Washington Blade - November 25, 2005
Lou Chibbaro, Jr.

Noting that Medicaid is the single largest provider of medical coverage for people with AIDS, the groups urged the Senate to reject the House proposal and insist on adoption of a more modest budget-cutting proposal for Medicaid approved by the Senate last month.

"Medicaid is the cornerstone of the nation's response to the HIV/AIDS epidemic in the United States, serving an estimated 230,000 people with HIV/AIDS who are poor or disabled," officials with the AIDS groups stated in an Oct. 26 letter lobbying House leaders opposing the cuts.

"For these individuals, Medicaid is literally a lifesaver - providing comprehensive, reliable, and affordable access to a range of health and long-term services," officials with the groups said.

Among the groups signing on to the letter were the AIDS Institute, AIDS Action, the AIDS Alliance, the National Association of People with AIDS, the National Alliance of State & Territorial AIDS Directors and the Gay Men's Health Crisis of New York.

The House approved the Medicaid cuts by a vote of 217-215 as part of a larger budget reconciliation bill aimed at reducing the nation's deficit.

The vote fell almost entirely along partisan lines, with all 200 Democrats present voting against it and 217 Republicans voting for the measure. Fourteen Republicans broke ranks with their party leadership to vote against the bill. Two Democrats were absent during the vote.

Gay Reps. Barney Frank (D-Mass.) and Tammy Baldwin (D-Wisc.) voted against the bill while gay Rep. Jim Kolbe (R-Ariz.) voted for it.

In the D.C. area, Reps. Tom Davis (R-Va.), Frank Wolfe (R-Va.), and Wayne Gilchrest (R-Md.) voted for it while Reps. James Moran (D-Va.), Steny Hoyer (D-Md.), Chris Van Hollen (D-Md.), and Albert Wynn (D-Md.) voted against the bill.

Preserving Medicaid

Rep. Joe Barton (R-Texas), chair of the House Committee on Energy & Commerce and one of the lead backers of the Medicaid cuts, said the cuts were part of a reform package that is needed to preserve Medicaid and was supported by a number of the nation's Democratic governors.

He pointed to statistics showing that Medicaid costs, which now exceed $300 billion a year, are rising rapidly and creating a potentially catastrophic impact on the states, which must pay about 40 percent of Medicaid costs.

"If you want Medicaid patients to lose health care, the thing to do is nothing," Barton said. "An argument to keep what we have is an argument for bankruptcy."

Carl Schmid, director of federal affairs for the AIDS Institute, said AIDS and gay rights organizations favor Medicaid reform but don't believe it should take the form of cuts in Medicaid benefits for the poor. According to Schmid, other reform proposals call for cutting expenses by raising fees for drug companies and HMOs, which provide services under Medicaid. He said other measures against waste and fraud could also be employed to reduce Medicaid expenses.

"They are trying to cut expenses through the budget process by taking away benefits from those who need it," Schmid said.

AIDS service providers have said the existing law costs the government more in the long run because it hinders the ability of people with HIV to obtain the medical care that could prevent or postpone the onset of AIDS. Treating full-blown AIDS is said to be far more costly than treating HIV.

David Boez, executive vice president of the Cato Institute, a libertarian think tank, said budget cuts in programs such as Medicaid are needed to reduce an out-of-control federal budget deficit that, in the long run, will hurt people with AIDS along with all other Americans.

"Simply piling up more debt will lead to a worse situation," said Boez, who is gay.

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