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Watching President Trump’s State of the Union address Tuesday night, my mind raced back to one of my patients, panting as she strung together a few words. “My difficulty breathing,” she paused, “has gotten worse in the last few weeks.” In her hospital bed, she looked gaunt and tired. She was struggling with homelessness and had stopped taking her HIV medications months ago, as she did not have insurance and could not afford the cost of her medications. As her doctor, I feared that she had a life-threatening lung infection, an unfortunate but preventable complication of her HIV.