Wednesday, March 12, 2008

Where is the Federal Commitment to ADAPs?

The AIDS Drug Assistance Programs (ADAPs) are authorized under Title II of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. Ryan White provides medical care assistance to those with low-incomes and little or no insurance. Approximately $1 billion dollars annually goes toward comprehensive care programs, which include health care, support services and drug assistance programs. Most of the funding is made available for ADAPs to provide anti-retroviral therapy, as well as to purchase health insurance for eligible clients.

For the last several years, ADAPs increasingly faced funding shortfalls that have placed more and more HIVers on waiting lists. As of last year, waiting lists routinely jeopardized the health, well-being and lives of hundreds of Americans living with HIV/AIDS. In fact, clients even died in South Carolina, West Virginia and elsewhere.

President Bush and Congress have attempted to address the problem with small increases, including a $38 million increase in 2005, $35 million in 2006, and $10 million in 2007. In addition, in June 2004 the President also released an emergency $20 million dollars to help provide services to those on the waiting lists. But never have these increases kept pace with the actual need.

There is also a financial rational for fully funding ADAPs. In advocating for additional funding, supporters of ADAPs point to the cost-effective nature of the program. The annual per-patient cost under ADAP last year was only $12,500, as compared to over $40,000 for treating a person with AIDS by Medicaid.

The likelihood of the cash-strapped ADAPs receiving additional federal funding is questionable with Congress embroiled in partisan differences over next year’s budget priorities. At present, proposed increases for the program are relatively small and far from the $135+ million needed to adequately address the waiting lists.

This raises the question about the federal commitment to fully funding ADAPs? What should AIDS advocates do about this problem?


Bucko said...

The gap in ADAP funding is incomprehensible to me. Partisan politics and providing health care to some of society's most vulnerable members is a literally lethal combination and makes a mockery of the process.

One point that is inferred but not stated explicitly in this article is that ADAP/Ryan White funds are for the working poor: people who are struggling to keep themselves fed and sheltered within the parsimonious income eligibility restrictions imposed by the various local agencies administering these funds. When I lost my insurance, my income potential was less than half of what it had been the year previously, with the catastrophic consequences such a loss would impose on anyone.

Once diagnosed HIV+, purchasing private, individual health insurance simply isn't an option any more. It is unavailable at any price. Those who work for smaller, entrepreneurial businesses (the backbone of American commerce) which do not offer small-group insurance have their earnings kept at artificially low rates just to remain eligible for the health care and medicines required for them to survive.

And many small-group insurance programs, even when offered, impose restrictions on pre-existing conditions and coverage caps that make them of dubious value to someone living with HIV. One can find oneself paying hundreds of dollars per month for "coverage" that doesn't cover his/her most basic needs.

In most cases, there are distinct economic advantages to stopping work all together, getting a good lawyer and going on SSDI/Medicare. After figuring in such benefits as Section 8 and food assistance (as well as the superior health care provided to Medicare recipients), the quality of their lives can actually improve by stopping work. Why wouldn't they? At what point does one’s pride in remaining a productive member of society give way to the pragmatic need to work the system to his/her advantage?

The current American medical crisis is an insurance crisis, and one that will only be properly addressed by the next presidential administration. The priorities of the current administration, which has overseen nearly-unprecedented growth in the size and scope of the Federal Government while flat-lining funds to those living with HIV/AIDS obviously rest elsewhere.

Anonymous said...

The ssdi/Medicare program is no cure-all either. The program requires you to enroll in a PART-D
PRESCRIPTION drug plan which is a stand-alone program from Medicare but only offered in conjuction w/Medicare cdoverage. This program is ran by the Big Insurance/Pharmaceutical Cos. and each year they require you to fall into a Donut coverage, which requires you to pay 100% retail cost of your Drugs, up to $4,500 out of pocket before they kick in a pay 90%, you pay 10%. This is outrageous if you're on HIV drugs, as I am. My MD put me on Atripla, which costs $1,489.00/30-day supply, in addition to 3 other non-HIV drugs I have to buy, which is around $170 ea. When you go to agencies for help, they can't believe this, and they give you the agency line, "sorry, but you're receiving too much income from SSD, Bottom line and they send you away. What a patient to do? wait and go to the emergency room with an ARD?, WHICH WOULD COST MORE THAN THE dO-NUT HOLE COVERAGE? ANY SUGGESTIONS OR COMMENTS?