Northwest Arkansans living with HIV have access to better, more complete health care because of the Patient Protection and Affordable Care Act, health officials said last week.

About a thousand people in Washington and Benton counties are living with the virus, which can go unnoticed for years and can lead to fatal immune system problems if untreated. Infection is still increasing in Arkansas, and the counties share an HIV clinic in Fayetteville.

Rules in the health reform law help HIV patients get and keep comprehensive coverage, local and state officials said. First, existing conditions such as HIV infection no longer mean insurance can be denied. Second, coverage obtained under the law can help fill gaps in aid already given by the federal government.

"The underlying message from our perspective is this is a big benefit to the people we serve," said Ralph Wilmoth, section chief of the Arkansas Department of Health's HIV, STD and Hepatitis C division.

A Costly Disease

More than a million people in the U.S. are living with HIV, including almost 6,000 Arkansans, according to the Centers for Disease Control and Prevention.

HIV depletes the body's immunity by killing the blood cells that fight bacteria and other microbes, a process that can hugely amplify otherwise mild illnesses if it worsens to AIDS. It can be treated but no widespread cure exists.

The virus is spread through sexual contact and by blood, such as when infected people share needles. A hug or a handshake won't spread it.

HIV first entered public awareness in the early 1980s, when it appeared primarily among gay or bisexual men. Victims were often shunned, and hundreds of thousands have died from the disease's effects in the U.S., according to the Centers for Disease Control.

Treatment has improved drastically since then, but HIV medicines are expensive.

Kevin Daniel tested positive for HIV eight years ago at the Fayetteville clinic, which gets about $230,000 from the two counties. Daniel said his treatment costs more than $45,000 -- more than he can afford with two jobs, he said. Multiple requests for comment from the clinic weren't returned.

Daniel's one of about 1,500 Arkansans who have their medicine costs covered by the federal Ryan White program, which pays states to help with HIV-related medical expenses.

The program doesn't cover non-HIV medical problems, however, whether they're broken bones or colds or diabetes, which is where regular health insurance comes in.

Almost a third of people with HIV have no public or private coverage, according to the U.S. Department of Health and Human Services. Daniel was one of them at the time of his test. If he applied for insurance, he likely would have been turned down, as would others with HIV.

'They most likely would not pass underwriting with our company," said Max Greenwood, spokesman for Arkansas Blue Cross and Blue Shield. She added people who contracted HIV and already had insurance wouldn't have lost it. A request for comment from QualChoice wasn't returned.

The other option was Arkansas' high-risk Comprehensive Health Insurance Pool, one of about three dozen state-run insurance programs for people deemed uninsurable by private companies. Its premiums were roughly $300 a month, $100 more than average private plans.

The health care act requires coverage even with conditions such as HIV, however, ending such high-risk pools. While the overall law remains divisive, voter polls consistently showed about three-fourths support for this new rule in the past several years.

"Everybody's allowed to go to the doctor and take care of themselves without fear of it being a pre-existing problem or something like that," said Patty Johnson, who helps head the Northwest Arkansas Center for Equality's HIV testing and counseling program in Fayetteville. "That in itself is the most amazing part, I think personally, of the (law). They cannot screw you over saying 'Well, you already have HIV.'"

Increased Coverage

Fortunately for Daniel, his viral load was low enough his doctor didn't prescribe medication until after he got insurance through his employer.

He's changed jobs since then, however, and last week began the process of signing up for the state's private option. The program uses health care act money to help people with sufficiently low incomes buy insurance.

With the health care law's insurance exchanges and private option in place, about two-thirds of Ryan White recipients are now covered by Medicare, Medicaid or private insurance. That's 200 people more than before the law.

"Since the (Ryan White) program is required by legislation to be 'payer of last resort,' we will continue our efforts up until the last moment on March 31 to get clients enrolled onto the exchange," said Tiffany Vance, program director. She was referring to Monday's deadline to apply for coverage without incurring a fine.

Some Ryan White participants will get less help from the program after getting insurance, said Wilmoth, the HIV section chief. But the department now helps with insurance co-pays and deductibles for HIV patients who make less than 400 percent of the federal poverty line, or about $90,000 for a family of four.

That means the state can help people with HIV get more services than previously allowed while still saving money overall, Wilmoth said.

"That increases their longevity and their general well-being," he said. "We believe it is absolutely of benefit."

Daniel said he's still skeptical of how affordable his new insurance will be, however. When he looked for private insurance on his own, the monthly premiums he found were almost $700. He hadn't yet seen what the private option might require.

"I really don't know who to point the finger at," Daniel said. "They can't discriminate against you for having a pre-existing condition, but they can certainly make it more expensive."