Ask Lambda Legal - Keeping the ‘Affordable’ in the Affordable Care Act

I was finally able to get health insurance through Obamacare, and thankfully, I qualified for the federal subsidies to help pay my premium. However, I heard that the subsidies might not be available for much longer. Is that true?

In some states, it’s true that they may not be available for much longer. The Affordable Care Act (ACA) reformed aspects of the U.S. health-care and insurance system and expanded access to private health insurance for millions of people. Under the ACA, a health insurance exchange -- through which individuals are able to select and purchase a health insurance plan -- was set up in every state. Thirteen are operated by individual states, and the rest are operated by the federal government. And if your income is 100 percent to 400 percent of the federal poverty level (for a family of four, that would be $23,850-$95,400), the federal government provides financial assistance to pay your health insurance premiums, no matter where you live. These federal subsidies are an essential component of the ACA for the many people who would not otherwise be able to afford health insurance.

Unfortunately, some people wish to undo the Affordable Care Act, which provides access to health care for millions of previously uninsured individuals. The U.S. Supreme Court is now reviewing King v. Burwell, in which the challengers seek to eliminate federal subsidies for insurance premiums for people living in states that have not set up their own health-care exchanges.

Lambda Legal submitted a friend of the court brief in this case on behalf of nine national HIV advocacy organizations, focusing on the disparate impact that an adverse decision will have on people of color living with HIV.

The great majority of HIV-positive people in the United States have incomes less than 400 percent of the poverty level, so the outcome of this case is critical. Many people living with HIV would become ineligible for subsidies and would no longer be able to afford health insurance, potentially denying them access to the life-saving medication and care they need.

And in the states whose residents potentially could lose their subsidies as a result of this case, there is a veritable public health emergency going on for communities of color. In this country, a black person is eight times more likely to contract HIV than a white person and after infection has a 13 percent greater chance of an AIDS-related death. If we don’t correct course, these disparities are only going to get worse.

Today, the key to halting the HIV/AIDS epidemic is access to affordable, reliable and comprehensive care, and that access is especially critical for vulnerable communities of color. A robust health-care system available to all is essential to achieving our goal of an AIDS-free generation.

If you have questions or feel that you have been discriminated against based on your sexual orientation, gender identity or HIV status, please contact our Legal Help Desk at

Scott Schoettes is HIV Project Director for Lambda Legal, the national organization that works to secure full civil rights for LGBT people."
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