A community advocate talks about recent government changes to health insurance and shares resources to help people with HIV access care.
Recent federal changes to health insurance eligibility and spending could affect health insurance coverage and treatment access for many people living with HIV in the United States.
In spring 2025, the majority in Congress passed Public Law No. 119-21, H.R. 1. This budget reconciliation bill makes significant changes to Medicaid financing and eligibility.
Among other changes, H.R. 1 enacts new work reporting requirements and more frequent eligibility determinations for people enrolled in the Affordable Care Act (ACA) Medicaid expansion.
It also restricts federal reimbursement for care to citizens, legal permanent residents, and certain migrants from Cuba, Haiti, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau. Other groups of lawfully present immigrants will no longer be eligible for coverage.
According to the Congressional Budget Office, the changes H.R. 1 makes to Medicaid will increase the number of people without health insurance by an estimated 7.8 million by the year 2034.
The ACA premium tax credits are also set to expire at the end of this year. These tax credits help eligible people cover their premiums for health insurance purchased through the Health Insurance Marketplace.
Healthline spoke with Jonathan Frochtzwajg, the director of health justice policy at San Francisco AIDS Foundation, to learn how these changes could affect people with HIV and which resources are available to help affected community members access care.
This interview has been edited for brevity, length, and clarity.
Right now, health insurance coverage for HIV treatment is available to most people living with HIV, but the recent changes made by the majority in Congress seriously threaten people’s access to care in a number of ways.
Medicaid is the primary source of insurance coverage for people living with HIV, so Medicaid cuts have especially serious implications for this community.
Medicaid work reporting requirements are coming down, and they are designed to cause people to lose coverage.
Medicaid eligibility redetermination will need to be done every 6 months instead of every year, and that change is designed to cause people to lose coverage.
The H.R. 1 bill will also eliminate eligibility for many lawfully present immigrants, including refugees, victims of human trafficking, and so on.
The expiration of the enhanced premium tax credits affects those who have commercial insurance through the Marketplaces. The KFF put together a brief that noted that a larger share of people with HIV receive coverage through the Marketplaces than the general population, and they will see large cost increases for coverage.
We have information showing that when people’s healthcare insurance is unaffordable, they leave care, even if they have a serious, complex, and potentially fatal condition like HIV.
Folks can reach out to their local HIV service provider or public health department to learn what resources are available.
Every state has an AIDS Drug Assistance Program (ADAP). This is part of the Ryan White HIV/AIDS Program, which is the largest federal program focused on people with HIV.
The goal is to prevent people with HIV from going without treatment because of gaps in coverage. The federal government grants funds to states for their ADAPs, and pharmaceutical manufacturers offer rebates to the states for drug purchases.
States have a lot of discretion in how they run their ADAPs, but they always have an income eligibility limit. That limit is typically higher than the limits for other safety net programs, so more people can access benefits.
There are also safety net clinics, including Federally Qualified Health Centers and public health clinics operated by public health agencies. Safety net clinics are places where you can go for care regardless of your ability to pay or whether you have insurance or not. Depending on where you live, there may be fewer or more safety net clinics there.
I also want to mention manufacturer assistance programs. If someone is struggling with how to get their meds, this is something they should look into.
HIV drug manufacturers typically offer assistance programs to help people who don’t have insurance get access to drugs, or to help people who do have insurance but can’t afford cost-sharing pay for copays and stuff like that. These programs may be income-limited.
San Francisco AIDS Foundation offers benefits navigation, which means we can help enroll folks in healthcare coverage, help people figure out how to access care, address issues with their insurance, and refer them to safety net services.
We also have a public policy team that advocates for policies and budget investments that benefit people affected by HIV at the local, state, and federal levels. I think advocates like those on our team play an important role in making sure people with HIV are getting their fair share of resources and not being harmed by government policies.
We need advocates in the halls of power to make sure that the interests of people affected by HIV are being looked out for.
Jonathan Frochtzwajg (he/him) is the director of health justice policy for San Francisco AIDS Foundation, where he plays a lead role in public policy advocacy related to HIV and healthcare. Prior to joining the Foundation, he worked as the public policy manager for Cascade AIDS Project, serving Oregon and Washington State.