for guys in the US, will obamacare make you rethink being poz or wanting to get poz?

[barefootbob]

firstly THIS IS NOT TO DEBATE RIGHT OR WRONG OF OBAMACARE or POLITICS OF IT

with the changes in health care in the US, generally called obamacare, if you have a private health insurance or if the company you work for has one and "IF" it gets dropped because of obamacare will this:

if you are poz

- make things harder for you to get your health care\meds

- harder to keep the insurance you have

if you aren't poz

- knowing it "might" make it harder to get insurance\meds will is make you reconsider getting poz

or do you think it might even make it easier? one of the caveats of it is pre-existing conditions, I would assume that would also be HIV, but it could come at a cost.

anyhoo I was just curious what your take on it was.

**** rawtop, if this is too touchy a subject then feel free to delete it. ****

[MexPigMaster]

You have it all wrong. It will be easy to get HIV meds and they CANNOT drop your medical insurance.

[skinster]

I don't think it will be 'easier' to get meds - they are likely to overall cost more if original patents are not relinquished and ratio of sick people increases within the insured pool. That law IS NOT a free lunch for everybody. The cost of this program is not 0. I've never seen a prescription rider to go down in policy costs over time. I think it will be simpler to get meds processed, if you'd be able to afford both the knowledgeable doctor and the skillful treatment. So the 'difficulty' would shift from procedural hassle/denials to heavier individual financial burden. Which would still make you work harder for the beneficial outcome one'd be hopeful of. And if you can't afford the new insurance, guess what - you'd drop it for other-than-pre_existing reason and won't get the meds anyway.

[MexPigMaster]

If you live in New York State, there is a program called ADAP (AIDS Drugs Assistance Prorgam). It covers what your regular insurance doesn't cover. So, if you live n NY... you pay nothing for your HIV meds. I don't know about the other states.

[MexPigMaster]

Also, in NY State all HIV/AIDS people can apply for HASA (HIV/AIDS Services Administration). HASA provides you with Medicaid (if you can't afford regular insurance) and social and case workers. NY State has very GENEROUS benefits for people with HIV and AIDS

Edited November 23, 2013 by MexPigMaster

[pssilverbear]

ADAP is available in California as well. I just joined a program with the drug company for my meds that will pay my deductible from my insurance for me so my cost will be zero. It's a cool deal.

[Blueyedsoul]

Interesting thread everyone. It's sort of ironic that this has come up. Let me tell you about my last trip to the San Bernardino County Health Department (this morning). First, let me tell everyone that I received a call yesterday stating that my test results for HIV, HPV, HSV, Chlamydia, Gonorrhea were all negative/non-reactive. However, the Syphilis test showed positive/reactive. The MD on staff believes it's a false/positive since everything else came back negative. So, yes, I told him I wanted to be treated and as a result, I was given a shot of penicillin in my buttocks. After the treatment, I inquired about PrEP again. This is the second time I have inquired about PrEP and it's availability. Again, for a second time, I was told that the county would not and has not offered PrEP due to its cost. When I inquired about Obamacare (or for those politically correct reality deniers - the Affordable Care Act), the public health official told me that it is still unclear if the legislation will in fact cover PrEP. In his opinion, this official believes with almost 90% certainty that PrEP will not be covered. I was somewhat shocked but not surprised. I then challenged the official questioning the logic of this decision because the area I live in is poverty stricken with a large migrant farm worker Latino population. The area also has a significant amount of low income African Americans. Since both of these populations serocoversion rate is sky rocketing, you would think they would want the constituents to have the information for those considered high risk. The official just shook his head and told me, "Look at Desert Aids Project in the Palm Springs." I told him I would. I left dumbfounded.

So, for anyone sure of the answer (covered or not-covered), I suggest we all take a 'wait and see attitude' because this is one soup I plan on not tasting until there's a legitimate chef back in the kitchen.

And yes, Tiger Milner, that shot does hurt and my ass has been tender all day and night while at work. I read your earlier post a few days ago about that shot. Fuck. This really cramps my sex life.

I know, I know, you chasers and gifters are shouting why? Go out and pass it along you're saying... Sorry. I just can't. But I have found it hard to resist.

Edited November 23, 2013 by Blueyedsoul

[MexPigMaster]

In New York, you will not qualify for ADAP or HASA if you're negative. Unfortunately, they don't do preventive services ADAP and HASA are services only for people with HIV and AIDS. Maybe Obamacare can fix that... but don't know.

Edited November 23, 2013 by MexPigMaster

[rawTOP]

Obamacare will make things simpler for poz guys, not more complicated. The neg guys who are currently scared of conversion because they don't have health insurance won't have that as an issue any more, etc.

[skinster]

I disagree with some of the statements above. Obamacare is pointed to coverage of EXISTING conditions subject to needed medical treatment (as in 'you already got it' whatever that may be), not prevention, prophylaxis or PReP or any enhancement procedures to your own individual wellness altogether while you are still in good health. It just wants your 'healthy' money. And meds alone for a sick person is something far from being all that is partial to good health care organization. There are specialist visits, test/lab work, therapy of many kinds, hospitalization, etc etc. And while there are new items on that list that Obamacare will mandate to be covered upon full application of the law, far too many law subjects now are getting sweet-heart deals, postponements and exclusions. And don't forget, all those now with newly cancelled individual policies are forced into the pool with people who couldn't have coverage before due to those very best 'existing conditions', and someone has to pay for all those costs. Obamacare is not free. It was never designed to be free. It is just too much of trumping up in media is shoved away from any understanding or disclosures of it's costs and who's gonna be bearing them.

I am of the opinion that only time will tell how good all these 'benefits' would end up being, and I am reluctant to celebrate this law just yet. It's like buying a used car - every vehicle is unique, there are no 2 cars alike. But if I wanted a luxury one, I'd have to look for it and buy it myself. It's not what the closest salesman has on the lot. And the sales pitch with Obamacare is just overly underwhelming.

[rawTOP]

I disagree with some of the statements above. Obamacare is pointed to coverage of EXISTING conditions subject to needed medical treatment (as in 'you already got it' whatever that may be), not prevention, prophylaxis or PReP or any enhancement procedures to your own individual wellness altogether while you are still in good health.

Wrong. I watched a TV interview yesterday with the president of Mount Sinai which controls 3 or 4 of the biggest hospitals here in NYC. He was asked how healthcare would change with the Affordable Care Act and he said the biggest change will be in keeping people healthy and out of hospitals. So people who lament the closing of hospitals and count the number of hospital beds are focusing on the wrong thing. According to him the vision of the ACA is preventative care. Hence things like PrEP are extremely consistent with that vision. PrEP was barely on the radar when the ACA was drafted and given it's expense I'm not sure if there will be hiccups in coverage for it, but in terms of general strategy you're completely wrong about preventative care.

And don't forget, all those now with newly cancelled individual policies are forced into the pool with people who couldn't have coverage before due to those very best 'existing conditions', and someone has to pay for all those costs.

Wrong again. My best friend got a cancellation letter. He just signed up under another plan his insurance company was offering that did comply with the law. He did not have to go through an exchange.

Obamacare is not free. It was never designed to be free. It is just too much of trumping up in media is shoved away from any understanding or disclosures of it's costs and who's gonna be bearing them.

Strike three… My best friend's mother is 60 years old and didn't have health insurance (her husband is a Tea Party follower). Care to guess how much insurance under the ACA is going to cost her? Just $50/month. Yes, that's not free but it's completely affordable. No one said it was free - that's why it's called the AFFORDABLE Care Act.

[fskn]

The San Bernardino public health official you spoke with is incompetent. The ACA plans being offered in California were drawn up months ago. Full plan terms have been posted on Covered California, our state's insurance exchange Web site, since October. It is simply a question of reading the documents for each company's plan -- and calling the insurer if a plan includes a drug formulary (a list of specific drugs). Why so many people speculate about coverage instead of reading the documents, I don't understand. Barring a categorical exclusion written into a health plan, Truvada for PrEP, as an FDA-approved drug use, must be covered under the same terms that a plan uses for other prescription drugs (and in this case, for lab tests, a necessary part of the PrEP regimen).

Medicaid/Medi-Cal for very-low-income patients is a different matter, but there especially, there will be a regulation, manual or circular describing exactly what is covered.

One sad fact emerges: gay men in suburban and rural areas get bad medical advice and inferior care because their doctors lack experience treating large numbers of gay patients. I live in the East Bay -- 20 minutes away from San Francisco's City Clinic and Department of Public Health, pioneers in HIV prevention, testing and treatment -- and you should hear the terrible advice my uninsured friend got when he sought care on our side of the Bay after he had sero-converted. In medical matters, it pays to live in -- or receive care in -- a place where there is a concentration of gay men. Your life may depend on it!

[MexPigMaster]

Skinster just doesn't like Obamacare for whatever reason... Has nothing to do with reality. All I know is that I'm saving a shit load of money and I cannot be denied health care because I have AIDS. He must be a tea bagger (and I don't mean that in the sexual way). These tea baggers don't want poor and minority people to have health care.

Edited November 25, 2013 by MexPigMaster

[skinster]

Wrong. I watched a TV interview yesterday with the president of Mount Sinai which controls 3 or 4 of the biggest hospitals here in NYC. He was asked how healthcare would change with the Affordable Care Act and he said the biggest change will be in keeping people healthy and out of hospitals. So people who lament the closing of hospitals and count the number of hospital beds are focusing on the wrong thing. According to him the vision of the ACA is preventative care. Hence things like PrEP are extremely consistent with that vision. PrEP was barely on the radar when the ACA was drafted and given it's expense I'm not sure if there will be hiccups in coverage for it, but in terms of general strategy you're completely wrong about preventative care.

I hope you're right with this outlook. But a leap of faith is all in the eye and is just that - a leap of faith.

On the same prevention note it can be argued that PReP is a treatment course potentially used for an intentional exposure, and anybody attempting homosexual relations is deliberate in such exposure. Thus not a subject to be covered, not a pre-existing condition; and any intentional action, or that can be labeled as intentional, by a subject of insurance business can be excluded from compensation by letter of a law argued by a lawer for either side. Insurance is a game of numbers, and if something is not listed explicitly, like same experimental /pre-approval stage treatments, and may be PReP will not fall into that category, and it will turn out to our barebacker benefit. All for it, just haven't seen it affirmatively in writing anywhere. That's how much of a fringe we are.

What we are doing here is only speculating (since neither you nor me are medical professionals, have a law degree, or otherwise involved in legislative process writing these damn laws) on what so many nameless and directly involved specialists, analysts and quasi-professionals will be doing in any given situation SOMEHOW keeping our gay best interests close to their heart. Don't forget, I am in the same boat as you are, I've just been disappointed one too many times. There is a lot of vested interest, and we all want it to happen. But I am not about to pull up the green glasses and pick up on the yellow brick road.

Wrong again. My best friend got a cancellation letter. He just signed up under another plan his insurance company was offering that did comply with the law. He did not have to go through an exchange.

Good for him. It just says that some companies have enough business sense to keep their subscriber base and continue making money from them. I have not seen any competitiveness (to my current employer rate) in rates provided through few exchanges online though. Granted, no discounts/subsidies were applied, and don't think I'd qualify for those anyway, I just looked them up today.

As far as cancellations - demographics is also a numbers game, just like insurance. Admitted by all sides in the debate, 5% of insured will loose coverage due to ACA 'non-compliance', whatever. 5% in this country is 15 mil. people. In a pool that big you can find some very good outcomes in policy changes, and absolutely worst outcomes with flat cancellations for a policy change, and everything in between. Just one sample out of ~15,000,000 potentials is not very statistically noticeable.

Strike three… My best friend's mother is 60 years old and didn't have health insurance (her husband is a Tea Party follower). Care to guess how much insurance under the ACA is going to cost her? Just $50/month. Yes, that's not free but it's completely affordable. No one said it was free - that's why it's called the AFFORDABLE Care Act.

It's not about strikes, RT, unless you want it to be. The nature of cost calc includes income level, residence county and state, and breadth of coverage level by a plan for starters. It begins from catastrophic coverage, when like only extreme situations are included. All these 4 variables that I remembered from before are not included in your argument, not that I am counting. NYS runs it's own exchange, quotations from it are not referenced in portals for federally run or subsidized exchanges. Feds do show New Jersey. Do you know how much is a sample for a 50-yo? I didn't either. It's $391.21 regardless of county. 27-yo - a bit better - $229.56. A child - $139.09/month. A couple w/o age listing - $559.88. New York is not that far away territorially and in terms of cost of living nor income. I doubt insurance costs are any significantly different, it's not cars nor real estate. But if you can afford them - more power to you. I can't. I won't call it affordable either, and one needs to compare apples to apples. I do admit I did not look up rates for NYS. Where does a 60-yo with a $50 for a policy fit here? I don't think we live where she does. And her husband is insured separately for some reason. I hope political affiliation did not play into it.

PS:

Skinster just doesn't like Obamacare for whatever reason... Has nothing to do with reality. All I know is that I'm saving a shit load of money and I cannot be denied health care because I have AIDS. He must be a tea bagger (and I don't mean that in the sexual way). These tea baggers don't want poor and minority people to have health care.

You need to look at the numbers in whatever is it you're getting for coverage. Instead you chose to get personal. I am sad to learn you have AIDS. May be it is not that far along, and you just want more bragging rights in public or a higher moral ground. But I can't call it an achievement. Keep it pithy.

Edited November 26, 2013 by skinster

[fskn]

t can be argued that PReP is a treatment course potentially used for an intentional exposure, and anybody attempting homosexual relations is deliberate in such exposure. Thus not a subject to be covered, not a pre-existing condition; and any intentional action, or that can be labeled as intentional, by a subject of insurance business can be excluded from compensation by letter of a law argued by a lawer for either side. Insurance is a game of numbers, and if something is not listed explicitly, like same experimental /pre-approval stage treatments, and may be PReP will not fall into that category, and it will turn out to our barebacker benefit. All for it, just haven't seen it affirmatively in writing anywhere. That's how much of a fringe we are.

What we are doing here is only speculating...

Without wanting to debate the merits of Obamacare at all, I do want to clear up two errors.

First, Truvada for PrEP received FDA approval in 2012. It is NOT an experimental treatment. Most medical plans have categorical exclusions for experimental treatments, but PrEP no longer falls into the experimental category. Google "prep fda approval" to find the FDA press release.

Second, U.S. insurers are ALREADY covering PrEP. We've read accounts of this here on the forums, and I know it from personal experience, too.

I went through the qualifying process with my insurer -- Kaiser, California's largest -- and was offered PrEP at my usual $25/30 day prescription co-payment and $10/encounter lab test fee. Kaiser has formal guidelines for PrEP, which I have read, gone over with my primary care doctor, and gone over with the pharmacist who administers the PrEP program at Kaiser San Francisco.

What worries me about these online conversations is that speculation that PrEP isn't covered is deterring people from asking. Once they've read their health plan documents, checked the formulary (if applicable to the plan), and found a doctor who is willing to look up current FDA guidelines, most HIV-neg guys with better-than-catastrophic health insurance will find that PrEP is available and covered. If you encounter an uninformed doctor, it may simply be necessary to seek care in a large, diverse city like San Francisco or New York.