Cuts to federal funding for HIV prevention and services will have a major public health impact, but budget cuts will also be felt at the individual level: More than 15 million people could lose their health insurance by 2034.

 

Most of the losses would come from changes to Medicaid, including a new work requirement and limits on coverage of lawful immigrants. While a majority of Medicaid recipients who are not disabled do work, many are expected to fall through the cracks due to the increased red tape of documenting their eligibility. Around 40% of people living with HIV rely on Medicaid.

 

“Medicaid is a lifeline for many people with HIV, providing them with access to care and treatment that helps them live healthy lives,” says HIV Medicine Association chair Colleen Kelley, MD, MPH. “Imposing administrative hurdles and fees for low-income people with HIV will delay treatment, leading to poor health and increasing overall costs to the health care system.”

 

The remaining losses would result from changes to the Affordable Care Act (ACA), also known as Obamacare. Most people who purchase insurance through the ACA marketplaces receive tax subsidies to help defray the cost of premiums. During the COVID-19 crisis, the Biden administration expanded the subsidies to include people with higher incomes. When these extended subsidies expire at the end of 2025, middle-income people—especially those who are older but not yet eligible for Medicare—could see their monthly premiums skyrocket. The new rules also increase paperwork requirements and shorten the ACA open enrollment period (November 1 to December 15 for coverage starting January 1, 2026), so plan ahead if you need Obamacare coverage.