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A Republican-crafted plan signed into law by President Bush on December 8 to overhaul the nation's Medicare system could drastically affect tens of thousands of HIV-positive Americans who depend on government-provided anti-HIV drugs to survive. The measure includes a prescription-drug benefit for 40 million senior and disabled Americans, which prompted some Democratic lawmakers and organizations like the American Association of Retired Persons to back the proposal. A provision in the new law, however, could be disastrous'even life-threatening'for low-income HIV-positive Americans who receive antiretroviral medications through Medicare's sister plan, Medicaid. Because Medicare provides only direct medical services, many low-income HIV-positive people in the Medicare program receive their anti-HIV medications through Medicaid, making them eligible for both government health programs. However, a provision in the Medicare reform law, directed at so-called dually eligible program enrollees, limits access to all Medicaid-provided drugs to only two medications per drug class. Because anti-HIV cocktails usually contain three or more medications to treat HIV infections'and are all from the same large class, antiretrovirals'the new restrictions could effectively end suggested combination therapy regimens for many Medicare-Medicaid participants. Activists and AIDS service organizations, including AIDS Project Los Angeles and New York City's Gay Men's Health Crisis, were urging lawmakers to reject the bill and for Democratic senators Barbara Boxer and Dianne Feinstein, both of California, and Charles Schumer and Hillary Rodham Clinton of New York to filibuster the legislation. But the filibuster and other procedural efforts to derail the measure failed, and the bill passed in a 54'44 vote in the Senate and by a five-vote margin in the House. AIDS service providers and advocates are bracing for the full effects of the overhaul, worrying that low-income HIV-positive Medicare-Medicaid enrollees will be forced to turn to state-run AIDS Drug Assistance Programs, many of which already have implemented waiting lists and other access restrictions to deal with budgetary shortfalls. APLA executive director Craig Thompson says the Medicare changes 'will actually do harm by reducing access to medications that low-income people need to survive. And we are not talking about just a few people. Approximately 38% of APLA's 10,000 registered clients are eligible for Medicare.' Ana Oliveira, executive director of GMHC, was equally grim, saying the Medicare overhaul could hurt as many as 50,000 HIV-positive Americans. 'It is unacceptable that HIV-positive Medicare beneficiaries will have less access under this bill than they do now,' she said in a press release.