PI Action alerts & updates ... 2007
PI ACTION UPDATE
March 2007
In this issue
2007 Health Care Advocacy Agenda
Final 2007 Appropriations Bill Underfunds AIDS Care
President’s 2008 Budget: Same Old Attack on Health
Care
Medicare Part D Update
New Congress Means Renewed Opportunity to Pass ETHA
PI Expands Health Care Focus to Include Hepatitis C
California State Advocacy Update
Project Inform Reports from CROI
A Quote We Like
2007 Health Care Advocacy Agenda
Project Inform’s Health Care Advocacy program has developed
our 2007 agenda, identifying several areas of protecting and expanding
care and treatment for people with HIV/AIDS.
Our national priorities include improving the Medicare Part D drug
benefit, protecting Medicaid from funding cuts, passing the Early
Treatment for HIV Act, and securing badly needed increases for all
Titles of the Ryan White CARE Act. We have also expanded our focus
to advocate for increased appropriations for hepatitis C programs.
Project Inform also works at the California state level because
many, if not most, decisions regarding health care programs are
made at the state level. This year, Project Inform will work with
the California HIV Alliance and other advocates on many issues,
including full funding for the AIDS Drug Assistance Program (ADAP)
and fighting for protections for dual eligibles (Medi-Cal and Medicare)
in California who find it difficult to access their meds under Medicare
Part D.
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Final 2007 Appropriations Bill Underfunds
AIDS Care
Congress finally passed a “continuing resolution”, which
will fund health programs until September 30, 2007 (end of Fiscal
Year 2007). Advocates had pushed hard for increases in all Titles
of the Ryan White CARE Act. This was especially important given
the changes in the reauthorized CARE Act. For example, Title I (hardest
hit urban areas) needed an increase to fund the five new cities
that recently became eligible.
Fortunately, the final bill includes a $75 million increase for
Title II base. This money will go to all states for primary care,
support services, and/or to put in their ADAPs. The reauthorized
CARE Act was developed assuming this increase, and it will help
many states in need increase access to health care and treatment.
However, the rest of the CARE Act, including the ADAP line item,
received no increase. These programs have suffered from years of
insufficient funding. The result has been waiting lists for care
and treatment nationwide. Next year’s bill must contain increases
for the entire CARE Act. Look for Alerts from PI Action to assist
you in making your voice heard on this issue.
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President’s 2008 Budget: Same Old
Attack on Health Care
President Bush’s FY 2008 budget once again offered no substantive
solutions to the US health care crisis. With a growing number of
uninsured or underinsured people, the President took aim at Medicaid,
Medicare and the State Children’s Health Insurance Program
(SCHIP). These are basic health care programs that he has cut in
the past and yet serve the most vulnerable.
The President’s budget proposes cutting almost $26 billion
from Medicaid over the next five years. This is on top of cuts of
over $4 billion over five years signed into law in the Deficit Reduction
Act in 2006. The proposed funding level for SCHIP falls below what
it would cost states to simply maintain current enrollment, much
less cover the 7 million children who are currently eligible for
SCHIP or Medicaid but not covered.
The proposed Medicare cuts are harder to analyze but they appear
to impact areas that could affect access to care and shift more
costs to beneficiaries. At the same time, they do not address overpayments
to Medicare Advantage private plans. Independents studies show these
plans are significantly overpaid to serve beneficiaries.
The President continued his lack of leadership on the Ryan White
CARE Act. Once again, his budget proposal calls for no increases
to most of this program. He proposes a $25 million increase for
ADAP and a $6 million increase for Title III, which funds community-based
clinics. However, the $6 million is not new money, but a shifting
of funds from the AIDS Education and Training Centers.
Finally, the President offered private market proposals that would
direct federal funds toward people who are healthy and have good
incomes. Two national organizations, Families USA and Center on
Budget and Policy Priorities have posted comprehensive analyses
of the effect of the President’s budget on major health care
programs.
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Medicare Part D Update
Medicare Part D entered its second year in January, 2007. While
there was not as much disruption or as many problems as expected,
especially for the dual eligibles (typically the lowest income individuals),
other issues continued to affect people with HIV/AIDS.
Probably most troubling was the loss for some beneficiaries of
Low Income Subsidy or extra help in the Medicare benefit. We know
this affected about 3,500 Californians with HIV and have reason
to believe that it affected many others in the 36 states that operate
a Medicaid medically needy program. Not only did individuals lose
their extra help, greatly impairing their ability to access necessary
drugs, but most were unaware of their status until January 1, 2007.
This was due to the completely inadequate education provided by
Centers for Medicaid and Medicare on the loss of the benefit. For
more information, here read our comprehensive update on Medicare
Part D.
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New Congress Means Renewed Opportunity
To Pass ETHA
With new leadership in Congress that has identified expanding health
care as a priority, there is renewed optimism in passing the Early
Treatment for HIV Act (ETHA).
This legislation, which has been pending in Congress for several
years, would give states the option to expand their eligibility
requirements to include low-income people with HIV/AIDS who are
not yet disabled. It would also provide more funds to states to
help them take on this new population.
In most cases, a person currently needs to be disabled by conditions
associated with AIDS before receiving services from Medicaid. ETHA
would allow Medicaid to be more in line with the federal guidelines
on standards of HIV care. ETHA would then provide access to care
and treatment immediately after a person is diagnosed with HIV.
If states enacted an ETHA program, it would also help relieve CARE
programs struggling to meet the needs of people who could otherwise
qualify for Medicaid under ETHA.
Senators Gordon Smith (R-OR) and Hillary Clinton (D-NY) are longtime
champions of this legislation and plan to reintroduce this bipartisan
bill soon. In the House, Speaker Nancy Pelosi (D-CA) will again
be a lead co-sponsor of the bill and will work with Representative
Elliot Engle (D-NY). Efforts are underway to identify a Republican
co-sponsor.
Project Inform will work with our advocacy colleagues, including
the Treatment Access Expansion Project and the HIV Medicaid/Medicare
Working Group to pass this important bill. To learn how to get involved
in this effort, email Ryan Clary or call him at 415-558-8669 x224.
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PI Expands Health Care Focus To Include
Hepatitis C
Project Inform recently added hepatitis C funding to our national
health care advocacy agenda. About 4.1 million Americans have been
infected with hepatitis C virus (HCV); yet, only about 40% are aware
of their status. An estimated 225,000 HCV-infected people are also
living with HIV.
Last year, we joined the Hepatitis C Appropriations Partnership
(HCAP), a national coalition of community-based hepatitis and HIV
organizations and pharmaceutical companies that advocates for increased
funding for federal viral hepatitis programs. Like much of the CARE
Act, these programs have been flat-funded for years. Hopefully,
with new leadership in Congress, this will change. HCAP is requesting
a modest increase of $11 million in federal funding for HCV programs.
We also urge President Bush to issue a Presidential Proclamation
supporting May as National Hepatitis Awareness Month. Even though
public health officials and advocates have recognized this month
since 1995, the President has yet to respond to pleas to issue this
proclamation. His leadership is needed to help educate Americans
about this disease and to encourage testing. Please take a moment
to respond to this PI Action Alert and send a message to the President!
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California State Advocacy
Project Inform works with its partners through the California
HIV Alliance and the Low Income Health Advocates Group to ensure
adequate funding and the development and implementation of thoughtful
legislation in the fight against HIV/AIDS in California. This year
our top budget priority is full funding for ADAP. However, due to
savings in ADAP as well as California’s leadership in securing
significant rebates for pharmaceutical drugs, ADAP is not currently
in need of extra state general fund contributions.
That allows us an opportunity to address the static portion of
the epidemic. California estimates the following: about 1 out of
4 who have HIV do not know their status; of those who do know, about
1 in 5 do not seek care for a number of reasons; and we experience
8,000–9,000 new HIV infections each year. Our budget and legislative
proposals focus on allowing more people to know their status and
get connected to care. You can read the full advocacy agenda for
the California HIV Alliance, including budget and legislative issues.
In spite of the best efforts by the Low Income Health Advocates
to work with the administration and the Legislature, California’s
Emergency Drug Benefit ended on January 31, 2007. The EDB provided
temporary access to needed medications for dual eligibles when they
were unable to get them through their Medicare plans. Although the
program served more than 50 people each day, there was no political
will to continue the program into the new plan year. This could
leave dual eligibles without options to access needed meds.
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Project Inform Updates from CROI
Project Inform’s treatment advocacy staff attended
the recent Conference on Retroviruses and Opportunistic Infections
(CROI) in Los Angeles. This meeting brought together the world’s
leading scientists to present and discuss the latest breakthroughs
in HIV/AIDS research. PI staff provided daily updates from the conference.
Be sure to check our website soon for a special post-CROI issue
of PI Perspective, our treatment journal.
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A Quote We Like
"The President’s budget sends a disturbing message to
American families: health care should only be for those who are
rich enough to pay for it on their own."
— Representative John Dingell,
Chairman of the House Energy and Commerce Committee, February 6,
2007
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