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In the news ... 2006 archivePI ACTION UPDATEJune 2006In this issue Medicare Part D Problems Continue Medicare Part D Problems Continue Although some of the most difficult problems associated with implementation of Part D have lessened, there are still ongoing problems. Most of the 36 states have stopped providing emergency coverage to their dual eligibles (those qualifying for both Medicaid and Medicare) who were unable to access their medications. California, home to one-sixth of the dual eligibles in the country, has continued a restricted coverage program in recognition of the ongoing problems. Plan year 2007 is likely to bring more confusion similar to that experienced earlier this year. The Centers for Medicaid and Medicare Services, the federal agency that oversees Medicare, has announced that they are encouraging, and expect, fewer plan offerings. This is being done to reduce the confusion from choosing among numerous plans. However, it is also likely to mean that fewer plans will be fully subsidized by the Medicare Low Income Subsidy. For example, in areas with 10 fully subsidized plans from which to choose, there could be as few as two. There is no articulated plan regarding how dual eligibles will move from eliminated into the remaining plans. If you have questions regarding Medicare Part D or have information that you would like to see posted on Project Inform's website, contact adonnelly@projectinform.org. Ryan White Reauthorization Bill Introduced The House Energy and Commerce Committee will vote next on the bill. In the meantime, the original authors and other key legislators continue to discuss outstanding concerns and changes will be made as it moves through the process. The current version contains many proposed changes to the CARE Act, including an expansion in Title I jurisdictions (hardest hit urban areas), phasing out of "hold harmless" for cities and states, a slight shift in Title II funding to rural states, an increase in the AIDS Drug Assistance Program (ADAP) Supplemental fund, and a requirement that 75% of most CARE Act funding be spent on "core medical services". Project Inform continues to work with our advocacy partners, particularly the CAEAR Coalition, to address concerns with the bill and suggest improvements. We are particularly concerned about the low recommended funding levels for all Titles, which will make it much more difficult to get needed increases during each appropriations process. We are also concerned about the proposal to base Title I eligibility only on AIDS cases that are reported in the previous 5 years. This would greatly penalize cities that have older epidemics and have done a good job keeping people from progressing to an AIDS diagnosis. For example, San Jose, CA has around 1,500 actual living AIDS cases, but only 400 were reported in the past 5 years. This would make San Jose ineligible for Title I funding after a three-year "grace period". Many other cities face the same fate. Since people who have been living with HIV/AIDS for several years are likely in great need of care services, it is bad public health not to consider them when determining if a city should get Title I funding. Finally, Project Inform continues its advocacy to get get badly needed funding increases to states that don't have Title I areas, or where the majority of their cases are outside a Title I area, without large shifts of funding from urban areas. We strongly support a proposal embraced by a broad range of advocates that would get supplemental Title II (care and treatment) money to these states. For more information, the Federal AIDS Policy Partnership's Ryan White Reauthorization Working Group has created this informative fact sheet. Fiscal Year 2007 Appropriations Update The committees approved a $70 million increase requested by President Bush for Title II of the Ryan White CARE Act, but did not include his request for a $25 million increase in Title III for faith-based and community-based outreach. The rest of the CARE Act was flat-funded. The $70 million increase will allow states to spend more money on care and support services, and they will also be allowed to use some or all of the funds for their ADAP. However, the lack of increases for the other Titles and for the ADAP line-item, will result in continued long waits for health care and treatment around the country. It is unlikely that we will be able to improve these funding levels in the House. So now is the time to talk with your two Senators and urge them to support increases for all of the CARE Act. The Senate will begin debating AIDS funding soon. Look for PI Action Alerts in the coming weeks with more information. Dangerous Health Care Insurance Bill Defeated The bill was purported to make health care insurance affordable for small businesses. However, as written, it was much broader and would have taken away states' abilities to regulate the insurance industry. State consumer protections that keep insurance more affordable, particularly for sicker, older and more vulnerable people, would have been stripped away. Project Inform and some of our partners in the HIV Medicaid and Medicare Work Group sent a letter of opposition to the bill. Although we won this battle, many expect similar legislation to reappear, perhaps as soon as next year. See the "Private Insurance" section at Families USA's website for further information. Advocates Express Anger After UN Global AIDS Meeting They report that the document, while making progress in some places, fails in the areas of treatment and prevention. The final draft included no concrete targets for providing treatment to those desperately in need, nor for prevention to at-risk populations. A broad global coalition of advocates representing the summit's civil-society (Non Governmental Organizations) released this statement denouncing the outcome of the session as a failure. California State HIV/AIDS Budget Update The care item is the expansion of the CARE - Health Insurance Premium Program (CARE-HIPP) to subsidize beneficiary premiums for Medicare Part D plans and to update the program by dropping the disability requirement and extending COBRA payment coverage to the full extent of the California law. This would allow CARE-HIPP to better serve Californians and would also create some savings in the state's ADAP. The prevention items include the extension of a $5.6 million increase for HIV prevention approved in the last budget, and $7.5 million to fund treatment and prevention programs addressing methamphetamine use and HIV/AIDS among men who have sex with men. Members of a joint Senate and Assembly conference committee approved the staffing necessary to expand the CARE-HIPP and the extension of the $5.6 million for prevention. The conference committee also recently approved $10 million for methamphetamine prevention activities to address five high-risk populations, including men who have sex with men. The items await the Governor's approval. Goodbye to Michael Montgomery Michael made a significant contribution at the Federal level as well, educating elected officials about California's programs and fighting for adequate funding for services and lower prices for anti-HIV drugs. He also stayed in touch with the emerging trends of the epidemic. For example, he was instrumental in helping to plan an HIV resistance testing program that was in place by the time the assay became a formal part of the HIV standard of care in managing HIV disease. Michael is a wonderful example of a state government official who uses his vision, skills and leadership position to advocate appropriately on behalf of people with HIV/AIDS and to improve the quality of the California HIV care and prevention efforts. He will be missed and we wish him the best in his retirement. A Quote We Like — Senator Edward Kennedy (D-MA), |
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