Bay Area Reporter - October 8, 2009
Seth Hemmelgarn, s.hemmelgarn@ebar.com

In a September 24 letter to President Barack Obama, the steering committee of the HIV Health Care Access Working Group, a coalition of 84 national and community-based AIDS service organizations, outlined several pieces they want to see in any final health care reform bill.

It isn't clear which, if any, of these pieces will make it into the final bill, but Anne Donnelly, a member of the steering committee and director of health care policy for San Francisco-based Project Inform, expressed some hope.

"I think it's going to be a fight, but I really want to remain optimistic that we can do something really historic if we all work hard at it," Donnelly told the Bay Area Reporter.

The first thing the letter mentions is expansion of Medicaid coverage to all low-income individuals, including childless adults. Current eligibility rules exclude most people with HIV from accessing Medicaid until they become disabled.

"Expansion of Medicaid coverage to all low-income individuals" up to 150 percent of the federal poverty level "will allow many people with HIV to access lifesaving treatment and care that will keep them healthy and productive," the letter said.

According to the federal Department of Health and Human Services, the poverty guideline is $10,830 for one person and $14,570 for a family of two.

Donnelly said the group would even like to see up to 200 percent of federal poverty.

She said that one particular concern for California is, especially in light of the state's recent budget cuts, "We'd be very concerned this expansion would be financed adequately by the federal government so that California could do a good job in delivering what it needs to deliver to folks who are on Medicaid."

California's Medicaid program is known as Medi-Cal.

In its letter, the group also called for a strong national public insurance option. The public option, which is facing stiff opposition and an uncertain fate, would ensure the establishment of comprehensive standards for benefits and affordability nationwide, and would lower costs through competition, according to the letter.

The group also stated strong support for "an annual meaningful out of pocket cap on cost sharing and premium assistance based on a sliding scale." The committee wrote that there must also be substantial premium subsidies to protect low-income individuals and families up to 400 percent of the federal poverty level.

Finally, the letter calls for a prevention and public health investment fund.

"Stabilizing our public health system and expanding the delivery of HIV prevention programs are essential to reducing the number of new infections and related health care expenses," the letter said. "This fund must be established with dedicated funding."

"Now's the time for people to get involved," said Donnelly. "It's fair to say we've seen less response from the community than we'd expect in such a crucial and important policy decision. This really could make a dramatic difference in the lives of people with HIV" and other chronic diseases.

"Now's the time for people to act," she added.

In an e-mail to the B.A.R., Drew Hammill, a spokesman for House Speaker Nancy Pelosi (D-San Francisco), wrote that the health care reform proposal moving through Congress would achieve Medicaid eligibility for everyone, including childless adults, up to 133 percent of the poverty level.

"The importance of this cannot be overstated in terms of people living with HIV/AIDS," wrote Hammill. "This is essentially what the speaker has been trying to do for years through her Early Treatment for HIV Act, which would've ensured that people with HIV infection qualified for Medicaid if they meet the income requirements."

Hammill added that "this is better," because Medicaid income requirements are "well below" 133 percent in most states.

Hammill also wrote that Pelosi pushed to have language included in the House Energy and Commerce Committee bill that would allow states to cover everyone with HIV infection, under current state disability income requirements, between enactment and January 1, 2013 with an enhanced federal medical assistance percentage.

January 1, 2013 is when everyone, including people with HIV, with incomes at or below 133 percent of the federal poverty level, regardless of resources, would be eligible for Medicaid under the House bill, wrote Hammill. Rather than receiving an enhanced match for this population, states would receive 100 percent federal cost share.

After January 2013, people above 133 percent could be enrolled in a health care exchange with subsidies based on income up to 400 percent of the federal poverty level, "again regardless of resources," wrote Hammill.

Limited care

Joe Franklin, 37, is HIV-positive and has hepatitis C. He was just hired as client services manager at AIDS Housing Alliance-San Francisco.

Franklin said that he's currently not covered by any program but is eligible for services funded by the Ryan White HIV/AIDS Treatment Modernization Act. He said that those services include HIV-specific medical care and HIV medications, but where he falls between the cracks is that the AIDS Drug Assistance Program was designed specifically for HIV, not hepatitis C.

Franklin, who lives in Brisbane, said that without insurance one option for care is San Mateo County's Edison Clinic, which offers outpatient medical care for people with HIV/AIDS. He said he plans to move to San Francisco so he can take advantage of the Healthy San Francisco program, which isn't health insurance but was designed to make health care services accessible and affordable to uninsured San Franciscans.

Franklin said that he's not disabled so he doesn't qualify for any state-sponsored plans such as Medi-Cal, and that he needs universal health care.

Shortly before he hired Franklin, Brian Basinger, the housing alliance's founder and director, said that the position would mark the first time the alliance had hired a full-time employee.

There's a "whole question about 'What are we going to do about health insurance?'" said Basinger. "I'm kind of waiting for Washington" to know what his options would be as an employer, he said.

Basinger, who strongly supports the public option, also said, "Having a system where health insurance is employer-provided creates barriers to disabled people with AIDS. Employers aren't interested in hiring us because they're concerned about how it will impact their health insurance premiums ... and for people with AIDS who are contemplating going back to work, we don't have the option to go without health insurance."

"Able-bodied people might be able to go without health insurance for a month" when they lose their jobs, he said. "We can't."

Other legislation

Out lesbian Congresswoman Tammy Baldwin (D-Wisconsin), who co-chairs the Congressional LGBT Equality Caucus and sits on the House Energy and Commerce Committee, inserted language in the bill dealing with LGBT health care disparities earlier this year.

Among the things that Baldwin's language addresses are ensuring data collection on the health of LGBT populations, and strong non-discrimination provisions to guarantee access to health care for all communities.

Meeting in San Francisco

The White House Office on National AIDS Policy is holding a community meeting on developing a National HIV/AIDS strategy in San Francisco on Friday, October 16, from 6 to 8 p.m.

The meeting will be at the Mission Bay Conference Center at UCSF, Robertson Auditorium, 1675 Owens Street. Those interested in attending can sign up at http://www.cmpinc.net/ONAP.

For more on the meeting, see this week's Guest Opinion on page 4 and visit http://www.whitehouse.gov/administration/eop/onap/action/
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