House moves to strip health coverage from millions of Americans including many people with HIV

The 2025 reconciliation package advanced by the House of Representatives’ Energy and Commerce Committee on May 14 would take away Medicaid coverage from more than 10 million Americans, including many people with HIV. Medicaid is the largest health insurer for people with HIV, with more than 40% having Medicaid coverage. The proposed cuts to the Medicaid program would threaten the health of people with HIV, as HIVMA noted in a statement following the committee’s advancement of their portion of the bill.  

“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,” said Colleen Kelley, MD, MPH, FIDSA, chair of HIVMA. 

House Republican leaders have indicated a desire to pass the bill before Memorial Day, but it is unclear if this timeline will be met. The Senate is expected to develop its own reconciliation bill, and the two chambers of Congress would then need to negotiate a final package. HIVMA members are on Capitol Hill on May 19 to educate lawmakers about the importance of Medicaid in their states and districts and to urge them to oppose the cuts. 

The bill, now up for debate in the full House of Representatives, would cut Medicaid funding at unprecedented levels (more than $700 billion) by reducing enrollment, increasing cost sharing and restricting state funding mechanisms. Highlighted below are three key policy changes that would impact people with HIV. For more details, see KFF’s Tracking the Medicaid Provisions in the 2025 Reconciliation Bill and the How Will the 2025 Budget Reconciliation Affect the ACA, Medicaid and the Uninsured Rate? 

“Work” or “community engagement” requirements that deny access to the health care needed to work  

• Requires most Medicaid expansion enrollees to report 80 hours of work or “community engagement” activities a month 
   

Why it matters: 

• A majority of Medicaid enrollees work, with the exception of those who are unable to because they are disabled  
• Evaluations of states, such as Arkansas and Georgia, that have enacted work requirements cut off people who are working and led to lower levels of enrollment while increasing administrative costs  
   

More frequent eligibility determinations for the Medicaid expansion population 

• Requires states to conduct eligibility determinations every six months for the Medicaid expansion population  

Why it matters: 

• More frequent eligibility verifications for Medicaid beneficiaries and people with HIV have been shown to cut off services for people who are eligible and who are in greater need of health coverage and services 
   

Requires higher cost sharing for some of the Medicaid expansion population 

• Imposes cost sharing of up to $35 on adults with incomes between 100% and 138% of federal poverty levels (or $15,650 to $21,597 in income per year for an individual) 

Why it matters: 

• Studies routinely find that higher cost sharing limits access to necessary health care services  

This is not a done deal. The 2025 reconciliation bill will need to pass the House of Representatives and the Senate to be enacted. Help stop cuts to Medicaid coverage that will harm people with HIV by letting your members of Congress know how their constituents would be impacted by cuts to Medicaid coverage. Personalize the message to have the greatest impact.  

The reconciliation bill under consideration in the House also contains a provision that would tie Medicare physician payment updates beginning in 2026 to the Medicare Economic Index, a measure of practice cost inflation. 

While this approach has long been supported by the medical community as an improvement to the current policy for annual physician reimbursement updates, it alone may not have a major impact, particularly since the updates are tied to a low percent of MEI in 2027 and beyond. Under this provision, in 2026, physicians would receive an update of 75% of MEI (estimated to be a 1.9% increase); in 2027 and each subsequent year, they would receive 10% of MEI (estimated to be a 0.23% increase for 2027). MEI projections can change, which means the estimated payment adjustments for physicians would change accordingly. 

About IDSA and HIVMA
The Infectious Diseases Society of America is a global community of 13,000 clinicians, scientists and public health experts working together to solve humanity’s smallest and greatest challenges, from tiny microbes to global outbreaks. Rooted in science, committed to health equity and driven by curiosity, our compassionate and knowledgeable members safeguard the health of individuals, our communities and the world by advancing the treatment and prevention of infectious diseases. Within IDSA, the HIV Medicine Association is a community of health care professionals who advance a comprehensive and humane response to the HIV pandemic, informed by science and social justice. Visit idsociety.org and hivma.org to learn more.