Bipartisan Group of Representatives Introduces Early Treatment for HIV Act in House
Rep. Nancy Pelosi (D-Calif.) and a bipartisan group of more than 70 cosponsors on Thursday introduced the Early Treatment for HIV Act (HR 3859), which would allow states to expand Medicaid coverage to low-income HIV-positive people who have not yet developed AIDS, the Advocate reports (Advocate, 2/27). Under current Medicaid rules, only HIV-positive people who have developed AIDS can receive treatment through the program. In July 2003, the Treatment Access Expansion Project, a collaborative project of the HIV/AIDS community, health care providers and the pharmaceutical industry, released a study conducted by PricewaterhouseCoopers that found that over 10 years, ETHA could reduce by 50% the death rate for HIV-positive people on Medicaid. In addition, over 10 years, disease progression could be slowed and health outcomes improved, according to the study. Based on estimates of low-income populations currently ineligible for Medicaid, the study assumed that 30,000 people would enroll in ETHA if all states participated in the program. PwC found that under traditional budget analysis rules, ETHA would cost $359 million over five years and about $2.5 billion over 10 years. Taking into account other possible benefits and savings under ETHA, including $192.8 million in costs resulting from a declining death rate and more people staying on Medicaid, the true cost of ETHA would be $55.2 million over five years, saving $31.7 million over 10 years, according to the study (Kaiser Daily HIV/AIDS Report, 7/9/03).
The bill is supported by a broad coalition of health care providers, AIDS advocates and the pharmaceutical industry, according to the Advocate. "The cruel irony of the current situation is that poor people living with HIV are denied treatment and care under Medicaid until they develop serious AIDS-defining conditions (that would have) often (been) preventable if Medicaid coverage had been available to them sooner," Paul Feldman of the National Association of People with AIDS said (Advocate, 2/27). NAPWA Executive Director Terje Anderson said, "New HIV treatments have successfully improved both the health and quality of life for many people living with this disease. However, without access to early intervention health care, these advances remain out of reach for thousands of poor and low-income pre-disabled persons living with HIV" (TAEP release, 2/26). Laura Hanen, policy director of the National Alliance of State and Territorial AIDS Directors, said, "ETHA gives states the opportunity to bring their Medicaid eligibility rules in line with federal government guidelines on the standard of care for treating HIV" (Advocate, 2/27). "ETHA will enable us to remove barriers to early intervention health care at a savings to our communities and to our health care system. It's the right and compassionate thing to do," AIDS Institute Executive Director Gene Copello said (TAEP release, 2/26).
Easing Financial Burden
ETHA also would relieve the increasing financial burden on "safety net" programs such as the Ryan White CARE Act and the AIDS Drug Assistance Programs, according to an HIV Medicine Association release (HIVMA release, 2/26). ADAPs -- which are supported with both state and federal funds -- provide HIV/AIDS-related medications to low-income, uninsured and underinsured HIV-positive individuals. According to an "ADAP Watch" released by NASTAD in January, 15 states have waiting lists or access restrictions for their ADAP programs (Kaiser Daily HIV/AIDS Report, 1/27). Bill Arnold, executive director of the Title II Community AIDS National Network, said, "A sound domestic health policy on HIV/AIDS must ensure early access to care and treatment to all Americans. No one should die on a waiting list for access to treatment, which is currently what is happening in this country" (TAEP release, 2/26). Fred Dillon, policy director for the San Francisco AIDS Foundation, said, "People living with HIV and AIDS should not live with fear and anxiety about whether they will have access to life-saving medical care, medications and support services. The federal government should pass ETHA at the earliest opportunity to promote broader guaranteed access to HIV care through the country" (SFAF release, 2/26). "While we must intensify our prevention efforts, including education about behavioral risk and research for a vaccine, we must also respond to the growing demand for HIV care," Pelosi said, adding, "We urge our congressional colleagues and President Bush to join us in this effort" (Pelosi release, 2/26). Sens. Hillary Rodham Clinton (D-N.Y.) and Gordon Smith (R-Ore.) last year introduced a similar measure in the Senate, where the bill is expected to be reintroduced this year, according to the Advocate (Advocate, 2/26).