A New Era for HIV Health Care
The Top Six Actions Every HIV Advocate Should Take
1. Defend Health Care Reform
Despite the significant strides that health care reform offers in combating HIV (increasing access to Medicaid and private insurance, eliminating harmful and discriminatory insurance practices, increasing prevention efforts), the reform that members of Congress courageously passed last year is in danger of repeal. We cannot let the promise that reform holds for millions of Americans fall victim to a partisan attack.
2. Ensure that HIV Services and Ryan White Infrastructure Are Integrated Into Health Care Reform
The Ryan White program has been an essential source of care for thousands of people with HIV, and will continue to provide important services even after some of the major health care reform provisions go into effect. Given the funding difficulties that Ryan White faces and the changes brought about by health care reform, however, we cannot rely on Ryan White alone to ensure that HIV treatment needs are met. We must think creatively about how to integrate its comprehensive services and skilled providers into broader systems.
Ryan White programs offer an important blueprint for the kinds of services needed by people with chronic illnesses. In many ways, Ryan White programs serve as a best-practices model for complete and cost-effective care. We must ensure that these models are integrated into broader health care systems. This means starting conversations with providers, advocates, and lawmakers about how the services that people with HIV depend on can be integrated into community health centers, Medicaid, and private insurance.
3. Ensure That the "Essential Health Benefits" Package Meets the Needs of People With HIV and Other Chronic Illnesses
The health care reform law requires that all plans sold through insurance exchanges, as well as the benefits offered to people newly eligible for Medicaid (those who were not eligible for Medicaid on the date the law was enacted), include "essential health benefits." This package must contain ambulatory and emergency services, hospitalization, maternity and newborn care, mental health and substance use services (including behavioral health treatment), prescription drugs, rehabilitative services and devices, laboratory services, preventive and wellness services, chronic disease management, and pediatric services (including oral and vision care). Because the U.S. Department of Health and Human Services must define the specifics of the package, advocacy is needed to ensure that the benefits meet the wide-ranging needs of those who will be entitled to them, including people with HIV.
4. Address the Current ADAP Crisis
We are in the midst of an unprecedented AIDS Drug Assistance Program (ADAP) funding shortage (see "The ADAP Crisis: Waiting for Meds" in this issue). The result has been an access-to-care and public health crisis, with over 8,000 people currently on ADAP waiting lists throughout the country. States have also enacted other cost-saving measures such as limiting the drugs covered by ADAP. We must put pressure on state and federal lawmakers to ensure full funding of ADAP, now and through 2014, when the Medicaid expansion will offer prescription drug coverage to most low-income people with HIV.
5. Support Implementation of the National HIV/AIDS Strategy
In July 2010, President Obama announced a National HIV/AIDS Strategy (NHAS), detailing goals and priorities to address the AIDS epidemic in the U.S. and providing a roadmap for drastically cutting the number of new HIV infections, increasing access to care and treatment, and reducing health disparities. As a community, we fought hard for the NHAS, and we must be prepared to continue to fight for its full implementation. Advocates should work with federal agencies, state health officials, and community-based organizations to implement NHAS provisions, such as supporting state applications for "1115 waivers," which are needed to immediately expand Medicaid to people with HIV who are not disabled.
6. Defend Medicaid
Today, Medicaid is an essential lifeline to care and treatment for many people with HIV. Starting in 2014, Medicaid will become an even more important source of care for thousands of currently uninsured people with HIV who will be eligible for Medicaid because of health care reform. To make sure that Medicaid is able to meet this need, HIV advocates should join forces with others outside the HIV community to protect against harmful cuts to the Medicaid program at both the state and federal levels.
There are many unknowns regarding health care reform, and the HIV advocacy community must be ready to respond to setbacks. Whether Congress, the President, or state governments have the political conviction to fulfill the promise of health care reform in ways that most benefit our community is an open question.
That being said, now is not the time to ignore the tremendous opportunities presented by the new funding and innovative service delivery initiatives provided through health care reform. Instead, we should be working to defend the law and to ensure that Ryan White services, providers, and models of care are integrated into health care reform initiatives. The role of Ryan White in health care reform is a complicated issue, and the HIV community will benefit from an open dialogue about the best way forward.
Robert Greenwald is the director of the Legal Services Center of Harvard Law School's Health Law and Policy Clinic and Director of the Treatment Access Expansion Project (TAEP). Amy Killelea is a clinical fellow and attorney with the Clinic and TAEP.
This article was provided by ACRIA and GMHC. It is a part of the publication Achieve. Visit ACRIA's website and GMHC's website to find out more about their activities, publications and services.
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