December 29, 2009

December 29, 2009
Health Care Reform


Thanks for stopping by to see what is going on in another day of my life. Today is Tuesday and I hope you are having a safe and great week so far.

I am very busy now getting things in order and getting ready for a trip to Jacksonville. I have a very busy schedule while there so unfortunately I will not have the time to see everyone I would like to while I am there.

But what I would like to talk about today is health care reform. I mean it is not like we have not been hearing a lot about the subject matter.

My assessment of the health care reform legislation is not a defense of this Administration or this Congress. I strongly support passage of a health care reform bill (House over Senate version) as I do believe its benefits strongly outweigh its short comings.

Again, despite some serious omissions and some terrible provisions (thanks primarily to Republicans joining forces with Conservative Democrats), I believe that the bill as a whole is a significant step forward in ensuring early, quality and more affordable health care to many people living with HIV and AIDS. Here is my quick pro v. con list:

KEY IMPROVEMENTS:

Private Health Insurance

• Increased Access – largely eliminates discrimination on health status – eliminates pre-existing condition preclusions, charging more based on health status and lifetime caps. (Does allow premium adjustment for age, family size, geography and tobacco (senate only)

• Increased Coverage – establishes a new mandatory benefits packages for plans in the exchange that includes prescription drugs, mental health, substance abuse services, and preventive services.

• Affordability – provides subsidies up to 400% of FPL – not enough, but significantly reduces the cost of care to low income folks and does not include the harmful TrOOP language as was in Medicare Part D.

Public Health Insurance

• Increased Medicaid Eligibility to all citizens below 133% of FPL -- this is huge and, with all its faults, in most cases Medicaid is not steerage care. It is in fact, not profit driven and designed to meet the care and treatment needs of the chronically ill, disabled, etc. Most people with incomes below 133%FPL will be eligible for Medicaid – neither disability, nor an HIV or AIDS diagnosis is required for eligibility.

• Increased Medicaid reimbursement rates to providers – this is also huge as it will keep providers with large numbers of Medicaid patients in business.

• Phase out of Medicare Part D “donut hole” over by 2019 – another big step forward.

HIV Specific

• HIV testing of at-risk (House and HELP), ADAP as TrOOP and ETHA (House only)

Other Key Improvements

• Investments in public health infrastructure, addressing health disparities and supporting clinical workforce

KEY DISAPPOINTMENTS

Private Health Insurance

• Affordability –still too expensive

Public Health Insurance

• Senate fails to include a public plan option

• No new mandated Medicaid benefits for historic Medicaid program so state variation continues

HIV Specific

• Senate fails to include ETHA; no broad HIV Screening

Other Insufficient Key Improvements

• Insufficient investment in prevention, wellness and disparities

• House and Senate fail to address legal immigrant 5 year exclusion

• Inclusion of abstinence only funding and restrictive parochial language for several provisions

Those are my thoughts. What about yours? Drop me a line and let me know.

Until we meet again; here's wishing you health, hope and happiness.

Happy holidays!



big bear hug,





Daddy Dab