Washington Blade - November 11, 2005
Lou Chibbaro, Jr.

The amendment calls for a demonstration project that gives states the option of providing Medicaid coverage to low-income people with HIV who otherwise meet Medicaid eligibility requirements. It sets a cap of $450 million for the program over five years.

At the request of Senators Gordon Smith (R-Ore.) and Hillary Rodham Clinton (D-N.Y.), the Senate attached the amendment to a controversial fiscal year 2006 budget reconciliation bill that, among other things, calls for across-the-board cuts in social welfare programs and would allow oil drilling in Alaska's Arctic National Wildlife Refuge.

The House was scheduled to vote on its own version of the budget reconciliation bill on Nov. 10. Because House rules usually don't allow non-germane amendments to budget-related measures, the House was expected to pass the reconciliation bill without language providing Medicaid coverage for people with HIV similar to the Senate version. A House-Senate conference committee would make the final decision on the Medicaid proposal.

The Smith-Clinton amendment is a scaled back version of the Early Treatment for HIV Act, or ETHA, a bill Smith introduced earlier this year. Similar versions of ETHA had been proposed since the late 1990s, when President Clinton promised to study the idea of enrolling people with HIV in Medicaid. The bills have died in committee each year since that time.

Smith, who has been one of the Senate's leading advocates for Medicaid coverage for people with HIV, was forced to reduce the scope of the legislation in the amendment because the budget reconciliation bill was aimed at reducing federal spending, and attempting to attach the full ETHA bill would have been "problematic," according to Chris Matthews, Smith's spokesperson.

"We could not have gotten the full bill through," Matthews said. "It will be an uphill battle to get this through the House."

Saving millions

AIDS activists and gay rights groups have said full Medicaid coverage for low income people with HIV - most of whom do not have private health insurance - would save the government millions of dollars because it would delay the onset of AIDS and its related opportunistic infections and diseases, which are more expensive to treat.

Gay rights and AIDS groups have cited a recent study by the consulting firm Price Waterhouse Coopers that shows, over ten years, the death rate for people with HIV who would become eligible for Medicaid under ETHA could be reduced by 50 percent.

While Smith's original ETHA legislation calls for providing Medicaid benefits for all low-income people with HIV who are otherwise eligible for Medicaid, the Smith-Clinton amendment passed by the Senate on Nov. 3 scales back the program into a "demonstration" project with a $450 million cap on Medicaid expenditures over a five-year period.

Similar to ETHA, the amendment also leaves it up to the states to decide whether to adopt the program.

It could not be determined by press time how many otherwise eligible people with HIV would be excluded from Medicaid coverage under the Smith-Clinton amendment compared to Smith's original bill.

Under existing Medicaid rules, the federal government and the states share the cost of Medicaid coverage through various formulas. States may provide additional funds to increase benefits. The sharp increases in Medicaid costs in recent years has created financial burdens for many states, prompting some to scale back on Medicaid programs.

"This is a major accomplishment," said Carl Schmid, director of federal affairs for the AIDS Institute, a national AIDS advocacy group, in describing the Smith-Clinton amendment.

"It's very good because it will cover a lot of people," Schmid said, even though it isn't as comprehensives as the original bill.

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