New York (MainStreet) -- Obamacare saves lives.

That may seem blunt, but human life is the third rail of health care reform. We’re not allowed to talk about it, because that conversation inevitably leads to the consequences of repealing Obamacare and some measure of responsibility for those who demand it. Opponents routinely insist instead that it's rude to bring up sick people and what happens when they can’t afford their medicine. They tell us that this is a sanitized issue about budgets, politics and numbers.

Maybe some people really do see politics as nothing more than running up the Red Team’s score against the Blues, but the rest of us have to live on that playing field. As much as pundits and politicians would like to pretend otherwise, health care reform is about saving lives. Expand access to insurance and you expand access to the things it buys, namely chemotherapy, surgeons and other medical care. Take it away, and you take that access with it.

No amount of howling will change those facts. It’s why opponents of the Affordable Care Act have to resort to specious arguments (the website doesn’t work!) or outright falsehoods (people aren’t paying their premiums). Their endgame involves very real suffering, and who wants to talk about that??


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That's why it needs discussion. We need to think about how repeal would hurt the most vulnerable among us, such as HIV and AIDS patients who according to a recent Kaiser study are solidly better off thanks to the Affordable Care Act.

According to study co-author Lindsey Dawson, access to care has expanded significantly for the HIV community over the past year. The Medicaid expansion in particular has helped make life easier, sometimes even possible, for thousands of people who would otherwise have fallen through the cracks.

From the brief:

"One of the most important components of the ACA for people with HIV is the expansion of Medicaid eligibility. Prior to the ACA… [f]ederal law categorically excluded non-disabled adults without dependent children, unless a state obtained a waiver or uses state-only dollars to cover them. These Medicaid eligibility rules presented a “catch-22” for many low-income people with HIV who could not qualify for Medicaid until they were already quite sick and disabled (usually having progressed to an AIDS diagnosis)."

Like many diseases, AIDS strikes hardest among the poor and “it’s not specific to HIV,” Dawson said. “It’s specific to health disparities at large… It has to do with access to resources.”

Before Obamacare, a childless HIV patient had to wait for his disease to become crippling before qualifying for Medicaid. That helped the disease to proliferate, according to Dawson, because lowering a patient’s viral load makes him or her much less contagious. Between the Medicaid expansion and the elimination of pre-existing conditions, which once priced even some well off members of the HIV community out of private coverage, access to care has expanded dramatically.

Now low-income HIV patients in expansion states can sign on to Medicaid without having to wait until AIDS has ruined their quality of life. For others, health insurance has finally become affordable. A few people who can neither get Medicaid nor private insurance can still rely on Ryan White, a single-payer government program that has successfully helped many HIV patients manage their disease.

Of course, as Dawson pointed out, access to coverage doesn’t always mean access to care. People have to find the right doctor and navigate the still-complicated maze of health insurance rules and regulations. Kaiser’s research found, for example, that many HIV patients didn’t properly understand the relationship between deductibles and premiums during the 2014 enrollment and significantly underinsured themselves for the coming year.

A lot more education is necessary before people can take full advantage of the ACA’s health insurance marketplaces, but they’re a good start. What’s more, even after just the first year, they appear to be a successful one.

“What we do know is that folks with HIV do have better outcomes when they have access to coverage,” Dawson said, “And that’s not just HIV. That’s the case with other diseases as well. When folks have access to treatment they’re able to recover more easily.”

Let’s call a spade a spade here: Republicans in Congress have no plan to replace Obamacare and no intention of doing so. If they did, we would have seen it in bill form during one of their more than 50 votes to repeal the law. At a minimum, they would have fixed the alleged mistake at issue in King v. Burwell. What they have on the table is a return to the old system that would hurt, physically hurt, a lot of people.

Maybe Republican politicians don’t believe that, in which case health care would join global warming, gun control and the dangers of gay marriage on their list of fact-free fairy tales. Maybe they just don’t care. But like it or not the numbers don’t lie. Kaiser’s study on the HIV community is another voice in the growing chorus pointing to the fact that Americans are better off thanks to this clunky, complicated law.

Obamacare saves lives. Impolite, but true.

--Written for MainStreet by Eric Reed, a freelance journalist who writes frequently on the subjects of career and travel. You can read more of his work at his website A Wandering Lawyer.