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Health Care Reform Debate: What’s in it for Person living with HIV/AIDS?
Health care reform has taken the wind out of virtually every other conversation in Washington. It seems that Congress is not focused on anything else. The pace of movement on reform of the U.S. health care system is taking on breathtaking speed in the nation’s capital. Already two Congressional committees with jurisdiction over this issue have issued draft bills, and another committee is scheduled to introduce a bill any day. Newspapers, political blogs and the airways are filled with articles and stories about various health care reform proposals and counter-proposals making their way through the capital’s political process. It seems that everyone has an opinion on the issue and is busy advocating their position in Washington.
While most health care advocates are pleased that the White House and Congress have finally decided to address this very challenging and politically charged issue, questions arise as to how particular groups will be impacted. For HIV advocates, as well as for advocates of other disability communities or groups representing persons with expensive health care needs, careful attention must be paid to the “devils in the details” and the potential unintended consequences of reform. As we level the playing field and ensure everyone has access to health care, caution must be taken to make sure that there aren’t “losers” in the process.
Process for Reform
On the Senate side, the Health, Education, Labor and Pensions (HELP) Committee chaired by Edward Kennedy (D-MA) and the Finance Committee chaired by Max Baucus (D-MT) have put forth separate reform proposals. In the House, the committees with jurisdiction over health reform have come together in an effort to present a unified approach. The Energy and Commerce Committee, chaired by Henry Waxman (D-CA), the Ways and Means Committee, chaired by Congressman Charlie Rangel (D-NY), and the Education and Labor Committee chaired by George Miller (D-CA) have issued what is know as the “tri-committee” proposal.
While other bills and proposals have been introduced to reform the nation’s health care system, legislation with the greatest likelihood of passage will arise from the leadership of those committees. A range of other options have been introduced in Congress (such as single payer), and they all have various constituencies, but their likelihood of passage remains low – some would say impossible.
Major Components of Reform
According to Senate Finance Chairman Baucus “All options are on the table.” Nonetheless, certain options have clearly risen to the top as the most likely to win approval. To date, the following provisions are being given the greatest consideration:
• Mandatory requirement for all citizens to enroll in an insurance plan. This would include the elimination of pre-existing conditions clauses in health plans and the elimination of insurance premiums depending on an individual’s health status. There would also be subsidies for low- and moderate-income individuals.
• Mandatory requirement for employers of a certain size to provide health insurance for their employees or face penalties.
• The creation of state, regional or federal intermediary entities to monitor and certify insurance programs – similar to Massachusetts’ Connector program.
• Greater federal oversight for insurance plans, including the establishment of a minimum benefits package.
• The creation of a government-run insurance plan that will compete with private industry plans.
• Modernization of the health care system through electronic medical records (EMR).
• Focus on prevention efforts to control costs.
• Development of quality control measurements to help compare health outcomes, effectiveness and costs.
• Expansion of Medicaid to cover all low-income individuals, regardless of health status (and cover persons living with HIV).
Two major points of disagreement in the discussion over health reform are cost (how do we pay for all this?), and whether to include a government-run plan that would compete for clients with private industry. Republicans and the insurance industry are fiercely opposed to a government-run health care plan, but many Democrats are just as adamant about creating such a plan. While there are some health advocates who feel strongly that the country should moving to a single-payer system, the consensus from policymakers in Washington is that this option is not realistic at this time.
What do Persons Living with HIV/AIDS Need in Health Care Reform?
While not advocating for a particular proposal, many in the HIV community have come up with a set of general principles for health care that persons living with HIV/AIDS need. They are:
• Increase access to health care by broadening Medicaid's eligibility requirements.
• Ensure access to quality health care by establishing a mandatory minimum Medicaid benefits package.
• Make health care more affordable by limiting Medicaid and Medicare cost-sharing.
• Increase the federal Medicaid matching rate to states in economic crisis.
• Help slow the HIV epidemic by implementing routine HIV screening.
• Improve access to health care by eliminating the two-year Medicare waiting period for people with disabilities.
• Protect vulnerable Medicare beneficiaries facing “donut hole” prescription drug coverage gaps.
• Promote stability by investing in the clinical workforce.
• Increase health care options by improving access to private health insurance and implementing a public insurance plan option.
• Increase access by expanding the role of Ryan White community-based programs.
What’s the likelihood of implementation?
This is not the first time that a President has attempted to push for health care reform. Franklin D. Roosevelt briefly considered including universal health coverage as part of the “New Deal” Social Security Act. Later, President Harry Truman attempted to create a single-payer health care system, only to see it thwarted by Congress. In 1971, Senator Kennedy pushed for a single-payer national health insurance plan, going around the country holding town halls on the issue. President Nixon countered with his own plan, but when the Watergate scandal broke, it overshadowed any momentum on reform efforts and the idea died. President Jimmy Carter campaigned on a promise to create a national health care plan but once elected focused on cost-containment issues. Lastly, most everyone is familiar with the attempts by the Clinton Administration to create a universal health insurance system, which was rejected by Congress after the Health Insurance Association of America (HIAA) and the National Federation of Independent Businesses turned the public against their idea through a series of television commercials.1
Will reform actually happen? Unlike past conversations about reforming the country’s fragmented and inequitable health care delivery system, this time it seems that virtually everyone has a proposal that would make some changes to health care. During the Clinton Administration many groups were out front opposing changes and advocating for the status quo. This time many of those same groups have some up with proposals of their own. It is most likely that some convening, if incomplete, health care reform will be enacted this year.
Public opinion also appears to be strongly in favor of amending the nation’s health care delivery system in order to ensure coverage for all Americans. A recent New York Times/CBS News poll released on June 20 found that “Americans overwhelmingly support substantial changes to the health care system and are strongly behind one of the most contentious proposals Congress is considering – a government-run insurance plan to compete with private insurers.” 2
1 Kaiser Family Foundation, “Focus on Health Reform: National Health Insurance- A Brief History of Reform Efforts in the United States”, March 2009. http://www.kff.org/healthreform/upload/7871.pdf
2 “In Poll, Wide Support for Government-Run Health”, The New York Times, June 20, 2009 http://www.nytimes.com/2009/06/21/health/policy/21poll.html
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