The recent battle over severe proposed cuts to HIV/AIDS programs in California proves why health care reform is badly needed in the United States. Our vital system of HIV care is built on a patchwork of gap-filling programs such as the AIDS Drug Assistance Program. Despite their importance, these programs are quite vulnerable, as they depend on yearly fights for adequate funding. While the state Legislature's proposed budget largely protects Californians who depend on these programs, it is unclear whether the governor will support it. This perilous situation shows the urgent need for legislation to guarantee every American living with and at risk for HIV stable access to quality health care and preventative services that cannot be taken away easily due to budget cuts.
Fortunately, Congress and President Barack Obama are working diligently to develop meaningful health care reform legislation. This is the first time in 15 years that we have a real opportunity to address the national shame that over 46 million Americans are completely uninsured, millions more are underinsured, and more than 50 percent of bankruptcies are caused by skyrocketing health care costs. However, in the rush to ensure coverage, we must make sure that the results of reform efforts protect the needs of the most vulnerable populations, including people living with and at risk for HIV/AIDS.
Project Inform, along with our advocacy partners in the National HIV Health Care Access Working Group, has prioritized three crucial provisions that must be included in health care reform. These are not the only provisions that would benefit people with HIV/AIDS. But they would assure a major expansion of care, treatment, and prevention services just as HIV/AIDS agencies seek greater control of the epidemic through efforts to significantly increase the percentages of HIV-positive people who know their HIV status and engage in care and treatment:
- Eliminate the Medicaid disability requirement and expand eligibility to all low-income people. Medicaid is an entitlement program and not subject to annual fights for funding. This provision would give approximately 42 percent of all uninsured people living with HIV immediate access to stable health care through Medicaid. It would also provide access to health care for people with hepatitis B and C, and other chronic conditions, who have not yet become severely ill.
- Include the Early Treatment for HIV Act. Currently, HIV-positive people need to be disabled before becoming eligible for Medicaid. ETHA has been pending in Congress for years and would correct this error by allowing states to expand Medicaid eligibility to include low-income people with HIV who are not disabled. It would ensure they get early access to lifesaving care and treatment and would reach more than 75 percent of uninsured people with HIV.
- Provide a strong public insurance option. Public health programs have much lower administrative costs than most plans in the private market, which allows for reasonable premiums and other costs, while providing quality care. A strong public option could provide a national standard for the private market, while providing greater stability for people with HIV than private plans, which can charge higher prices, close, merge, or change benefits at will.
While most proposals released so far are only in draft form, it is clear that the House of Representatives' priorities for health care reform are far closer to ours than the Senate's. The draft House proposal includes ETHA language, a public option, and expansion of Medicaid to all Americans earning up to $16,000 in annual income. With their proposal, House leadership, including Speaker Nancy Pelosi (D-San Francisco), have made it clear that health care reform must work for people who can least afford insurance.
Unfortunately, the news is not as good in the Senate, where opportunities for expanding Medicaid appear to be in jeopardy and many Republicans and moderate Democrats have expressed strong opposition to a true public insurance option.
Congress will begin serious debate and negotiations about health care reform after the July 4 holiday. People with HIV and their advocates must get involved now to ensure the best possible expansion of health care coverage. Here are some ways you can be part of this effort:
- Call Speaker Pelosi's office (415-556-4682). Thank her for her leadership in developing a health care reform bill that expands Medicaid for people with HIV and includes a public option. Ask her to fight to make sure these vital provisions remain in any final legislation.
- Call California Senators Barbara Boxer (415-403-0100) and Dianne Feinstein (415-393-0707). Urge them to do everything they can to get Medicaid expansion and a public option into the Senate version of health care reform.
- Go to the Treatment Access Expansion Project's Web site at http://www.taepusa.org to find Action Alerts with sample phone messages, fact sheets, and analyses of various health care reform proposals.
The time for health care reform is past due. People with HIV and their advocates need to make their voice heard to ensure that reform not only broadens coverage for everyone, but provides quality comprehensive care and preventative services for those living with and at risk for HIV. If the health care system serves the most vulnerable among us well, it will serve all Americans.
Anne Donnelly is director of health care policy at Project Inform; Ryan Clary is the director of public policy at the agency.