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April 2005 NORA Coalition Hears Update on ADAP and CARE Act Reauthorization On Monday, April 11, the National Organizations Responding to AIDS (NORA) Coalition, for which AIDS Action serves as the convener, held its monthly membership meeting. The meeting included an update of the 2005 reauthorization of the Ryan White CARE Act, with a special emphasis on the AIDS Drug Assistance Program (ADAP). William McColl, AIDS Action’s political director, was the featured speaker. The Ryan White CARE Act is the largest source of federal funding devoted solely to providing care and treatment to people living with HIV in the United States. Congress first passed the legislation in 1990 and must reauthorize it every five years.* This year marks the CARE Act’s third reauthorization. According to Mr. McColl, Members of Congress are using the opportunity presented by this year’s reauthorization to evaluate certain aspects of the CARE Act and to make changes to the legislation which they believe will enhance its ability to meet the medical and support-service needs of people living with HIV. Mr. McColl explained to NORA members that there is “a real quickening of the pace [of Congressional work on reauthorization] right now.” He noted that the Senate has begun to identify areas of concern and possible avenues for improvement within the CARE Act. This work, which is being done in a bipartisan fashion, is led by Senators Mike Enzi (R-WY) and Edward Kennedy (D-MA), who are the Chairman and Ranking Member of the Health, Education, Labor, and Pensions (HELP) Committee, which has jurisdiction over the CARE Act in the Senate. According to Mr. McColl, the House right now plans to allow the Senate to work on the reauthorization first, and then follow later in the year with its own bill. In the House, work on the bill is being led by Republican Representatives Joe Barton (TX), Mary Bono (CA), and Joseph Pitts (PA) and Democrats Edolphus Towns (NY) and Lois Capps (CA). All are members of the Energy and Commerce Committee, which has jurisdiction over the CARE Act in the House. Mr. McColl then turned to a discussion of ADAP in the context of reauthorization. ADAP is a component of Title II of the CARE Act, which has four titles. ADAP is a program managed by the states, and its purpose is to provide anti-retrovirals and other HIV related medications to people who would otherwise be unable to afford them. Funding for ADAP now represents one-third of the total CARE Act budget. According to Mr. McColl, many state ADAPs face monetary shortfalls. Such shortfalls have necessitated cost containment measures by states, including waiting lists for entry into the program. In addition, because each state manages its own individual program, there is a great deal of variability among state ADAPs. Specifically, there are differences in states’ ADAP eligibility requirements and in the number of drugs covered. This variability means that ADAP clients are not assured of continued or consistent coverage when they move from one state to another. In an effort to overcome the challenges presented by funding shortages and by the degree of variability among the states, AIDS Action has released a proposal, Streamlining and Modernizing the AIDS Drug Assistance Program (ADAP) of the Ryan White Care Act. This publication outlines solutions to the problems discussed above and recommends that these solutions be implemented through the 2005 CARE Act reauthorization. Mr. McColl summarized the proposal, highlighting some of its recommendations and identifying their anticipated outcomes, if implemented. He noted that the AIDS Action proposal “sets a floor” by creating national minimum standards for eligibility and for coverage in all states. More specifically, the proposal recommends that all states set eligibility for ADAP at 350% of the federal poverty level and that state ADAPs cover all anti-retrovirals and other HIV related drugs. By establishing this national standard for eligibility and drugs covered by ADAP, the proposal allows for continued and consistent coverage for patients who move from one state to another. Mr. McColl added that an enhanced record keeping process would allow for greater efficiency in moving patient records from one state to another. The proposal also recommends that all states have access to the lowest possible federal price for purchasing drugs. This measure would create cost savings for the states and facilitate their purchase of the required medications. In addition, the proposal calls for an increase in funding for ADAP (roughly $700 million in the first year and then an additional $100 million a year for the next five fiscal years), Such an increase would address the systemic financial constraints that have led to waiting lists and other cost-containment measures within state ADAPs. According to Mr. McColl, the proposal further calls for ADAP to be placed within a separate title of the CARE Act—Title V. Placing ADAP in a title of its own will enable Congress to better oversee the program, to understand the beneficial effect of ADAP on health outcomes, and to focus more directly on ADAP and the distribution of medications. To learn more about AIDS Action’s position on CARE Act reauthorization and proposal for ADAP, visit http://www.aidsaction.org.
* Authorization is the action of Congress that creates, continues, or modifies a federal agency, program or policy, either for a specified period of time or indefinitely. If the authorization is for a limited period of time with a specified expiration date, the agency, program, or policy goes through the process of reauthorization, during which Congress reviews and amends the original legislation. For more information about NORA, e-mail Jessica Tytel at jtytel@aidsaction.org. |
