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Bragdon Opinion Greatest Legal Victory Since the Beginning of the Epidemic

Statement by Daniel Zingale
Executive Director, AIDS Action

June 25, 1998

A note from TheBody.com: Since this article was written, the HIV pandemic has changed, as has our understanding of HIV/AIDS and its treatment. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

Contact: media@aidsaction.org or call: 202- 986-1300


The Supreme Court today handed people with HIV their greatest legal victory since the beginning of the epidemic. The Bragdon decision is a victory of reason and responsibility over irrationality and illogic. While we are pleased by the Court&/content/art33488.html/content/art33488.html#146;s decision, justice is not done until Sidney Abbott is back in the dentist chair.

The Court’s action is also consistent with the views of the American people, as evidenced by public opinion research released today by AIDS Action demonstrating strong public support for anti-discrimination protections for people living with HIV.

The ground has shifted beneath us as a new standard has been set for federal treatment of people living with HIV. The federal government’s anachronistic treatment of asymptomatic HIV disease has threatened the lives of the most vulnerable HIV-positive Americans. Indeed, Medicaid does not provide AIDS preventing drugs for those with HIV infection until they develop full-blown AIDS, when treatment is less successful and more expensive.

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If the Supreme Court says people with HIV should be protected from discrimination, they should be protected from advancement to AIDS. Today, AIDS Action has written to the Health Care Financing Administration urging them to act on the Court’s decision and modernize Medicaid to cover people with HIV.


AIDS Action Director, Daniel Zingale with Sidney Abbott and her attorney Ben Klein, along with Miss America, Kate Shindle. Abbott, Klein and Shindle were recipients at the 1998 AIDS Action Leadership Awards.


Public Opinion Data and Medicaid Letter Follow


Public Opinion Research Data Regarding HIV Discrimination

To: Interested Press
From: Lake Snell Perry & Associates
Subject: Recent research findings:
Voters oppose workplace discrimination for people with AIDS
Date: June 24, 1998

Recent focus groups conducted by Lake Snell Perry & Associates for AIDS Action revealed strong objections to workplace discrimination against HIV-positive people and people with AIDS.1

While people do have concerns -- often scientifically unfounded -- about HIV transmission and the public health risks presented by contact with people with AIDS, the focus group respondents still strongly defended the right to work. As one Atlanta woman said, “People want to work and…you don’t let them work because they have HIV -- that is kind of sad.” Another Atlanta woman said simply, “HIV [positive] people should not be punished” and another agreed, “They can live productive lives.”

Other participants voiced the concern that fear of discrimination might discourage people from being tested for HIV. Said one woman in Milwaukee, “I’m thinking for being hired, discrimination there wouldn’t be fair.” A Milwaukee man applied the fear of discrimination to his own life, “I wouldn’t take the AIDS test… I don’t want to be blackballed.”

Finally, some participants noted that people who are working will be better able to take care of themselves and will not rely as much on government or community assistance. Said one woman, “As long as they are productive, they can pretty much care for themselves or carry insurance…, and that is less government burden. As long as they are functioning, they should be allowed to [work].” (Atlanta woman)

Largely unfamiliar with the intent of the Americans with Disabilities Act, participants were confused about why this law would apply to able-bodied people with HIV: “…Covered by the disability act but yet they are working?” asked one Atlanta woman. Nonetheless, they agreed strongly with the intent of the ADA -- to provide discrimination protection for those with disabilities who are able to work. “Maybe there is another law that can cover them as opposed to disability,” suggested a woman in Atlanta. “Yeah, some kind of discrimination or something other than [the] Disabilities Act,” responded another participant.


1. Lake Snell Perry conducted a series of four focus groups among a cross section of American electorate in May 1998. Two groups were held in Milwaukee (white women without college degrees, white men with at least some college education); two groups were held in Atlanta (African-American women with at least a high school diploma; white women with college degrees). Qualitative research is different in nature than quantitative research in that it allows the researcher to dig beneath the surface of opinions in order to uncover beliefs, perceptions, and attitudes.


Text of Letter to HCFA Regarding Medicaid

June 25, 1998

Nancy-Ann Min DeParle
Administrator
Health Care Financing Administration
314G HHH Building
200 Independence Avenue, SW
Washington, DC 20201

Dear Nancy-Ann,

Today’s landmark Supreme Court decision in Bragdon v. Abbott has, in one stroke, altered the landscape of how the federal government treats populations affected by HIV disease. As the AIDS epidemic has shifted from diagnoses of almost certain death to, in many cases, a manageable chronic condition, the federal response to this shift has, until today, been lethargic.

Indeed, despite the Court’s recognition of the new medical significance of asymptomatic HIV disease, federal health programs have yet to make this important distinction, jeopardizing the long-term health of thousands of the most vulnerable Americans.

Current Medicaid policy that provides access to protease inhibitor drugs only for HIV positive individuals diagnosed with full-blown AIDS is a recipe for disaster. In essence, the federal government is telling low-income HIV-positive Americans that they can’t receive AIDS-preventing drugs until they develop AIDS. If automobile safety regulations followed this model, air bags would only be required in cars that have already crashed.

Despite the absence of reliable statistics as to its exact size, the under and uninsured are among the fastest growing segments of the AIDS population. In the last fiscal year, federal Medicaid costs for AIDS patients were estimated to be $1.8 billion with a beneficiary pool of more than 100,000 people. Ironically, studies show that costs of caring for people with full-blown AIDS are nearly twice that of healthy HIV-positive individuals.

AIDS Action has proposed a “Reinventing Medicaid” plan that would modernize the program to conform to current standards of care as defined by the National Institutes of Health. Under the plan, which was endorsed by Vice President Gore in 1997, Medicaid would provide eligibility to HIV-positive individuals who would otherwise meet income eligibility for the program.

Reinventing Medicaid to cover healthy HIV-positive Americans would save lives and save money. Every major study of protease cocktails has proven that early treatment provides the best route for preventing the onset of illness. Moreover, the cost of providing drugs early would offset exorbitant hospitalization and other medical costs associated with AIDS treatment.

Moreover, there is new evidence to suggest strong public support for Reinventing Medicaid. As part of the first-ever message research project around AIDS issues, AIDS Action has learned that there is not only strong support for discrimination protection for people with HIV, but that there is strong opposition to the current Medicaid policy.

Said one man in Milwaukee, “Government does everything backwards.” Another Milwaukee man asked, “with $1.6 billion (spending on certain AIDS programs) you can’t have the air bag before the accident?”

And among a group of African-American women in Atlanta, the reaction was even stronger. Said one woman, “… it is really sickening to think they don’t even try to intervene until someone has AIDS knowing that prevention is really the key.”

If the Supreme Court says people with HIV should be protected from discrimination, then logic and morality dictate that protecting them from developing AIDS is just as important. Today, the dynamic has shifted and now is the time to follow the lead of the Court by modernizing Medicaid to meet the current standards of care.

Sincerely,

Daniel Zingale
Executive Director

A note from TheBody.com: Since this article was written, the HIV pandemic has changed, as has our understanding of HIV/AIDS and its treatment. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!



  
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This article was provided by AIDS Action Council.
 
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