When taken as prescribed, PrEP is 99 percent effective at reducing HIV transmission. Currently, there are 1.2 million Americans living with HIV; the good news is that according to the Centers for Disease Control and Prevention, HIV transmission in the U.S. decreased by 12 percent between 2018 and 2022. This is in no small part due to the ACA’s preventative care requirements to cover the medication in full. But despite these small successes, PrEP uptake is still largely uneven. A 2024 study found much higher usage in liberal states, especially when compared with states in the Deep South. Uptake in New York was estimated at around 22 percent, compared to just 4 percent in West Virginia. Without the preventative care requirement, the gaps could further widen as millions of Americans would not be able to afford the roughly $2,000 per month to protect themselves against infection.
But patients at risk of HIV are hardly the only ones who could be affected by a negative SCOTUS ruling. Research from the Health Care Cost Institute estimates that without the ACA’s preventative care requirements, basic health care services could become unaffordable for millions of Americans. When spread across all insurance enrollees, the cost of a colonoscopy runs around $11, and $24 for a mammography. If individuals had to pay for these services, the costs could jump to $1,444 and $255, respectively. Things like cholesterol tests, which are currently fully covered by insurance, would cost $15. That might not sound like a lot, but for somebody living on the poverty line, for whom that money represents two gallons of gas to get to work, $15 could be the difference between an extra decade of life and a heart attack.
With climate change potentially causing a host of new deadly viruses, there is no telling what preventative care measures will be needed in the following decades. It is equally hard to predict what new trends in public health might arise in the next century that will provoke the condemnation of a new right-wing movement, which now wants to subject long-settled matters, such as the efficacy of the polio vaccine, to a renewed “debate.” HIV provided the perfect opportunity for politicians like Jesse Helms to further marginalize an already vulnerable population. “We’ve got to call a spade a spade,” he said to his fellow senators, “and a perverted human being a perverted human being.” With a new administration openly beating their chests about transforming the federal government into an engine of retribution against disfavored groups, it’s simultaneously frightening to think how little has changed since the late 1980s, and how much could—very quickly—change again.
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