United States Should Subsidize HIV/AIDS Care for Low-Income Residents, Report Recommends

The U.S. government should subsidize HIV/AIDS care for all low-income residents, according to a report released on Thursday by a National Academies' Institute of Medicine committee panel, the San Francisco Chronicle reports (Russell, San Francisco Chronicle, 5/14). The report, titled "Public Financing and Delivery of HIV/AIDS Care: Securing the Legacy of Ryan White," was sponsored by HHS' Health Resources and Services Administration at the request of Congress (National Academies release, 5/13). IOM examined the current standard of care for HIV-positive people and determined whether the current care delivery system actually allows people living with HIV/AIDS to access it, according to the IOM Web site (IOM Web site, 5/14). Lauren LeRoy, president of Grantmakers in Health and head of the panel that drafted the report, said that the current system for subsidizing HIV/AIDS care in the United States is a "patchwork of programs" with "significant variations" in the level of care, according to the Chronicle (San Francisco Chronicle, 5/14).

Currently, approximately 950,000 people in the United States are living with HIV/AIDS, and approximately 40,000 more people contract HIV each year (Fox, Reuters, 5/13). According to an HIV/AIDS policy issue brief, titled "Financing HIV/AIDS Care: A Quilt With Many Holes," released on Thursday by the Kaiser Family Foundation as part of the IOM report, between 42% and 59% of the people living with HIV/AIDS in the United States do not receive "regular care" ("Financing HIV/AIDS Care: A Quilt With Many Holes," 5/13). State Medicaid programs -- which are funded with both state and federal money -- cover most of the treatment for low-income, uninsured HIV-positive people. In addition, Ryan White CARE Act money helps fund state and local programs aimed at providing care to underinsured or uninsured low-income HIV-positive people. However, the IOM report says that varying eligibility requirements and benefit limitations mean that thousands of HIV-positive people do not receive "necessary" treatment, according to the release (National Academies release, 5/13). "The fact that about 40,000 new AIDS diagnoses and 16,000 deaths occur each year further indicates that our current system is failing to ensure adequate health care for persons living with HIV infection," the IOM report says (Reuters, 5/13). According to the Kaiser Family Foundation brief, the "multiple sources of coverage and care for people with HIV ... are not well coordinated across programs, making it difficult for patients, their advocates and providers to navigate access" ("Financing HIV/AIDS Care: A Quilt With Many Holes," 5/13).

The IOM report says that the current system is "unresponsive to the fact that HIV/AIDS is a national epidemic with consequences that spill across state borders" and recommends that the federal government create a new program to address the problem, the AP/South Florida Sun-Sentinel reports (Wolfe, AP/South Florida Sun-Sentinel, 5/13). IOM calls for the establishment of a new entitlement program that would group most current state and federal HIV/AIDS care programs into one national organization with "streamlined rules" and a larger budget, the Chronicle reports. The so-called HIV Comprehensive Care Program would create a national standard of care for low-income HIV/AIDS patients (San Francisco Chronicle, 5/14). The report says that a single public financing arrangement -- including consistent nationwide eligibility requirements and a federally defined list of services -- would "address gaps and a lack of coordination" in the current system, under which a patient may lose coverage after moving to another state, the AP/ Sun-Sentinel reports (AP/South Florida Sun-Sentinel, 5/13). The program would be able to provide antiretroviral drugs to an additional 58,687 people living with HIV/AIDS who never before have received treatment, according to the report, the Atlanta Journal-Constitution reports (Wahlberg, Atlanta Journal-Constitution, 5/14). The program also would offer uniform reimbursement to health care providers throughout the country. The program would be available to all HIV-positive U.S. citizens with incomes at or below 250% of the federal poverty level, which was $22,500 for a single person in 2003. People living with HIV/AIDS who earn more than 250% of the federal poverty level but do not have access to private health insurance would be allowed to participate in the program by paying a monthly premium based on their incomes, according to the release (National Academies release, 5/13).

IOM estimates that the program would cost $7 billion over 10 years -- $5.6 billion more than current federal spending on HIV/AIDS care for low-income people, Reuters reports (Reuters, 5/13). The report suggests that the federal government employ cost-saving strategies to reduce the program's budget, including negotiating price discounts with pharmaceutical companies for drugs as do agencies such as the Veterans Health Administration. Using the Federal Ceiling Price for antiretroviral drugs could save the government about $419.3 million annually, according to the report. In addition, the program could bring some funds into its budget that currently are channeled through Medicaid and the Ryan White CARE Act. The report also calls for the CARE Act to be "refocused" in order to support enrollment in the new program and to offer services that would not be provided under the new program, such as voluntary HIV counseling and testing. In addition, the report suggests that CARE Act funds be used to subsidize care for low-income immigrants who would be ineligible for the new program, according to the release (National Academies release, 5/13). The report says that the program eventually "would pay for itself" through future reduced health care costs, according to Reuters (Reuters, 5/13).

HHS in a statement responding to the IOM report said that the recommendations may not be "realistic," according to the Journal-Constitution. The agency said that implementing the recommendations would require "sweeping legislative changes" (Atlanta Journal-Constitution, 5/14). Steve Morin, director of the University of California-San Francisco AIDS Research Institute, said that the plan had "no political viability" under the current administration. He added that the November election could bring about changes that might warrant "rethinking public financing" for the program, according to the Chronicle. Dr. James Kahn, a panel member from the UCSF Institute for Health Policy Studies, said, "We were aware of, but did not consider as a constraint, the issue of political feasibility" while drafting the report. He added that the panel's goal was to create a "more workable system" and release the information for public comment, the Chronicle reports (San Francisco Chronicle, 5/14). Panel head LeRoy said, "Failing to provide these cost-effective, life-saving drugs to all Americans who need them, including individuals who lack insurance or cannot afford them, is indefensible." She added, "Current programs are characterized by limited state budgets, limited services and a confusing array of eligibility requirements -- all of which undermine the nation's goals for preventing and treating HIV/AIDS" (Reuters, 5/13). NPR's "Morning Edition" on Friday reported on the IOM report. The segment includes comments from LeRoy and Dr. Paul Volberding, chief of medical services for the San Francisco Veterans Affairs Medical Center (Wilson, "Morning Edition," NPR, 5/14). The complete segment is available online in RealPlayer.