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Republican Healthcare Plan Could Destroy Access To PrEP

TIME explores how the Republican's proposed "repeal and replace" plan of the Affordable Care Act could result in those that need it losing access to PrEP. 

The proposed plan from Republicans eliminates the expansion of Medicaid, which will make health insurance less accessible for the poor. Health insurance is key to making PrEP affordable, especially in conjunction with Gilead's co-pay assistance, which is also not guaranteed to continue.

Here's an excerpt from TIME

The thing about PrEP, as it's commonly referred, is that it's expensive: roughly $1,500 a month without insurance (with insurance, it can cost anywhere from $0 to $500) . Peterson, a Seattle-based professor and author of “The PrEP Diaries,” gets coverage through an employer health plan, but once relied on Washington's drug assistance program (DAP), which started covering PrEP after the Affordable Care Act’s Medicaid expansion began insuring people who used to go through DAP.

Future "PrEPers" might not be so lucky. House Republicans released a long-awaited blueprint to replace the ACA on Monday, confirming plans to eliminate Medicaid expansion and other key Obamacare features. The proposed plan would complicate PrEP access, particularly for low-income Americans in the 31 states, plus the District of Columbia, that adopted the Medicaid expansion.

The new bill would begin phasing out federal money for the expansion in 2020, likely blocking new applicants and access to meds like PrEP. If the plan passes in its current form, traditional Medicaid will be replaced by per-capita grants, a fixed-sum per person, which could result in cuts over time. And a proposed repeal of the ACA's cost-sharing assistance, which paid insurers to reduce the burden of enrollees based on their income, would make coverage more expensive for poor Americans, says Lindsey Dawson, senior HIV policy analyst of the Kaiser Family Foundation.

Gilead, Truvada’s manufacturer, provides some co-pay assistance through a self-funded program, but it’s unclear of how that program will fare after the ACA repeal. Gilead declined to comment.

To be clear, these are uncertain times for many facets of health care. But gutting PrEP access would mean losing a critical shield in the fight against HIV.

“No matter which way you spin it, a repeal would be devastating,” says Noël Gordon Jr., a senior program specialist for HIV prevention & health equity at the Human Rights Campaign. “It would not only halt the progress we’ve made, but it has the potential to turn the tide the other direction, where we could potentially see the spread of HIV.”

Are you concerned that the proposed Republican health care plan could make access to health insurance more difficult for the poor? Concerned that lack of insurance could keep PrEP out of reach to low income individuals? Thoughts about the potential spread of HIV?