The priorities that the President has outlined could, in fact, have very damaging impacts on the programs that serve some of the most vulnerable Americans, including Medicaid, Medicare and the Ryan White CARE Act. You can learn more about potential challenges and how you can be involved here.
article (PDF) from Families USA's Ron Pollock said that eliminating the program would drive up healthcare costs for insured people as providers were forced to raise rates to cover the costs of uncompensated care.
Advocates believe that the Governor's proposed "reforms" would lead to a loss of currently guaranteed essential healthcare. The potentially damaging components included a "pre-approval" authority that would allow the state to make significant unspecified changes in the program to manage spending without federal oversight, a proposed new definition of medical necessity allowing the state to provide only the least expensive "adequate" care, and far-reaching changes to the pharmacy benefit. A letter was sent by healthcare advocates -- including Project Inform -- to Governor Bredesen about this issue.
The situation in Tennessee has not yet been resolved, and the Governor and advocates are still negotiating. However problems in state Medicaids such as Tennessee and Mississippi (where state actions are threatening care for tens of thousands of current beneficiaries) may be just the beginning of deterioration of care in state programs as healthcare costs continue to escalate and state economies remain sluggish.
A document (MS Word) by Thomas P. McCormack of the Title II Community AIDS National Network summarizes proposed and enacted state Medicaid cutbacks and exclusions.
Fall 2004 ACRIA Update takes a comprehensive look at healthcare and drug development and regulatory programs for people with HIV. The issue includes articles on the Ryan White CARE Act, Medicaid and Medicare, the Food and Drug Administration, pharmaceutical Patient Assistance Programs, the AIDS Drug Assistance Program and clinical trials.
The newsletter's Medicaid and Medicare article provides further information on those two programs and ways to take action to protect them.
The federal government has posted many of these public comments online.
Final regulations are expected to be released early next year. We will let you know when they are available, as well as any opportunities to improve them through legislative changes.
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-- Shalini Eddens, Project Wise