PI Action alerts & updates ... 2006
PI ACTION UPDATE
June 2006
In this issue
Medicare Part D Problems Continue
Ryan White Reauthorization Bill Introduced
Fiscal Year 2007 Appropriations Update
Dangerous Health Care Insurance Bill Defeated
Advocates Express Anger After UN Global AIDS Meeting
California Budget Update
Goodbye to Michael Montgomery
A Quote We Like
Medicare Part D Problems Continue
The May 15, 2006 deadline to sign up with Medicare Part D, the new
prescription drug benefit, without penalty has passed. Hopefully,
most people with HIV/AIDS who needed to sign up with a Part D plan
met that deadline.
Although some of the most difficult problems associated with implementation
of Part D have lessened, there are still ongoing problems. Most
of the 36 states have stopped providing emergency coverage to their
dual eligibles (those qualifying for both Medicaid and Medicare)
who were unable to access their medications. California, home to
one-sixth of the dual eligibles in the country, has continued a
restricted coverage program in recognition of the ongoing problems.
Plan year 2007 is likely to bring more confusion similar to that
experienced earlier this year. The Centers for Medicaid and Medicare
Services, the federal agency that oversees Medicare, has announced
that they are encouraging, and expect, fewer plan offerings. This
is being done to reduce the confusion from choosing among numerous
plans. However, it is also likely to mean that fewer plans will
be fully subsidized by the Medicare Low Income Subsidy.
For example, in areas with 10 fully subsidized plans from which
to choose, there could be as few as two. There is no articulated
plan regarding how dual eligibles will move from eliminated into
the remaining plans.
If you have questions regarding Medicare Part D or have information
that you would like to see posted on Project Inform's website, contact
adonnelly@projectinform.org.
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Ryan White Reauthorization Bill Introduced
On May 9, 2006, a bipartisan group of House and Senate
legislators from key committees announced that it was ready to introduce
legislation to reauthorize the Ryan White CARE Act. The next week,
S. 2823, the "Ryan White HIV/AIDS Treatment Modernization Act
of 2006", passed the Senate HELP Committee. Senator Hillary
Clinton (D-NY) cast the only "no" vote based on her concern
about a potential significant funding cut to New York.
The House Energy and Commerce Committee will vote next on the bill.
In the meantime, the original authors and other key legislators
continue to discuss outstanding concerns and changes will be made
as it moves through the process.
The current version contains many proposed changes to the CARE
Act, including an expansion in Title I jurisdictions (hardest hit
urban areas), phasing out of "hold harmless" for cities
and states, a slight shift in Title II funding to rural states,
an increase in the AIDS Drug Assistance Program (ADAP) Supplemental
fund, and a requirement that 75% of most CARE Act funding be spent
on "core medical services".
Project Inform continues to work with our advocacy partners, particularly
the CAEAR Coalition, to address concerns with the bill and suggest
improvements. We are particularly concerned about the low recommended
funding levels for all Titles, which will make it much more difficult
to get needed increases during each appropriations process.
We are also concerned about the proposal to base Title I eligibility
only on AIDS cases that are reported in the previous 5 years. This
would greatly penalize cities that have older epidemics and have
done a good job keeping people from progressing to an AIDS diagnosis.
For example, San Jose, CA has around 1,500 actual living AIDS cases,
but only 400 were reported in the past 5 years. This would make
San Jose ineligible for Title I funding after a three-year "grace
period". Many other cities face the same fate. Since people
who have been living with HIV/AIDS for several years are likely
in great need of care services, it is bad public health not to consider
them when determining if a city should get Title I funding.
Finally, Project Inform continues its advocacy to get get badly
needed funding increases to states that don't have Title I areas,
or where the majority of their cases are outside a Title I area,
without large shifts of funding from urban areas. We strongly support
a proposal embraced by a broad range of advocates that would get
supplemental Title II (care and treatment) money to these states.
For more information, the Federal AIDS Policy Partnership's Ryan
White Reauthorization Working Group has created this informative
fact sheet.
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Fiscal Year 2007 Appropriations Update
Last week, the House Labor-HHS Appropriations Subcommittee
voted on Fiscal Year 2007 funding levels for HIV/AIDS care and treatment
programs. The full Appropriations Committee "marked up"
(discussed and voted on) the bill on June 13, 2006.
The committees approved a $70 million increase requested by President
Bush for Title II of the Ryan White CARE Act, but did not include
his request for a $25 million increase in Title III for faith-based
and community-based outreach. The rest of the CARE Act was flat-funded.
The $70 million increase will allow states to spend more money
on care and support services, and they will also be allowed to use
some or all of the funds for their ADAP. However, the lack of increases
for the other Titles and for the ADAP line-item, will result in
continued long waits for health care and treatment around the country.
It is unlikely that we will be able to improve these funding levels
in the House. So now is the time to talk with your two Senators
and urge them to support increases for all of the CARE Act. The
Senate will begin debating AIDS funding soon. Look for PI Action
Alerts in the coming weeks with more information.
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Dangerous Health Care Insurance Bill Defeated
The "Health Insurance Marketplace Modernization Act"
(S. 1955), introduced by Senator Michael Enzi (R-WY), was defeated
in the Senate on May 11, 2006, but not before passing the Senate
HELP Committee. Had it become law, the bill would have taken away
almost all state-enacted consumer protections for people buying
health care insurance individually or through their employers.
The bill was purported to make health care insurance affordable
for small businesses. However, as written, it was much broader and
would have taken away states' abilities to regulate the insurance
industry. State consumer protections that keep insurance more affordable,
particularly for sicker, older and more vulnerable people, would
have been stripped away.
Project Inform and some of our partners in the HIV Medicaid and
Medicare Work Group sent a letter of opposition to the bill. Although
we won this battle, many expect similar legislation to reappear,
perhaps as soon as next year. See the "Private Insurance"
section at Families USA's website for further information.
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Advocates Express Anger After UN Global AIDS Meeting
The United Nations General Assembly held
a special session on global AIDS in New York from May 31 to June
2, 2006. The purpose of the meeting was to review progress on its
"2001 Declaration of Commitment on HIV/AIDS". At the end
of the session, people with HIV and advocates from throughout the
world were disappointed and angered over the final document -- a
five year "political declaration" on the global fight
against HIV.
They report that the document, while making progress in some places,
fails in the areas of treatment and prevention. The final draft
included no concrete targets for providing treatment to those desperately
in need, nor for prevention to at-risk populations.
A broad global coalition of advocates representing the summit's
civil-society (Non Governmental Organizations) released this statement
denouncing the outcome of the session as a failure.
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California State HIV/AIDS Budget Update
Project Inform and our California advocacy partners are
monitoring our state budget request for Fiscal Year 2006-2007. We
have asked the California Legislature and Governor Schwarzenegger
to approve several HIV/AIDS care and prevention items in the upcoming
budget.
The care item is the expansion of the CARE - Health Insurance Premium
Program (CARE-HIPP) to subsidize beneficiary premiums for Medicare
Part D plans and to update the program by dropping the disability
requirement and extending COBRA payment coverage to the full extent
of the California law. This would allow CARE-HIPP to better serve
Californians and would also create some savings in the state's ADAP.
The prevention items include the extension of a $5.6 million increase
for HIV prevention approved in the last budget, and $7.5 million
to fund treatment and prevention programs addressing methamphetamine
use and HIV/AIDS among men who have sex with men.
Members of a joint Senate and Assembly conference committee approved
the staffing necessary to expand the CARE-HIPP and the extension
of the $5.6 million for prevention. The conference committee also
recently approved $10 million for methamphetamine prevention activities
to address five high-risk populations, including men who have sex
with men. The items await the Governor's approval.
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Goodbye to Michael Montgomery
Michael Montgomery, who has worked at the California State
Office of AIDS for twelve years and held the position of Chief for
five, will is retire this summer. Project Inform recognizes Michael
for the extraordinary job that he has done delivering care and treatment
to HIV-positive Californians and prevention for people at risk.
Through leadership, vision, and ability to work with all stakeholders,
Michael led the development of strong and effective programs serving
people with HIV/AIDS.
Michael made a significant contribution at the Federal level as
well, educating elected officials about California's programs and
fighting for adequate funding for services and lower prices for
anti-HIV drugs. He also stayed in touch with the emerging trends
of the epidemic. For example, he was instrumental in helping to
plan an HIV resistance testing program that was in place by the
time the assay became a formal part of the HIV standard of care
in managing HIV disease.
Michael is a wonderful example of a state government official who
uses his vision, skills and leadership position to advocate appropriately
on behalf of people with HIV/AIDS and to improve the quality of
the California HIV care and prevention efforts. He will be missed
and we wish him the best in his retirement.
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A Quote We Like
"In a nation of extraordinary wealth and limitless
creativity, there should have been no need for a 'Cover the Uninsured
Week'. It's shameful that we continue to allow 46 million of our
fellow citizens to go without regular access to decent health insurance."
— Senator Edward Kennedy (D-MA),
during a Senate floor speech on May 10, 2006
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