Bay Area Reporter - August 9, 2007
Bob Roehr

A milestone toward that goal was reached on August 2 with introduction of the bill in the House of Representatives by a bipartisan group of 27 Democratic and 27 Republican lead sponsors. Speaker Nancy Pelosi (D-San Francisco) is a longtime proponent of the measure.

"It's an exciting day," said Representative Eliot Engel (D-New York) at the Capitol Hill news conference that launched the bill. "Sometimes we hear commentators saying that Democrats and Republicans can't agree on anything. This bill shows that they are wrong."

"To tell people to just sit and wait [to develop full-blown AIDS] before you can get health care coverage under Medicaid is cruel, and makes no sense. It defies logic, as federal treatment guidelines call for early access to medical care," he added.

The legislation gives states the option of amending their Medicaid program for low-income persons to allow for early treatment of HIV. It is modeled after an existing program for breast and cervical cancer, and a component of the SCHIP (State Children's Health Insurance Program) legislation that would extend health coverage to more children, which is currently moving through Congress.

Lead Republican sponsor Representative Ileana Ros-Lehtinen (Florida) said, "We've got to give patients the opportunity to live a long, healthy, prosperous life ... This bill reminds us of all of the work that remains to be done to ensure that Americans across the land have the tools they need to fight this HIV/AIDS epidemic."

Robert Greenwald, director of the Treatment Access Expansion Project, said, "It is impossible to meet the care and treatment needs of people living with HIV through discretionary healthcare programs, we need access to Medicaid." Ryan White programs by themselves cannot grow quickly enough.

The CDC's plan for increased testing aims to identify 250,000 people in the U.S. living with HIV who don't know that they are infected with the virus. That will only increase pressure on programs such as the Ryan White CARE Act.

"Preserving an immune system is more effective than trying to rebuild it," said Margaret Hoffman-Terry, a Pennsylvania physician and secretary of the board of the American Academy of HIV Medicine. "We need [access to] coverage to start when the diagnosis starts."

"We have the technology to give these people long healthy lives; what we need is the political will to provide that standard of care," she said.

Political will and money is what has stalled the concept of ETHA for a decade.

Engel said ETHA was not included as part of the SCHIP legislation for financial reasons. "It comes down to money, I don't want to whitewash it," he said.

Under the budgetary restraints adopted by the Democrats known as "paygo" (pay as you go), new spending has to be offset by cuts elsewhere or new taxes. Engel said, "We are going to have to find the money" but he believes "the political climate is right" to do that.

A key technical issue is that the Congressional Budget Office must score each piece of legislation for its effect on the budget. Engel explained that the CBO has only two persons scoring health care proposals and they focus on more immediate costs and savings to the program.

The congressman said he will push the CBO to use a broader measure of benefits and savings - including having people remain healthy, working taxpayers - and over a longer period of time than is usual in making their cost/benefit analysis of the bill.

Political strategists suggest that it may come down to Pelosi putting pressure on the CBO to use a more expansive cost/benefit measure in order to get a more favorable rating for ETHA.

A companion bill was introduced in the Senate in March by lead sponsors Hillary Clinton (D-New York) and Gordon Smith (R-Oregon).

Ronald Johnson, deputy director of AIDS Action, said, "We will do everything we can to make it [enactment of ETHA] happen this year. The reality is, it may not."

He acknowledged that with Democrats taking control of Congress, "expectations were high" for items on both the gay and AIDS agendas, which some advocates had claimed had been blocked by the Republican leadership, particularly in the House, might move forward rapidly. That has not happened and "it is leading to some frustration."

"It is incumbent upon the current leadership to do everything it can to make it happen. And it is incumbent upon us in the advocacy community to hold their feet to the fire. They are our friends, but we must continue to push them," Johnson said.

HIV travel ban

Representative Barbara Lee (D-Oakland) introduced legislation on August 2 that would lift the ban that prevents persons living with HIV/AIDS from traveling or immigrating to the U.S.

Last December President Bush announced that the current waiver process for visas would be streamlined, but eight months later the administration is still having internal discussions about how best to do that.

"It defies reason that, because of this misguided law, we cannot host an international HIV/AIDS conference in this country. This law is unjust and unnecessary and it is time to change it," said Lee.

The AIDS Institute applauded her action. Executive Director Gene Copello said, "The current ban is based on ignorance and fear. It is time that policy corresponds with current science."

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