By Julia Belluz

There’s just one big problem with Trump’s grand strategy: Since taking office in 2016, his administration has been undercutting the fight against the virus — most notably by sabotaging the Affordable Care Act and encouraging states to introduce work requirements for Medicaid.

To put it simply, the ACA was a “watershed moment in the [HIV] epidemic’s history,” as the Kaiser Family Foundation’s director of global health and HIV policy, Jennifer Kates, told me in 2017. The law was designed to get more people access to health care, including those who were traditionally denied coverage because of “preexisting conditions” like HIV, or who were driven out of the marketplace because their health care was unaffordable. And so under the law, the disease was no longer a barrier to health insurance.

The law also expanded access to Medicaid, the government health insurance plan for low-income Americans. And remember: More than half of people living with HIV in the US are low-income.

So it’s no surprise that the insurance rate for people living with HIV increased under the ACA, according to the Kaiser Family Foundation, in states that expanded Medicaid. The death rate from the virus also declined in those states.

But while the Trump administration hasn’t successfully repealed the health law, it has managed to undermine it. And this slow sabotage of Obamacare is expected to subvert the fight against HIV, said Kates, who is currently working on an analysis of the data. “The ACA has driven increased coverage [for people with HIV],” she said, “so the extent that it’s scaled back or restricted, it’ll likely affect coverage.”

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