers refused new coverage for people with HIV infection. Medicaid, an important program for uninsured people with low income, was limited to only those in certain categories (eg, pregnant women or children), and although people who had progressed to AIDS were categorized as eligible (ie, "disabled"), those with early stage HIV disease were not. The Patient Protection and Affordable Care Act is a landmark change in health care law in general and for people with HIV infection in particular. Its provisions offer dramatic improvements in health coverage, although a Supreme Court ruling that limited the expansion of Medicaid poses ongoing problems in some states. This article summarizes a presentation by Timothy M. Westmoreland, JD, at the IAS-USA continuing education program, Improving the Management of HIV Disease, held in Washington, DC, in May 2015.