Institute of Medicine Urges Restructuring of U.S. Low-Income HIV Treatment and Care

A Congressionally mandated study sponsored by the U.S. Department of Health and Human Services has urged that the U.S. replace the current patchwork of Medicaid and other funding mechanisms with an HIV Comprehensive Care Program having "a strong focus on comprehensive and continuous primary care, substance abuse, and mental health services to support adherence to HAART." The proposed program, a Federally funded entitlement administered by the states and meeting nationwide standards of treatment and of provider reimbursement at the Medicare (not Medicaid) rate, would be open to families up to 250% of Federal poverty level, but those with higher incomes and without access to private insurance could join on a sliding scale. The committee of 16 experts who produced the report estimated that this system would increase Federal spending $5.6 billion over 10 years, and prevent 20,000 deaths during that time. Thousands now go without treatment due to lack of funding, uncoordinated eligibility requirements, and other problems.

The program would cost $4.2 billion less over the 10 years, however, if the government paid the same discounted prices for antiretrovirals as it currently pays for the Veterans Administration and some other Federal agencies.

"Failing to provide these cost-effective, life-saving drugs to all Americans who need them -- including individuals who lack insurance or cannot afford them -- is indefensible," said the committee chair, Lauren LeRoy, president and CEO of Grantmakers in Health, Washington, D.C.

The Institute of Medicine announced  the report on May 13, although only pre-publication copies were then available.

Note: "entitlement" programs are those that provide coverage to all who qualify, instead of depending on annual appropriations. Medicare and Medicaid are entitlements; ADAP is not. This is why noone has to stop seeing their Medicare doctor or leave a nursing home when an annual fund runs out, while ADAP patients are put on waiting lists and denied treatment due to lack of funding.

How to Get the Report

Pre-publication copies of Public Financing and Delivery of HIV/AIDS Care: Securing the Legacy of Ryan White can be purchased -- or read free online, through awkward software -- at http://www.nap.edu/catalog/10995.html. Pages 3-17 contain the text of the executive summary.