Housing Works: Housing Prevents AIDS. Housing Improves Health.

Representatives of U.S. territories are quietly working behind the scenes to make sure that they are not forgotten in the Congressional debate over health care reform, a process which could have major implications for the AIDS crisis in Puerto Rico.

Earlier this month, Representatives Pedro Pierluisi (D-Puerto Rico), Madeleine Bordallo (D-Guam), Donna Christensen (D-Virgin Islands), Eni F.H. Faleomavaega (D-American Samoa) and Gregorio Kilili Camacho Sablan (Northern Mariana Islands) sent a letter to Rep. Henry Waxman (D-CA) urging him to ensure that federal contributions to Medicaid for the territories achieve parity with contributions for U.S. states. The letter also urges Waxman to ensure that residents of the territories are fully eligible for federal credits that will help people get health insurance.

While an early “Discussion Draft” of the health reform bill extended health credits for the territories, the current draft does not.

The representatives also expressed their concerns in a face-to-face meeting with Waxman and New York Rep. Charlie Rangel a few days after sending the letter. “We got a commitment from both Representatives to make sure that our health needs are met,” said Arin Goodman, senior legislative aide to Sablan. “Rangel seemed especially outraged that, with the high levels of military enlistment from the territories, we were left out of the bill.”

Medicaid madness

Increasing Medicaid for Puerto Rico would be a major step forward in fighting the AIDS epidemic there. Insufficient Medicaid funds force many Puerto Ricans living with AIDS to rely on programs funded by the Ryan White Care Act. Ryan White has been notoriously mismanaged on the island, a situation that has resulted in a lack of access to AIDS medications through the Ryan White-funded AIDS Drugs Assistance Program (ADAP).

In 2008, the U.S. spent approximately $20 per Medicaid participant per month in Puerto Rico, compared to $330 per participant per month in the U.S. This alarming disparity is widely acknowledged: As a candidate, Obama stated his desire to “to continually raise the cap on federal contributions to Medicaid in Puerto Rico until it disappears.”

Despite the commitments from Waxman and Rangel, securing more health-care funding for the territories will not be easy. “Waxman expressed the concern that people always express about cost—nobody knows how much this will cost because there is so little data,” Goodman said. “Nonetheless, he is committed to working with us.”

The efforts of the representatives from the territories were sure to be echoed by a delegation of Puerto Ricans living with HIV, Puerto Rican AIDS activists and representatives of Housing Works, Amor Que Sana and CAIM, who, as of press time, were preparing to attend a series of meetings with U.S. Congressmen, the White House Office of National AIDS Policy and the U.S. Department of Housing and Urban Development.

Their agenda includes pushing for Medicaid parity, access to drug treatment—half of all HIV infections in Puerto Rico are spread through injection drug use—and access to housing.

The Update will have a full report on those meetings next week.