As I’m sure you’ve heard by now, women have a lot to gain from the parts of the Affordable Care Act that remain intact. Co-pay-free birth control! Annual Well Woman exams! Legal protection against gender-based price gouging!
But there are still some serious, buzz-killing holes. For instance, poor, undocumented women don’t qualify for key preventative benefits. And then there’s the SCOTUS-produced loophole that allows states that are openly hostile to Obamacare and the letter "O" to decide whether they’ll expand Medicaid coverage without the threat of losing federal dollars. (Read Imara Jones’s comprehensive analysis for the big picture.)
State discretion on Medicaid expansion is particularly troublesome for black women living with HIV, says C. Virginia Fields, CEO of the National Black Leadership Commission on AIDS. "In [several] of the 26 states that brought the Supreme Court challenge, we have large pockets of Black women living in poverty and with AIDS: Alabama, Florida, Georgia,* Mississippi and South Carolina. We had hoped that the Medicaid expansion would allow uninsured women diagnosed with HIV to qualify for Medicaid sooner so that they would be able to receive [free or affordable] treatment before the onset of AIDS. Under the Supreme Court ruling, I doubt if there’s going to be any relaxing of those standards."
According to the Kaiser Family Foundation, there is a higher concentration of HIV in black communities than in others. Black women account for a staggering 57 percent of all new HIV infections among women; unprotected intercourse with black men is the most common form of transmission. African American women also bear the brunt of new AIDS cases among women–64 percent.
To slash these ridiculous rates, black women need fewer barriers to treatment. Joyce Turner Keller, 61, a Baton Rouge-based, HIV-positive archbishop and activist, knows this firsthand. When I talked to her last Friday, she was furious, furious that her governor, Bobby Jindal, had signaled that he would refuse Medicaid expansion, particularly given that Louisiana has a waiting list for its AIDS Drug Assistance Program. "The state of Louisiana already lacks adequate medical services. It cannot afford to take care of our citizens. How dare our governor turn down money? He doesn’t know what it is to be in the body of an HIV-positive person. He doesn’t know that I have to shave my hair down to the scalp because my hair is falling out due to side effects of the medications. He has a pharaoh mentaility. I’m like Moses: I want him to let my people go!"
According to Keller, people with HIV and AIDS have to publicly demand that their elected officials follow through with Medicaid expansion. "Health care is not some plush little item that you buy because you think it looks good on you! We need to come of the shadows and take to the streets. We need to be visible to show our discontent. I think we’re being too quiet about it. We need to unify and to demand that we get what is rightfully ours."
*Post has been amended since publication.