Group Recommends Revamp of Public Care Funds

Because eligibility requirements for public HIV care programs for low-income HIV-positive Americans vary greatly from state to state and budget shortfalls are becoming more commonplace, the federal government should streamline public HIV care for low-income, underinsured, and uninsured people, according to a report released in May. The report, prepared for the Department of Health and Human Services by the nonprofit Institute of Medicine, says thousands of low-income HIV patients are unable to access antiretroviral treatment because of a 'patchwork' of state programs with 'significant variations' in the level of care offered. A separate study released by the Kaiser Family Foundation shows that between 42% and 59% of HIV-positive Americans do not receive regular care. 'The fact that about 40,000 new AIDS diagnoses and 16,000 deaths occur each year further indicates that our current system is failing to ensure adequate health care for people living with HIV,' says the Institute of Medicine report. 'The current federal-state partnership for financing HIV care is unresponsive to the fact that HIV is a national epidemic with consequences that spill across state borders.' To alleviate the problem, the report recommends the establishment of a new federal entitlement program for HIV care that encompasses state Medicaid and other public care services with streamlined rules and a larger overall budget. Such a nationwide program would be able to provide anti-HIV drugs to nearly 58,000 HIV-positive people who have never before received treatment, which would prevent around 20,000 deaths over a 10-year period. The recommended income eligibility requirements for the program would be 250% or less of the federal poverty level, which is $23,275 for a single person. Individuals earning too much still would be able to join the program by paying a monthly premium based on their incomes. The Institute of Medicine estimates the program would cost $7 billion over 10 years. HHS reacted coolly to the report, saying that the recommended program may not be 'realistic' and that implementing such a new entitlement service would require 'sweeping legislative changes' by Congress. Steve Morin, director of the University of California, San Francisco, AIDS Research Institute, told the San Francisco Chronicle that the report's recommendations have 'no political viability' under the Bush administration.