February 3, 2006

This Week in Washington
1. President Commits to New Domestic HIV Funding in State of the Union Address
2. House Passes Budget Reconciliation Bill, Includes Cuts to Medicaid

Announcements
1. Medicare Part D Beneficiaries Encouraged to Share Experience Using the New Benefit
2. National Black HIV/AIDS Awareness Day in February
3. NIMH/IAPAC International Conference on HIV Treatment Adherence
4. Funding Available for Implementation of HIV Prevention Services for Native Americans and African American or Latina Women

This Week in Washington
1. President Commits to New Domestic HIV Funding in State of the Union Address
In his 5th annual State of the Union Address, which took place on Tuesday, January 31, before a joint session of Congress comprising both the Senate and the House of Representatives, President George Bush put forward a legislative agenda which encompassed the HIV epidemic abroad as well as the epidemic here in the United States.

In a passage highlighting the domestic HIV epidemic, President Bush called for new funding to go to the states to end waiting lists for medications in the United States. For a second time in a State of the Union address, the President also called for the reauthorization of the Ryan White CARE Act, which expired on September 30, 2005. (He had first had called for its reauthorization in last year’s State of the Union address.) In addition, he announced that his Administration will lead a nationwide effort to work closely with African American churches and faith-based groups to deliver rapid HIV tests to millions.

The full text of the passage reads as follows:

A hopeful society acts boldly to fight diseases like HIV/AIDS, which can be prevented, and treated, and defeated. More than a million Americans live with HIV, and half of all AIDS cases occur among African-Americans. I ask Congress to reform and reauthorize the Ryan White Act ... and provide new funding to states, so we end the waiting lists for AIDS medicine in America. We will also lead a nationwide effort, working closely with African-American churches and faith-based groups, to deliver rapid HIV tests to millions, end the stigma of AIDS, and come closer to the day when there are no new infections in America.

AIDS Action Board member, Pernessa Seele, founder and CEO of The Balm In Gilead was a guest of First Lady Laura Bush at the address. The mission of The Balm In Gilead, a not-for-profit organization, is “to improve the health status of people of the African Diaspora by building the capacity of faith communities to address life-threatening diseases, especially HIV/AIDS.” According to a press statement released by The Balm In Gilead, Ms. Seele was invited to sit in the First Lady’s Box as a symbol of the President’s commitment to working with African American churches.

“HIV/AIDS is a public health crisis in the African American community,” said Ms. Seele. “Today, I am happy that the President of the United States is paying attention to the crisis and acknowledging the vital role faith communities can play in eliminating this public health crisis.”

AIDS Action issued a press release which highlighted the President’s call for new funding and an end to the waiting lists for HIV medicines in the United States. AIDS Action noted that the organization had sent recommendations to end waiting lists and strengthen the CARE Act’s AIDS Drug Assistance Program (ADAP) to the President last year and had expressed a readiness to work with the Administration and Congress to “make certain that no one in need of HIV medications will go without them.”

Regarding the global HIV epidemic, President Bush stated that the United States had taken “unprecedented action to fight AIDS and malaria,” and called upon Congress not to “shortchange” these efforts. The full text of the State of the Union address can be found at http://www.whitehouse.gov/stateoftheunion/2006/index.html.

In a related development on February 1, the White House released an additional “fact sheet” titled Continuing the Fight Against AIDS in America. According to this White House release, “the President has made fighting the domestic spread of HIV/AIDS a top priority.” In addition, it provided some details about HIV spending priorities in light of the State of the Union address. The release of the fact sheet comes just days before the President releases his budget recommendations on Monday, February 6.

The fact sheet specifically calls for $185 million in “new spending.” The $185 million breaks down into three components:

• $70 million available to “states in need to bridge the existing gaps in coverage for Americans waiting for life-saving medications.”
• $90 million to the purchase and distribution of rapid HIV test kits
• $25 million in grants to outreach by local community and faith-based organizations in hardest hit areas. The fact sheet says that the grants are intended to “raise awareness, increase early detection, combat stigma, and facilitate access to treatment” particularly for African American, Latino, Native American, and other minority populations.

The fact sheet also highlights the New Partners Initiative which was launched by the President on World AIDS Day, December 1, 2005. According to the fact sheet, the initiative is intended to help faith-based and community organizations with little or no experience in working with the United States government to apply for grants to “ensure that PEPFAR [President’s Emergency Plan for AIDS Relief] resources reach more people more effectively.”

The fact sheet can be found at:
http://www.whitehouse.gov/news/releases/2006/02/20060201-10.html

2. House Passes Budget Reconciliation Bill, Includes Cuts to Medicaid
On the evening of Wednesday, February 1, the U.S. House of Representatives passed the hotly debated budget reconciliation bill. The “Deficit Reduction Act of 2005,” (S. 1932), as the bill is officially titled, passed by a narrow margin of two votes (216-214). Thirteen Republicans and all Democrats voted against the bill’s passage. The bill is now on its way to the President for his signature, which will make it law.

S. 1932 calls for two sets of cuts: one equaling $39 billion over five years and the other equaling $99 billion over ten years. Both sets of cuts include significant reductions to the Medicaid program, in addition to many other programs that benefit poor and middle-income Americans, such as programs that provide food stamps, student loans, and child support enforcement. According to a report in the February 1 issue of CQ Healthbeat, these program cuts will result in a federal-spending savings of only .3% over five years and “will put only a small dent in the federal budget deficit.” Although the cuts’ impact on the overall federal budget may seem small, opponents of the bill predict the effects on low-income Americans will be significant.

The bill makes allowances for states to alter their Medicaid programs in new ways, including increasing beneficiary premiums and co-pays as well as reducing certain benefits. Many health advocates and policy experts believe that the majority of states will exercise this option to a more or lesser extent. Further, because over half of the HIV care in the United States is financed by the Medicaid program, they are certain that these changes in the law will have a negative effect on people living with HIV who depend on this public insurance program for their health care.

The Congressional Budget Office (CBO) recently released it’s analysis of the anticipated effects of the provisions in the reconciliation bill.* The following points are among the CBO’s findings:

• Cost-sharing and premium requirements will likely reduce Medicaid spending by $9.9 billion over five years.
• States will likely impose higher cost-sharing requirements for physician services, non-emergency visits to emergency rooms, and prescription drugs.
• An estimated 13 million people (20 percent of Medicaid enrollees) will ultimately be affected by cost-sharing increases.
• An estimated 80 percent of the savings achieved from higher cost sharing will be due to decreased use of services.
• Approximately three-quarters of states imposing cost sharing will likely allow providers to deny services to beneficiaries for lack of payment; therefore, there will be greater decreases in utilization in these states.
• Due to new premiums being implemented, it is expected that some beneficiaries will not apply for Medicaid, will leave the program, or will become ineligible for services due to nonpayment. An estimated 45,000 enrollees will lose coverage in fiscal year 2010, and 65,000 will lose coverage in fiscal year 2015 because of the new premiums—approximately 60 percent will be children.

* The CBO describes itself as “a…nonpartisan agency that produces policy analyses, cost estimates of legislation, and budget and economic projections that serve as a basis for the Congress's decisions about spending and taxes.” More information is available at http://www.cbo.gov.

Announcements
1. Medicare Part D Beneficiaries Encouraged to Share Experience Using the New Benefit
Since the Medicare Part D prescription drug benefit took effect on January 1, there have been an overwhelming number of reported problems with the benefit. A high concentration of these reports come from “dual eligible beneficiaries”—individuals who receive benefits from both Medicare and Medicaid. Most of the people living with HIV who are receiving drugs through Part D—approximately 70,000 people—are dual eligibles.

HIV advocates encourage clients who have had trouble filling one or more prescriptions under the new Medicare Part D drug program to inform the Centers for Medicare and Medicaid Services (CMS) of the problems so that the agency can work to fix it.
Reports can be sent electronically to lorraine.zicha@cms.hhs.gov, Ekegler@cms.hhs.gov and hivma@idsociety.org.

Parties who wish to submit reports do not have to include personal identifying information. Information to consider sharing with the CMS includes:

• A description of what happened
• The names of the medication(s) being used, especially if it is an HIV drug
• Pharmacy name and general location (city and state, at a minimum)
• Name of the prescription drug plan being used
• Possible causes of the problem experienced

For parties who do not wish to reveal their e-mail addresses, there is another way to get a report to CMS. E-mails may be sent anonymously to the HIV Medicine Association (HIVMA) at hivma@idsociety.org. HIVMA will collect reports, remove all personal identifying information and then forward the remaining information on to CMS.

2. National Black HIV/AIDS Awareness Day in February
Beginning in 2000, National Black HIV/AIDS Awareness Day has been observed on February 7—as it will be again this year. As a community mobilization effort, the primary goal of this day of observation is three-fold: to motivate Black Americans at risk for HIV to gain a better understanding of HIV and its transmission; to get tested; and to inspire HIV advocates, educators and other stakeholders to step up efforts to increase HIV awareness, participation, and support for HIV prevention, care, and treatment among African Americans.

Further information on National Black HIV/AIDS Awareness Day and ways to get involved can be found at
http://www.blackaidsday.org/index.html

3. NIMH/IAPAC International Conference on HIV Treatment Adherence
The National Institute of Mental Health (NIMH) and the International Association of Physicians in AIDS Care (IAPAC) will convene the NIMH/IAPAC International Conference at the Hyatt Regency in Jersey City, NJ, March 8 – 10. According to the conference Web site, human service, health care, and behavioral science professionals and practitioners will come together to examine strategies that are scientifically sound and practical for the purpose of enhancing adherence to HIV treatment in a variety of settings. Participants will have the opportunity to share ideas about improving adherence to anti-retroviral regimens in the conference’s effort to strengthen collaborations among government agencies, program practitioners, and researchers.

Further information on the conference, accommodations, and registration is available at
http://www.hivadherenceconference.com.

4. Funding Available for Implementation of HIV Prevention Services for Native Americans and African American or Latina Women
The United States Conference on Mayors (USCM) has issued a Request for Proposals (RFP) as part of its HIV/AIDS Prevention Grants Program. USCM plans to award grants totaling approximately $740,000 to local health departments, non-profit community-based organizations, and Native American tribes/nations to support the implementation of HIV prevention projects for the following populations, who are at high risk for HIV: Native Americans (three grants, each for $60,000), African American women and Latinas. Three grants, each for $60,000, will be awarded to projects targeting Native Americans, and eight grants, each for $70,000, for projects target either African American women or Latinas.

The RFP is available for downloading at http://www.usmayors.org/hivprevention/rfp2006.pdf. (Hardcopy requests can be directed to Lillie Brown at (202) 861-6752 or e-mail: lbrown@usmayors.org. Interested parties must submit an original proposal and three copies to the U.S. Conference of Mayors by Monday, February 27, 2006, 5:00 p.m., EST.

The AIDS Action Weekly Update
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