June 27, 2008
UPS AND DOWNS FOR FEDERAL FUNDING
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Domestic AIDS funding: Always a roller coaster flickr.com/photos/kelpatolog/59719356/ |
Global funding was the number one item on the AIDS advocacy agenda this week, with advocates fighting the clock before the G8 summit. But several smaller-potato domestic AIDS issues were in play as well. The outcome? Good and bad.
The good:
Thanks in part to all your phone calls (and the lobbying of almost every U.S. governor), six of the seven proposed changes to the Centers for Medicare & Medicaid Services (CMS) regulations are expected to be held off until March 31, 2009. -- The Dems snuck in a measure to curtail the misguided regulations changes into the war funding bill, which passed both houses last week. Targeted case management programs, including COBRA, are safe, at least for the next few months. The only regulation that will stay in effect is limiting federal funding for certain hospital outpatient services, such as dental care and preventive care. The legions of advocates against the new regulations are hoping that when the CMS changes are up for review again in March, the next administration is friendlier towards the health of poor and sick people.
The U.S. House of Representatives Financial Services Appropriations Subcommittee moved forward an appropriation for $1.4 million to develop a White House Office of National AIDS Policy. Led by Rep. Jose Serrano (D-NY), the committee reccommendation reads, "The Committee calls on the new Administration to develop and implement a National AIDS Strategy that engages multiple sectors in strategy development, is comprehensive across federal agencies, sets timelines and assigns responsibility for implementing changes, identifies targets for improved prevention and treatment outcomes and reduced racial disparities, and mandates annual reporting on progress."
While $1.4 million is only enough to cover the cost of salaries and general office supplies, it's a significant first step that sets up a structure to build a plan.
"We're not going to sit down tomorrow, and get rid of HIV, but we need a plan to allocate funding to address this epidemic, particularly with research and prevention," said Marsha Jones, a Campaign to End AIDS (C2EA) member who is on a national AIDS strategy committee. "I have no hope in John McCain to do this, but I have much hope as it relates to Obama. But this really should be a non-partisan issue."
On September 26, C2EA will caravan to the presidential debate in Oxford, Mississippi to demand that the next president, no matter who he is, commit to creating a national plan to combat AIDS in his first 100 days in office.The bad:
We're still in the notorious donut hole. Although the CHAMP Act passed by the House last session included a provision to allow ADAP and Indian Health Service spending to count toward true out-of-pocket costs for Medicare—which, complicated as it sounds, would have saved $250 million for ADAP—neither the House nor the Assembly have included the fix in their Medicare bill. Those two programs combined were only expected to cost $100 million over five years from Medicare.
Since Medicare Part D went into effect in 2006, the HIV Medicaid and Medicare Workgroup (HIVMMWG) have been trying to convince Congress to approve the ADAP as TrOOP cost-saving measure. People on Medicare Part D prescription drug benefits reach the dreaded "donut hole" when the cost of their meds exceeds $2,510. They can't receive Medicare Part D benefits until they pay a $4,050 out of pocket, referred to as "true out of pocket costs" or TrOOP. ADAP as TrOOP would allow the joint state-federal AIDS Drugs Assistance Programs (ADAP) to pay the $4,050.
Medicare CMS could make the changes itself but in 2006 claimed "Congress did not specifically designate other Government-funded health programs at entities whose cost-sharing assistance could count toward TrOOP." And some members of Congress are weary of spending money from one government program to pay for another, even if it does pay dividends in saving ADAP for those who really need it."Some members are philosophically opposed to using federal dollars to get more federal dollars. Because [ADAP's] a discretionary program that's always underfunded, this bill hasn't gotten much traction," said Andrea Weddle of the HIV Medicine Association.
Weddle also said it's been hard to swell up grassroots support for something that comes across as a complicated, wonky issue. "I think we've gotten better about talking about it. It's harder about relating it to people," she said. Still, Weddle said the HIVMMWG will try to get this passed again next year under a different, presumably more Democratic, Congress.