July 13, 2011

July 13, 2011
Medicaid a Possible New Front in Battle Against AIDS

Welcome to another day in my life. Today is Wednesday and we have almost made it through the middle of another work week. I hope you are having a safe and great week so far. It is another busy one for Dab the AIDS Bear and me.

You have heard me talked about the ADAP Crisis in the United States. But what happens if our elected officials cute Medicaid as they have talked about doing.

Federal spending on AIDS prevention and treatment has not specifically been targeted as part of deficit reduction efforts, but advocates warn that if Medicaid is cut as part of any agreement, progress in battling the epidemic would be undermined.

About 40 percent of people with the HIV infection and AIDS are covered under Medicaid. Some of these patients are enrolled in both Medicaid and Medicare, and as a group they represent the poorest, sickest and most costly beneficiaries. Spending cutbacks for “dual eligibles” would especially threaten care, advocates say.

A coalition of AIDS groups on June 17 wrote Nancy Ann DeParle, White House deputy chief of staff for policy, urging the Obama administration to object more vigorously to proposals advanced by some Republicans to turn Medicaid into a block grant program and give states more flexibility to cut enrollment by easing standards outlined in the health care overhaul (PL 111-148, PL 111-152). “We do not feel that the administration has spoken up on the need not to cut Medicaid,” said Carl Schmid, deputy executive director of the AIDS Institute.

This year marks the 30th anniversary of the discovery of HIV/AIDS. Treatments are available to help patients live healthy and productive lives and reduce the risk of transmission, but only if federal funds continue to be available, the letter says.

Fundamental changes to Medicare are considered “too hot to handle” as part of any deficit reduction plan. But cuts in Medicaid spending are viewed as more likely because the federal-state program lacks the same widespread and visible support of the elderly and their advocacy groups, said Ronald Johnson, vice president of policy and advocacy at AIDS United.

While a variety of diseases regularly vie for attention and money from Congress, AIDS stands out in the public health policy world. The Centers for Disease Control and Prevention says more than 1 million people in the United States are living with HIV. Of those, one in five have not been tested and do not know they are infected. And each year the disease is spread to another 56,000.

Black Americans are disproportionately affected, accounting for almost half of all new cases, the CDC says. Because AIDS is an infectious disease, preventing and treating it is considered a federal responsibility.

In recent years, advocates have quietly succeeded in getting more federal funding to fight AIDS. Domestic funding has risen from $16.7 billion in fiscal 2007 to $20.3 billion in the current year (PL 112-10).

This has occurred even though AIDS does not grab the kind of public attention it did when it was first discovered. An April Kaiser Family Foundation poll found that 7 percent of those surveyed viewed HIV/AIDS as the nation’s most urgent health problem, compared with 68 percent in 1987. Yet 53 percent also said the government is spending too little to fight the disease. And 63 percent said Congress is not doing enough to help treat the HIV/AIDS problem.

‘Difficult Environment’

The Obama administration has been praised for unveiling a national strategy to combat AIDS and proposing increases, even if they are small, in fiscal 2012 spending.

Jeffrey Crowley, director of the White House Office of National AIDS Policy, said in an interview that now is a “difficult environment” to secure spending to fight AIDS. But he said the administration is working with states to help them find efficiencies in their Medicaid programs to better treat people with AIDS. A senior administration official, speaking on background, said President Obama opposes any deficit plan that would undermine Medicaid.

Senate Democrats have vowed to resist rollbacks. Tom Harkin of Iowa, chairman of the Labor-HHS-Education Appropriations Subcommittee, said “drastic” cuts in discretionary spending will make it “hard to keep up with critically needed services like providing life-saving drugs to Americans with HIV and AIDS.” Black Americans watching AIDS spread through their communities must speak out and “rev this up a bit,” said Rep. Barbara Lee, D-Calif. The NAACP also is planning an advocacy conference in Washington.

Fighting AIDS has long attracted bipartisan support in Congress. Republican senators such as Tom Coburn of Oklahoma, Michael B. Enzi of Wyoming and Richard M. Burr of North Carolina have been consistent backers of the federal-state AIDS Drug Assistance Program, which provided prescription drug assistance to 205,000 low income patients with no or insufficient insurance during fiscal 2009. That program won a small funding increase as part of the fiscal 2011 spending deal Congress reached in April.

The program, however, still has a shortfall, and as of mid-June had a waiting list of more than 8,400 people in 13 states. The list has grown with the rise in unemployment. Some states have dropped people from the waiting lists by tightening income eligibility. Prescription drugs to treat AIDS cost $11,500 a year, Schmid said, and only a minority of patients have private health insurance to cover the cost.

So what are your thoughts? Drop me a line and let me know.

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

big bear hug,

Daddy Dab