Housing Works: Housing Prevents AIDS. Housing Improves Health.

AIDS advocates were pleased to see that House’s health care reform draft bill introduced last week has a number of important provisions that benefit poor people living with HIV/AIDS. Most notably, the bill would expand Medicaid eligibility for people with HIV who are not yet sick by including the Early Treatment for HIV Act (ETHA) in the proposal.

The inclusion of ETHA in health care reform would allow states to amend their Medicaid laws to include people with HIV, who in many states don’t qualify for Medicaid because they aren’t considered “sick.”

“This is exactly the type of common-sense measure we need to include as we craft comprehensive health reform legislation,” ETHA’s House sponsor Rep. Eliot Engel (D-NY) said in a statement. “Treating patients with HIV before the disease progresses to full-blown AIDS is not only more cost-effective for our health care system, but more importantly, it will also save lives while preserving the quality of life for thousands of persons living with HIV.”

ETHA was not included in any of the Senate versions of the bill, so advocates will still have to push hard for the language to make it into the final legislation. But an additional plus is that the Obama administration has unequivocally stated its support for ETHA.

In a hearing with of the House Energy and Commerce Committee Wednesday, Engel asked Health and Human Services (HHS) Secretary Kathleen Sebelius if the Obama Administration supports the Early Treatment for HIV Act (ETHA), and if the provision is passed, would she work with the states to ensure they enact it. Sebelius responded, “Yes.”

Other good news

And thanks to the hard work of AIDS advocates, the House bill also includes many other notable improvements from the current health care system for people with HIV. The plan includes a public health insurance option (though it is unknown what such a plan would look like), and also increases Medicaid eligibility to incomes below 133 percent of the federal poverty line.

Another great fix would close a loophole in the Medicare Part D legislation. 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.

What happens next?

But the House bill is just that, a bill, and it is unclear how well it will fare when the Congressional Budget Office (CBO) analysis takes place. “I rate the chances of the House bill surviving as better than 50/50,” said William Arnold, Title II Community AIDS Action Network CEO.

And Treatment Access Expansion Project Executive Director Robert Greenwald said, “This is not the time to rest on our laurels.”

“The House bill has a lot of things in it. I’m not convinced that the CBO score is very high. Now is the time we push hard and make sure these improvements are included in the final legislation,” Greenwald said.

Whatever plan is made, of course, probably won’t be ideal. A single-payer health care plan is the best, and what Housing Works, as well as many other AIDS advocates, have pushed for. But this option doesn’t look to be in the cards.

“We’ve been ratcheting down our expectations from a single payer plan,” said Ernest Hopkins, federal affairs director of San Francisco AIDS Foundation. “But getting something in place and then incrementally improving it has been a way of achieving specific advancements. I’m very optimistic we’ll have reform by the middle of October. That’s much better than we have now. That covers thousands of more people with HIV, categorical eligibility will go away, and we’ll have a public insurance option of some form.”

People with AIDS in the United States are poorer than the general population and also more likely to lack adequate health care. Forty-five percent of people with HIV/AIDS in the United States have incomes under $10,000 a year, and 50 percent lack regular medical coverage.

What about Ryan White?

In the long term, changes to health care would hopefully mean that the Ryan White CARE Act could be used to fund support services and be the “payer of last resort” as it’s intended to be. If more people are eligible for Medicaid, there will be less need for the AIDS Drug Assistance Program.

“We won’t see any actual change on the ground until two to three years out when we’ll see if ADAP is spending its money,” Arnold said. “In the short term, Ohio’s about the go belly up. 150 people on ADAP waiting lists. Arizona’s cutting eligibility. Who knows how all these things will play out at the local level?”

The Ryan White CARE Act is set to sunset in September 2009, and most AIDS advocates are calling for at least three-year extension of the program with some technical fixes until health care reform is better sorted out. Those fixes would include allowing provisions of food pursuant to a doctor’s prescription of nutrition as a core medical service; medical transportation as a core medical service; and helping stabilize State ADAPs Programs by ensuring that rebate income may be spent after federal funds are dispersed. See the full documents.

The majority of the Senate Health committee supports the fixes made by the majority of AIDS advocates.

Housing Works and Campaign to End AIDS offered the minority view that change is needed sooner.

Most AIDS groups oppose Senator Enzi’s (R-WY) amendment to the Affordable Health Choices Act bill (Health Care Reform) now under consideration by the Senate Health Committee that would extend Ryan White for five years without any fixes.