AIDS Action Weekly Update
May 2, 1997
Welcome to AIDS Action Council's Weekly Washington Update, an on-line newsletter for Handsnet subscribers that reviews what is happening in Washington on AIDS policy issues each week. If you have any comments or questions, please feel free to contact us at the e-mail address listed below.
Budget Framework Agreement Reached
After weeks of negotiations, White House officials and Congressional leaders have come to an agreement to balance the budget within the next five years. Initial reports about the agreement, which was announced today, May 2, included cuts of $200 billion from Medicaid, Medicare and other entitlement programs over the next five years, cutting domestic discretionary spending by $68 billion, and providing for $135 billion in tax cuts. There have, however, been some last minute modifications in the agreement resulting in changes in the originally reported cuts. These changes include a tax cut of $85 billion over five years, a $15 billion cut to Medicaid, a reduction from the initial cut of $24 billion, and over $65 billion in cuts to domestic discretionary programs. While it is unclear how the Medicaid cuts will be actualized, there remains the possibility that the program will be restructured as a per capita cap or that the cuts will come primarily from payments to disproportionate share hospitals (DSH). The proposed cuts to domestic discretionary programs could prove disastrous to federal AIDS programs, the Ryan White CARE Act, HIV prevention at the Centers for Disease Control and Prevention (CDC), AIDS research at the National Institutes of Health (NIH), AIDS programs within the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Housing Opportunities for People With AIDS (HOPWA), which are already overburdened and hard pressed to meet the current needs. It is important that AIDS advocates contact their members of Congress to ensure that AIDS programs are protected during the appropriations process. See below for more on the Medicaid program. For further details on the budget, please see the AIDS Action Alert posted in Handsnet under AIDS-HIV Issues/Alerts.
Medicaid Briefing By Administration Officials
Administration officials, Gary Claxton and Debbie Chang of the Health Care Financing Administration (HCFA) met with members of the National Organizations Responding to AIDS (NORA) coalition Wednesday, May 2, to outline the president's proposal to reform the Medicaid program. At that time, the plan involved achieving a cost savings of $24 billion over five years, $15 billion from cuts to disproportionate share hospital (DSH) payments, and $7 billion through the implementation of a per capita cap which will put a ceiling on the federal Medicaid payment per beneficiary distributed to states. The bill also provides for $13 billion to be put into the programs to enhance coverage for children, and to correct some of the coverage lost to legal immigrants as a result of the welfare reform law. Members of the coalition expressed their opposition to the per capita cap for several reasons including the fact that because the high cost of treatment for AIDS, Medicaid recipients living with HIV/AIDS will exceed the cap and the cost of their treatment will shift to states. In order to handle these costs, states could be forced to cut certain benefits like providing for prescription drugs or not extending benefits to medically needy populations, many of which include people living with HIV/AIDS. While it appears that the balanced budget agreement eliminates the per capita cap, there remains the possibility that the program will be restructured as the budget resolution moves forward.
Poll Results Show Approval For Medicaid Expansion
Nearly 70 percent of Americans polled in a nationwide survey overwhelmingly support extending Medicaid coverage to low-income people in the early stages of AIDS so that these individuals can benefit from the new life-extending, life-enhancing AIDS drugs. The survey, conducted for AIDS Action Council by GOP polling firm American Viewpoint, polled 1,000 registered voters. The results of the survey show great support for AIDS Action's proposal to the Health Care Financing Administration (HCFA) to expand Medicaid for this population. AIDS Action originally proposed the Medicaid expansion initiative to HCFA and the Office of Management and Budget (OMB) officials, citing current Medicaid eligibility criteria as contradictory to AIDS clinical evidence and standard of care which call for early treatment for those with HIV. Over 53 percent of adults with AIDS in this country rely on Medicaid for health care, but many low-income individuals are denied access because they are not considered disabled by the Social Security Administration - a disability status usually follows a diagnosis of full-blown AIDS. Vice President Gore requested that HCFA report back to him by early May on the feasibility of implementing the Medicaid expansion initiative.
VA-HUD Appropriations Hearings
Hearings before the House VA-HUD Appropriations Subcommittee took place this week. AIDS Action Council testified for increases to the Housing Opportunities for People With AIDS (HOPWA) program. The testimony pointed out that stable housing is critical to prevent the early onset of illness for people with HIV/AIDS, and that it is a vital part of the AIDS care continuum. The President's budget request for FY 98 seeks an 8.1 percent increase for HOPWA for a total of $204 million. This figure falls below the $250 million estimate needed for FY 98, but would at least ensure that cities and states across the country and housing projects in communities across the nation can work to address the ever-increasing needs of individuals with HIV/AIDS. The Department of Housing and Urban Development (HUD) estimates that the increase requested in the President's FY 98 budget would provide housing and related services for an additional 2,836 individuals living with HIV/AIDS and their families.
Automatic Continuing Resolution Approved In Senate Bill
In spite of a threatened presidential veto, the Senate version FY 97 supplemental appropriations bill (S. 547) contains an automatic continuing resolution (CR) which will fund programs in spending bills which have not passed by the beginning of the next fiscal year. Under the automatic CR programs in these spending bills will be funded at 98 percent of their previous fiscal year funding. The president and Congressional Democratic leaders have expressed their opposition to an automatic CR because the across the board cuts will hurt many social, health, and education programs and provide no incentive for Congressional GOP leaders to actually work on a normal appropriations process.
The Senate is scheduled to vote on S. 547 next week.
Confidentiality Of Medical Records Bill To Be Introduced Next Month
Senators Bob Bennett (R-UT) and Patrick Leahy (D-VT) have announced their plan to introduce a bill next month that would ensure the confidentiality of medical records by setting standards for the protection of medical records. The legislation, which had broad bipartisan support during the 104th Congress, would allow patients the right to view their medical records, limit the disclosure of those records and establish criminal and civil penalties for the abuse of the information in the records. Senate Labor and Human Resources Chair Jim Jeffords (R-VT), a cosponsor of last session's legislation says this bill is a priority and he intends to move it in his committee as early as by the July Fourth recess. Both bills respond to growing concerns among consumers about access to medical records via computer and unwanted intrusions into the doctor-patient relationship.
This article was provided by AIDS Action Council. It is a part of the publication AIDS Action Weekly Update.