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Why Obamacare Falls Short for Some Living With HIV, AIDS in Central Texas

Part of President Barack Obama’s signature health care law is a provision that protects people with pre-existing conditions from being denied insurance coverage, including people who are HIV positive.

Still, the Affordable Care Act hasn’t solved everything for HIV patients.

When Brad Franklin turned 26, he went through some tremendously tough adjustments. For one, he lost his health insurance.

"Then I found out four months later due to a past relationship that I was diagnosed with HIV," Franklin says.

Under the Affordable Care Act, dependents can stay on their parents’ health insurance plans until their 26th birthday. While on his parents’ plan, Franklin didn’t think about the intricacies of insurance, but testing positive for HIV changed that.

"I was faced with I’ve never had health insurance before, I don’t even know how to navigate anything and I have HIV on top of everything," he recalls.

Franklin spent hours dissecting health insurance plans on the health insurance marketplace, but HIV patients get a lot of blood tests and the medication is extremely costly and he says he couldn’t find a plan on the marketplace that would help him afford these expenses. Instead, he bought a plan outside of the marketplace, directly through Humana.

"It ends up coming out to $6,000 some-odd dollars I pay each year, $3,650 for the deductible, $210 times 12, so like $6,000 some-odd dollars," he calculates. "After that it’s 100 percent paid, everything," he says, referring to most expenses being covered by Humana once he meets the deductible.

Franklin’s plan also has his current doctor included in the provider network, but that’s not common among the ACA marketplace plans.

"Sometimes some of the plans have limited provider access," says Dr. David Wright, an HIV doctor in Austin, who regularly talks to his patients about the kinds of plans they should consider. "Not only talk about cost of medications, what’s my deductible or what my out of pocket costs are going to be, but is my doctor on this particular plan?"

See, HIV doctors are labeled as specialists but experts say people living with HIV can't get the same care from physicians who don't specialize in this kind of care.

"There are also many co-morbidities that often people living with HIV are facing," says Melissa Carnagey, a manager with AIDS Services of Austin. "So treatment for those as well, it's important they have an HIV knowledgeable physician."

Some HIV medications increase the risk of diseases like diabetes. Carnagey also says one key part of the Affordable Care Act that would benefit her patients isn’t available to them -- at least for now. Texas state leaders have chosen not to expand Medicaid eligibility, and only people who earn between 100 and 400 percent of the federal poverty line qualify for a tax subsidy from the U.S. government to make their marketplace plan more affordable.

"So the marketplace is definitely not the end all be all or hasn’t fixed or addressed everyone’s needs when it comes to health care coverage in this community," Carnagey says.

Others, however, have been far happier with the plans available on the ACA marketplace -- people like 24-year-old Cy Daigle, who's HIV positive.

Daigle bought a Blue Cross Blue Shield silver HMO plan with a monthly premium that’s less than $100 a month because of the tax subsidies he gets from the government.

"The one that I picked is basically the only one that was really going to keep my medication at an affordable rate and I feel like I lucked out," Daigle says. 

In October, Brad Franklin participated in the AIDS Walk, which raises money for AIDS Services of Austin. He raised about $3,200 for the agency, which helps its clients, like him, afford their health insurance.

Franklin says getting insurance is important, but people also need to just get tested for HIV. He says he hopes to help reduce the stigma by being so open.

"I had worked so hard to come out of one closet door in my life, and you know, struggle with being a gay male, especially in the South because I grew up in Arkansas, that I wasn’t going to go back into another one," he says about his decision to share his story.

AIDS Services of Austin estimates about 6,000 people in Central Texas are living with HIV and AIDS. One in 5 don’t know they’re HIV positive.

This story is a result of a partnership with the Austin American-Statesman’s Tim Eaton and Kelly West. You can find more at Statesman.com.

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