PI Action alerts & updates ... 2003
Community Organization Sign-on Letter:
Medicaid Reform
Deadline to sign: 5pm PST Thursday, February 27
To sign: email rclary@projectinform.org
Dear [Member of Congress or Governor]:
We are writing to express our opposition to the President’s
proposal to restructure Medicaid. Medicaid is the largest source
of funding for health care for people with HIV/AIDS. Any action
to limit the ongoing commitment of the federal government to Medicaid
will seriously affect people living with the disease, as well as
those health care providers who care for them. We urge you to oppose
the inclusion of any of these proposals in any legislation and,
instead, to support temporary additional federal assistance for
states for their Medicaid programs.
Background:
People with HIV/AIDS rely on Medicaid for a vast array of services.
It is the major source of the prescription drugs that can forestall
their illness and disability. It is also the major source of diagnostic
and preventive care, as well as treatment for those who become sick.
Overall, state and federal governments provided roughly $7.7 billion
for HIV/AIDS care in FY 2002 through the Medicaid program, serving
well over 200,000 people with HIV/AIDS. While many people with HIV/AIDS
benefit from other federal programs—most notably Medicare
and Ryan White—these other programs cannot take the place
of Medicaid. The need for services is too large for these other
programs to compensate for lost Medicaid coverage—and these
other programs do not provide all of the Medicaid covered services
that are critical to people living with HIV/AIDS. Therefore, weakening
Medicaid would seriously harm the HIV/AIDS care infrastructure.
The President’s Proposal:
The President’s Budget proposes to restructure Medicaid by
inviting states to create a block grant. The essence of the proposal
is to replace the open-ended federal commitment of funds with a
pre-set formula of federal spending that is hard and fast over ten
years. Under the existing Medicaid system, if the costs of the state’s
program go up, so does the federal commitment. However, under this
proposal, if the costs of the state’s program were to go up
unexpectedly (because of a recession, an epidemic, medical inflation,
or changing technology), the federal contribution would stay the
same.
HIV/AIDS History and Medicaid:
Having dealt with HIV/AIDS over the years, we know why Medicaid
matters for the more than 200,000 HIV positive beneficiaries. The
arrival of the epidemic in the 1980s was obviously unpredicted and
could not have been built into a pre-set formula. Because of the
epidemic, there was a dramatic increase in the number of Medicaid
beneficiaries. Many people became sick and disabled; many lost their
jobs and their health insurance. Under the existing Medicaid system,
the federal government shared the expense of increased enrollment
with states automatically. If the block grant had been in place,
states would have been left on their own to cope with the costs
of this epidemic-related growth in enrollment.
Generally, states must treat all Medicaid beneficiaries equally.
While they have freedom to cover or not cover a wide range of “optional”
services, they are not permitted to pick winners and losers, by
covering services for one group and not for another. In the 1980s,
this core principle was tested when a few states tried to deny coverage
for the first HIV medication—even though they had elected
to cover prescription drugs for other beneficiaries. Eventually,
the requirement that states must treat all beneficiaries in a comparable
way was upheld.
Likewise, when protease inhibitors—the drugs that fight HIV
and postpone illness and death—were discovered and approved
in the mid-90s, the cost of HIV/AIDS pharmaceuticals rocketed from
$1,500 per person per year to more than $10,000 per person per year.
This, too, could not have been planned and budgeted for in a ten-year
formula. Under the existing Medicaid system, the federal government
shared that expense with states automatically. If the block grant
proposal had been in place, states would have been left with huge
shortfalls with no federal assistance. These medications have made
a huge difference. Before these effective therapies were available,
HIV had become the leading cause of death of Americans aged 25–44.
Because of the availability of these drugs—to which Medicaid
contributes mightily—there has been a dramatic reduction in
HIV-related deaths.
In short, because of the open-ended, uncapped nature of the federal
program, Medicaid was there when people with HIV/AIDS and their
home states needed it. Under a block grant, that would not be true.
We hope that health care for people with HIV/AIDS and all people
with chronic illnesses and disabilities will continue to improve.
But we fear that a proposal like the President’s block grant
will make it impossible for low-income and uninsured people to benefit
from improvements in care and treatment. Without a continued federal
commitment, States will not be willing or able to provide new therapies
and innovations to sick, poor people.
Many Members of Congress and Governors have supported increased
federal matching payments; such increased payments would help states
and the people who depend on Medicaid. We urge you to oppose the
President’s proposal and, instead, to work to enact these
other efforts.
Sincerely,
(initial list)
AIDS Treatment Data Network
Gay Men’s Health Crisis
Project Inform
