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Written by admin
Apr 21, 2011
The health care reform law just celebrated its first birthday. The HIV/AIDS community, for the most part, has been supportive of the president’s health care efforts. We’ve paid the price that comes with a government that does not embrace our sick. More than most, we felt a moral urgency to pass this legislation.
That doesn’t mean, however, we blindly fight all efforts to change the law. As changes to the health care law are debated, we must take part.
HIV/AIDS patients have much at stake when it comes to changes to Medicare. Roughly 100,000 depend on the program for health coverage. Medicare soon will be the single largest source of federal financing for HIV/AIDS treatment.
Americans have taken tremendous strides in the fight against HIV/AIDs. But this battle is far from over. There still isn’t a cure. And too many patients lack access to treatment. Tens of thousands languish on medication wait lists. ADAP has been abolished in some states.
Over the past 30 years, our greatest strength has been accountability. We always had a way of fighting cuts or laws that discriminated against people with HIV/AIDS. If a door was blocked, we created a new entrance and walked through it, proudly.
There are portions of the president’s legislation that actually threaten HIV/AIDS patients’ well-being. At the top of that list is the establishment of the new Independent Payment Advisory Board, or IPAB.
Comprised of 15 presidential appointees, IPAB’s purpose is to de-politicize Medicare cost-cutting. Starting in 2014, if Medicare is expected to exceed that year’s preset spending target, the board will have the authority to recommend cuts to the program.
These recommendations will automatically become law unless Congress stops them by making equivalent cuts – and then passes them with a three-fifths super-majority. If not, there is no appeal process nor administrative review. IPAB represents a step back in the fight against HIV/AIDS.
While there are limits on what IPAB can do, it will have the power to adjust reimbursement rates for Medicare providers. In practice, that means cutting payments to doctors.
Such cuts will drive even more doctors from Medicare. Physicians faced with the prospect of losing money on every additional enrollee are already declining to take on new Medicare patients. Others have opted out Medicare entirely.
HIV/AIDs patients depend on specialized physicians. Each patient has a unique combination of anti-retrovirals they rely on to stay alive. If HIV/AIDS patients on Medicare lose access to the few doctors available to them with this expertise, we’re literally endangering their lives.
IPAB is also empowered to restrict Medicare coverage of certain drugs and treatments. If IPAB decides that the biggest public insurance program, Medicare, will not pay for new, advanced treatments, firms won’t have the capital they need to develop new research lines. New, life-saving HIV/AIDS treatments could be passed over.
HIV/AIDS patients and advocates have earned a place at the table. It’s our right to pull back that chair and do what’s necessary to protect three decades of advances.
David Mixner, Washington, D.C.
