June 17, 2005

This Week in Washington
1. President Launches Outreach Initiative for New Prescription Drug Benefit
2. Energy and Commerce Committee Discusses Governors’ Medicaid Proposal

CARE Act in Brief
1. Interview with Texas ADAP Recipient and Advocate

Announcements
1. First National Conference on Methamphetamine, HIV and Hepatitis
2. 2005 HIV Prevention Leadership Summit to be Held This July in San Francisco

This Week in Washington
1. President Launches Outreach Initiative for New Prescription Drug Benefit
On Thursday June 16, 2005, President Bush officially launched the new Medicare Prescription Drug Benefit outreach initiative during an invitation-only ceremony at the Department of Health and Human Services (HHS). Marsha A. Martin, AIDS Action’s executive director, was in attendance along with leaders from more than 100 national health organizations and programs that serve the elderly and persons with disabilities.

Background on the New Prescription Drug Benefit
As reported in the June 3, 2005 issue of The Weekly Update, Medicare will implement a new drug benefit program on January 1, 2006 to respond to America’s growing need for drug coverage. This new benefit will pay for prescription drugs for 43 million seniors and individuals with disabling conditions—including HIV. Given the large number of people who will have to enroll in the program, the federal government decided to launch an outreach initiative to ensure that everyone who is eligible for the drug benefit gets enrolled.

Launching the Outreach Initiative
The President was joined for the launch by HHS Secretary Michael Leavitt and CMS Commissioner Mark McClellan, MD, Senator Craig Thomas (R-WY), former Senator John Breaux (D-LA), and former HHS Secretary Louis Sullivan. In addition, several cabinet members who have been involved in the planning of the government-wide initiative were also present They included Labor Secretary Elaine Chao, Housing and Urban Development Secretary Alphonso Jackson, Transportation Secretary Norman Mineta, Veterans Affairs Secretary Jim Nicholson and Social Security Administration Commissioner Jo Anne Barnhart.

HHS Secretary Michael Leavitt opened the ceremony by welcoming the attendees. He then introduced the President.

President Bush began his remarks by reviewing the Medicare Modernization Act and the prescription drug benefit created within the legislation to replace the drug discount cards that are currently used in the Medicare program. The President stated, “The new benefit will help every senior, as well as Americans with developmental and physical disabilities and mental illness and HIV/AIDS…. Continuing, he assured that “we are on track to deliver [this new] prescription drug coverage on time…”

President Bush then provided a detailed outline of the year-long initiative in which he stressed the importance of bringing the federal government together with community members and local organizations to collaborate on this comprehensive and far-reaching educational initiative.

In his address, President Bush also took pleasure in reminding attendees that forty years ago this summer, President Lyndon Baines Johnson, a Texan, had signed the Medicare bill, which created the program that entitles seniors and people with disabilities to health care. He said it is time for another President from Texas to bring Congress and the nation together to deliver a new Medicare program. Promising to bring preventive medicine, better health care, and prescription drugs to every American receiving Medicare, President Bush said “the new plan will provide greater peace of mind by helping all seniors and persons with disabilities pay for prescription drugs—no matter how they pay for medicine now.”

President Bush continued: “Because we acted, about a third of American seniors will be eligible for a Medicare drug benefit that includes little or no premiums, low deductibles, and no gaps in coverage. On average, Medicare will pick up the tab for more than 95 percent of prescription drug costs for low-income seniors.”

“To receive this important assistance, “low-income seniors and persons with disabilities will have to fill out a straightforward, four-page application form with, at most, 16 questions,” he explained. “No financial documents or complicated records are required, and the forms are easy to obtain. In fact, millions of applications have already been mailed….”

The President then stated, “If you or a family member receives one of these, I urge you to fill it out and send it in…when in doubt, fill it out…. You can get information 24 hours a day calling 1-800-MEDICARE. It's pretty easy to remember, 1-800-MEDICARE. Or you can use the Internet to visit the official Medicare Web site at medicare.gov. All you've got to do is type in ‘medicare.gov’ and you're going to find out what I'm talking about.

“Remember,” urged the President, “that information about prescription drug plans will be available starting October 1st, and November 15th is the first day to sign up for the new coverage. You need to circle those dates on your calendar, and tell the seniors in your life that modern medicine is on the way. This is a good deal and people need to take advantage of it.”

As has been reported in previous Weekly Updates, AIDS Action staff has been actively participating in meetings concerning the needs of people living with HIV and the new drug benefit. As we continue this work, we will provide reports on the outreach and enrollment process in future Weekly Updates.

2. Energy and Commerce Committee Discusses Governors’ Medicaid Proposal
On Wednesday, June 15, the House Energy and Commerce Committee held a hearing at which Governors Mark Warner (D-VA) and Mike Huckabee (R-AR) presented the National Governors Association (NGA)’s Medicaid Reform: A Preliminary Report. AIDS Action staff attended.

Main Concern for Health Advocates over NGA Plan
The bipartisan NGA proposal, which is outlined in the report, recommends ways for Congress to satisfy instructions in the fiscal year (FY) 2006 budget resolution, which was passed in April 2005. The instructions direct Congress to cut $10 billion from programs under the jurisdiction of the Energy and Commerce Committee in the House and the Finance Committee in the Senate. According to health advocates and Members of Congress who have been quoted in news publications, the cuts will likely come from Medicaid—a public insurance program for low-income individuals that is funded jointly by federal and state governments.

Cuts to the Medicaid program, which funds health care for over 50 million people with low income, would affect many people living with HIV. Currently, Medicaid pays to provide health care to 55 percent of adults living with AIDS and 90 percent of children with AIDS in the United States. Health advocates and Congressional staff warn that a $10 billion reduction in federal funding for the program could lead to tighter eligibility requirements and/or reductions in the services covered in many States.

Opening remarks from Committee Leadership
Chairman Joe Barton (R-TX) opened the hearing by praising the work of the NGA in arriving at a Medicaid reform proposal in a bipartisan fashion. Calling the Medicaid program a “budget buster,” he said that there are simply not enough taxes being paid into the program to support it. According to the Chairman, his goal is to “reform and save Medicaid.” Ranking Member John Dingell (D-MI) raised concerns about the effect of the proposal’s recommendations on Medicaid beneficiaries, claiming that the proposal will end up taking away services. He went on to say that he supports giving the states $10 billion more, rather than taking it away.

Content of NGA Proposal
Following Members’ opening statements, Governors Warner and Huckabee made their presentation on the proposal. Governor Huckabee described the process of creating the NGA report as “meticulous, tedious, and delicate.” However, as a result of this process, the report has the unanimous consent of the Governors from all 50 states. Continuing his remarks, he stated that the proposal’s recommendations fall into seven topic categories, which are:

1. Giving States more flexibility to manage Medicaid resources,
2. Re-forming asset shifting policy,
3. Modifying cost-sharing rules,
4. Flexibility in creating benefit packages,
5. Comprehensive waiver reform,
6. Judicial reform, and
7. Decreasing costs paid by U.S. commonwealths and territories.

Governor Warner added that the NGA opposes any legislative proposals that call for caps on Medicaid spending or block grants. Furthermore, he indicated his hopes for several changes to be made to Medicaid, including:

1. Bringing information technology advances into health care administration,
2. Making federal tax credits available for employers and employees so they can purchase private insurance packages, and
3. Changing the framework of the debate on long-term care.

Committee-Member Comments
Committee members from each party were present, and their remarks tended to support the positions of their respective party’s leadership on the committee. Republicans praised the NGA’s bipartisan work, which made the proposal possible, and did not criticize the proposal’s content. They were unanimous in their support of “saving” the Medicaid program, noting that it would require changes to lower costs but should also protect the beneficiaries, who need Medicaid to access health care. Representative Charles Norwood (R-GA) asserted that states need to focus on “getting people off Medicaid who shouldn’t be there,” such as “illegal aliens.” Representative Heather Wilson (R-NM) expressed her belief that, in addition to serving as a payer of medical claims, Medicaid should also help to ensure positive health outcomes.

Democrats were unified in their dismissal of the Governors’ proposal; judging the document to be driven by budget concerns rather than interest in limiting harm to beneficiaries. Of particular concern to many Democrats was the NGA suggestion that cost sharing (or co-pays) for Medicaid services be increased. Responding to this suggestion, Representative Lois Capps (D-CA) said that raising the cost sharing is an inappropriate measure to take, because Medicaid beneficiaries already pay a higher portion of their income for health care than do people with private insurance. Representative Janice Schakowsky (D-IL) added that the proposal would “take money out of the pockets” of the poor. In addition, Representative Sherrod Brown (D-OH) noted that cost sharing reduces services provided.

The Governors responded to the cost-sharing concerns by saying that payments made by Medicaid beneficiaries for services have not been increased since 1982; therefore, it is appropriate to increase them by a small amount. They did note, however, that this portion of the proposal was not expected to provide a huge amount of savings, compared to the other suggested changes.

Representative Engel (D-NY), who offered one of the final remarks on the issue of cost-sharing, made a specific reference to Medicaid beneficiaries who are HIV positive. He expressed concern that increased co-pays for prescription drugs would be unaffordable for people living with AIDS. For example, he stated, if co-pays for medicines are set at $3 per prescription, costs could add up quickly for individuals with an AIDS diagnosis, since they are typically on many different medications.

Switching issue areas, Representative Engel expressed further concern about the NGA’s proposed judicial changes. He cited a case in Missouri where beneficiaries took the state to court because of Medicaid’s refusal to pay for AIDS medications. Under the NGA proposal, he was worried such action would be prohibited.

Governor Warner responded to Representative Engel’s concerns by saying that Governors in each state must exercise some responsibility in the implementation of Medicaid reforms so that beneficiaries are not harmed in the ways that the Congressman fears. The Governor called for “balance” in the reforms and said he trusts that “for the most part [Governors] will do the right thing.”

During the hearing, Chairman Barton promised more hearings on Medicaid reforms would be held throughout the summer. He also said that the committee would be taking legislative action on Medicaid reforms in September.

CARE Act in Brief:
a frequently occurring series on the Ryan White CARE Act
1. Interview with Texas ADAP Recipient and Advocate
When Steve DeCorte speaks, he knows that more than 8,000 people living with AIDS in Texas are counting on him. As the project coordinator for the Advocacy Project of Texas, Mr. DeCorte serves as link between the state and federal legislators who are responsible for setting funding levels for Texas’ AIDS Drug Assistance Program (ADAP), the pharmaceutical companies that manufacture the life saving medications, and the thousands of Texans who depend on these drugs to stay alive.

Many pharmaceutical companies have programs that provide anti-retroviral medicines to states at little or no charge to help ADAPs maximize access to much-needed treatments. Texas, Mr. DeCorte notes, is one of 39 ADAPs nationwide with no waiting list for clients, and that translates into thousands of people with newfound hope.

“There are 40 medications that are covered by the program, and each one plays a critical role in not only keeping people alive but also improving their quality of life,” he says. “Many of the people in our program are able to hold jobs and stay healthy, which is remarkable given how different it was just a few years ago.” Eligibility for ADAP varies by state, and in Texas, the income limit is 200 percent of the federal poverty level, or $19,140 a year in 2005.

Mr. DeCorte, 43, says that his work brings him a profound sense of fulfillment. “Not too long ago, I helped someone find a new support group, as all the members of his former group had died. Now he knows he’s not alone.”

Announcements
1. First National Conference on Methamphetamine, HIV and Hepatitis
This biannual conference, hosted by the Harm Reduction Project, will be held in Salt Lake City from August 19 – 20. The conference has been designed to provide an arena in which scientists, service providers and professionals will gather to discuss the intersection between methamphetamine use, HIV, and Hepatitis, as well as other relevant issues. According to the Harm Reduction Project, it will be a time for all those involved in trying to enhance their community and agency response to methamphetamine use to come together for the following purposes: to share experiences and challenges, to learn from new data and new approaches, to acquire new skills, and to take a critical look at what has been achieved so far.

The conference program is currently being developed and will include plenaries, break out sessions, and opportunities for discussion. Information regarding registration, accommodations, the agenda, etc. is available online at http://www.harmredux.org/

If you have any urgent questions, you may call Amanda Whipple at 801.355.0234 ext. 3.

2. 2005 HPLS to be Held This July in San Francisco
This year’s HIV Prevention Leadership Conference (HPLS) will convene in San Francisco, CA from July 31 to August 3. The conference’s aim is to strengthen existing linkages among HIV prevention partners and to help such partners provide more effective HIV prevention programs. HPLS will provide skills development and training to program staff and partners for the implementation of their Centers for Disease Control and Prevention (CDC)-funded programs. Workshops, roundtables and other sessions will concentrate on capacity-building of prevention providers and developing the skills of leaders and program managers of HIV prevention program staff, CDC-funded capacity-building assistance providers, community-based organizations providing HIV prevention services, community co-chairs and other community planning leaders, health departments, and federal and national partner agencies involved in HIV prevention and care.

For more information contact National Minority AIDS Council (NMAC) by e-mail, at info@nmac.org, by telephone at 202- 483-6622; or by post at National Minority AIDS Council, 1931 13th St., NW, Washington, DC 20009-4432. Registration deadline is July 1, 2005. To register, link to http://www.nmac.org/conferences/HPLS2005/registration.htm

The AIDS Action Weekly Update
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