After months of shoddy service from a vendor, the California Department of Public Health last week finally pulled the plug on one of the contracts for the state's AIDS Drug Assistance Program. A.J. Boggs had been one of three contractors charged with managing ADAP, specifically overseeing enrollment and eligibility for the program that ensures that people living with HIV/AIDS who are uninsured or underinsured have access to medication. Boggs' contract will be terminated effective March 31. CDPH had spent millions of dollars and hundreds of hours of staff time attempting to salvage the program, but it became obvious that Boggs didn't know what it was doing. And the ineffective company also cost the state in other ways. For example, a new program that would help people statewide get access to PrEP has been delayed until next year because CDPH staff devoted so much time trying to fix ADAP errors. Problems included clients being turned away by their pharmacies or even being dropped from ADAP, according to advocates.
But CDPH officials had warnings from HIV/AIDS advocates and others that Boggs couldn't handle the job. In a lawsuit filed by Ramsell, which previously held the ADAP contract, HIV/AIDS officials expressed concern about the handover to Boggs, begging the state to "reconsider the transition timeline" because of problems. In a letter included in the lawsuit, Mario Perez, director of the Los Angeles County Department of Public Health's Division of HIV and STD Programs, told state officials that ADAP depends on "error-free and efficient implementation" so that patients can get their medications. Many of those clients, he added, are marginally housed or transitory, making it difficult to reach them by letter or phone.
There's another disturbing part to the lawsuit: Ramsell alleges that CDPH awarded Boggs the contract even though its bid was $9 million lower. In its response to the suit, CDPH acknowledged that Boggs' proposal "resulted in a higher cost (by $9 million) over three years compared to Ramsell's ..." That's a lot of money that could have been spent on the PrEP access program or other HIV/AIDS-related initiatives.
We'd like to see state health officials explain the missteps in this ADAP contracting debacle and take steps to ensure that future bidders can do the job. In the meantime, we hope that terminating Boggs' contract will enable the office to fix the errors and get the system working like it was before. Increasing access to ADAP should be the department's top priority. The enrollment and eligibility component of the ADAP contract is perhaps the most critical, and the state must make sure that any future vendor handling that aspect of the program is competent. It's inexcusable that months of contractor errors had both negatively affected PWAs and led to the delay of the PrEP access program.
Watching the GOP squirm
We've been waiting for this moment since Donald Trump was sworn in – real disagreement over congressional Republicans' plan to repeal the Affordable Care Act. Dubbed the American Health Care Act, the bill unveiled Monday would, as many predicted, favor the wealthy at the expense of the poor; establish tax credits that likely won't cover the cost of insurance; and impose a penalty if a person's insurance lapsed. The bill has not yet been reviewed by the Congressional Budget Office, so no one knows exactly how many people would lose coverage. The proposal also eviscerates Medicaid (Medi-Cal in California), replacing subsidies with block grants to the states that again, probably won't be enough money to cover insurance premiums.
We suspect this won't be the final version of any bill to repeal Obamacare. Already, various Republican factions have criticized the plan, with conservatives saying it's "Obamacare lite" versus moderates from those states that expanded Medicaid leery of the rollback.
Oh, and the current plan would defund Planned Parenthood, a favorite target of the right, negatively affecting health care for millions of poor and low-income women (and men).
Now that the House has presented its plan, people are finally realizing 1) it's very complicated to develop a health care plan and 2) Obamacare is becoming more popular every day, now that their medical coverage is at risk.
The GOP could simply improve upon the ACA, but the party has such loathing for Obama that it won't. But one thing to remember: while Trump vowed that a replacement plan would provide "insurance for everybody," it's clear that the American Health Care Act, or Trumpcare, will not.