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Lawmakers scramble to ensure and expand access to new
treatments as Ryan White and ADAP funding shrinks
**
▼
by Bob Roehr
ep. Nancy Pelosi (D-Calif.) recently
more specifically, how to measure costs and sav
introduced the HIV Treatment Im
ings. The Clinton administration continues to rely
provement Act, which she describes
upon a limited accounting that includes only
as a comprehensive plan “designed
direct medical expenses and savings. Thus it
to respond to new treatment opportu concludes that Medicaid expansion will cost more
nities created by our investment in AIDS
re which the White House opposes.
money,
search.”
Senak argued, “There is no law requiring
The bill in part seeks to expand access to
budget neutrality [in expanding access to Medic
Medicaid— in a limited manner—to those with
aid]. This is simply a matter of political will.”
HIV who do not have an AIDS diagnosis.
Many AI DS advocates are calling for a broader
Steve Morin is a Pelosi aide in transition to
measurement of federal expenditures, which
becoming director of the Policy Research Center
would include, among other gauges, the increased
at the AIDS Research Institute at the University of
tax revenue from those who continue working as
California San Francisco.
a result of better access to therapy. Such an
He briefed the International Association of
equation would likely swing the cost/benefit analy
Physicians in AIDS Care on the bill at the group’s
sis in favor of early intervention.
Nov. 11 conference in Washington, D.C.
The HIV Treatment Improvement Act, mean
Morin said the proposal tries to tackle prob while, would impose new demands upon the
lems of accessing the new treatment therapies.
states. Many already make their own contribu
tions to ADAP, but some are shirking that respon
“You don’t have to go too far to find people
who are receiving sub-optimal care,” he said,
sibility. Morin cited Colorado, which has limited
adding that while
access to its program
early intervention
and has foisted large
keeps people healthy,
numbers of patients
it also prevents them
onto charity pro
from reaching the dis
grams.
abled status which
At the same time,
qualifies them for
state officials there
have called a special
Medicaid, an entitle
ment program.
session of the Legis
“We are gradually
lature “to figure out
ways to rebate their
on a course to lose this
enormous state sur
$3.6 billion in re
sources that we cur
plus.”
rently use for HIV
The bill would re
care,” he said.
quire state ADAPs to
meet federal treatment
That puts pressure
guidelines in deliver
on Ryan White and
ing services.
AIDS drug assistance
programs as more pa Steve Morin
Morin called the
tients seek services. These programs are funded
measure a “comprehensive piece to raise visibil
under discretionary spending, a portion of the
ity around the problem,” but admitted he does not
federal budget that must shrink 16 percent over
expect the bill to pass in its entirety.
the next five years as part of the budget agree
eaction to the bill has been cautious. Winnie
ment. Medicaid, meanwhile, will be allowed to
grow slowly.
Stachelberg, political director of the Hu
“So if you are phasing people with HI V/AIDS
man Rights Campaign, applauded Pelosi’s
out of Medicaid, which is a growing program, and
leadership on AIDS issues throughout the year.
shoehorning them into a shrinking program, you
Christine Lubinski, deputy director of the AIDS
Action Council, however, said she’s concerned
are obviously creating a problem,” Morin said.
that putting the matter before Congress might
The solution he and Pelosi offered is “a cat
result in codifying a lower level of support than
egorical eligibility for people who are HIV-in
some states offer under existing programs.
fected.”
In an effort to both control costs and gain
She also would have handled the politics dif
ferently: “I would have grabbed a Republican
broader political support, the proposal would
provide more limited benefits than those received
cosponsor.”
by regular Medicaid recipients.
Not everyone favors Medicaid expansion.
Kevin Ivers, political director of Log Cabin Re
Morin believes the proposed Medicaid expan
publicans, said, “It goes in the wrong direction.
sion would cost about $5 billion, but it would save
It’s a non-targeted generalized expansion of en
nearly $4 billion in acute hospitalization and $3
titlements which means an expansion of bureau
billion in Social Security Disability payments.
cratic spending.”
He initially thought there was a real shot at
getting it attached to the recently passed Labor/
Jim Driscoll, Log Cabin’s AIDS lobbyist,
Health and Human Services budget reconcilia called Medicaid expansion unfeasible for a num
ber of reasons.
tion bill, but that opportunity slipped away.
“One is, what do you do with the other disease
Several AIDS lobbyists voiced frustration with
the lack of support from the White House, point groups? If you expand for AIDS you’ve got to do
ing to Vice President Al Gore’s April initiative on
it for Parkinson’s, cancer, all of them. And what
Medicaid expansion, now long delayed and ru does that do to the budget? Republicans are terri
mored dead.
fied of both the budget and attacks from other
“The HIV community has seen little tangible
disease groups,” he said.
results from Health and Human Services,” said
Scnak responded, “What we seek is not spe
Mark Scnak, policy director with AIDS Project
cial treatment for HIV, but for the government to
step up to the plate and fix a broken system that
Los Angeles. “To promise to study the issues is
simply inadequate.”
does not serve us adequately.”
The sticking point is “budget neutrality,” or
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