Currently, public health insurance programs pay for almost half of the medical care of persons infected with HIV/AIDS in the United States (an estimated 900,000 people in June 2000) through Medicare, Medicaid, or a combination of both programs. Uninsured people with HIV usually do not become eligible to receive Medicaid (a government program which covers certain medical needs including prescription drugs) until they have full-blown AIDS and are too sick to work. Since they are not eligible for Medicaid, and since they have no way to pay out-of pocket for drug treatment regimens that run $10,000 to $20,000 per year, low-income persons with HIV have little chance of obtaining the medications that have been proven to improve the length and quality of life for people living with HIV. 1

Medicaid eligibility consists of two components-income and categorical requirements. Both these requirements must be met for a person to be eligible to receive Medicaid coverage. Low-income people with HIV (who are usually under- or uninsured) usually meet the income requirements for Medicaid. However, unless the person with HIV has dependent children, is pregnant or under 18, he or she generally does not meet the categorical requirements and therefore is not eligible for Medicaid. Childless people over 18 with HIV usually do not meet categorical requirements unless they are disabled.

Some Medicaid comes in the form of cash assistance, or Supplemental Security Income (SSI), for those who are aged, blind, or disabled. Most people with HIV only qualify for SSI once they have develop AIDS to the point of being disabled. According to SSI standards, a person is disabled if he or she is "unable to engage in any substantial gainful activity by reason of a medically determined physical or mental impairment expected to result in death, or that has lasted or can be expected to last for a continuous period of at least 12 months." Additionally, a person with HIV must have a manifest symptom and a T-cell count of less than 200 to be eligible under the SSI definition. 2

Because the SSI definition requires that a person with HIV must have a symptom and a low T-cell count in order to qualify for cash assistance, p eople with HIV who cannot afford preventative medications must wait until they develop AIDS before they can coverage for needed medications. In other words, many low-income people with HIV do not have access to preventative medical care or medicines that could prevent the onset of infections or slow the decline of the immune system.

Early Treatment Improves Lives, Saves Money

On June 5, 2001, exactly twenty years after the first report by the Centers for Disease Control and Prevention (CDC) published its first report of what would later be known as AIDS, Reps. Nancy Pelosi (CA) and Richard Gephardt (MO) introduced H.R.2063, the Early Treatment For HIV Act of 2001. This bill has picked up considerable support in the House, with over 100 cosponsors. H.R. 2063 seeks to amend the Social Security Act to permit states to provide Medicaid coverage for low-income individuals infected with HIV who do not yet meet categorical requirements.

The benefits of early treatment for HIV are numerous. First, new treatments such as the highly active antiretroviral therapy (HAART) can successfully delay the onset of AIDS for many people infected with HIV. With this delay, persons infected with HIV can lead longer and more abundant lives. With fewer opportunistic infections, persons with HIV remain healthier and can stay in the workforce for a longer period of time.

Expanding Medicaid coverage with the passage of H.R. 2063 will also reduce the frequency of breaks in treatment. When persons with HIV have trouble covering the financial costs of medications, they are more susceptible to lapses in their drug regimens. These breaks in treatment can result in an increased risk of resistance to existing drugs in both the individual and in the general population as drug-resistant strains of HIV are transmitted. Drug-resistant strains of HIV are more difficult to treat and can result in higher overall treatment costs.

Increased Medicaid coverage will also decrease the financial burden on other funds such as ADAP (AIDS drug assistance program), the Ryan White program, and private foundations. In addition to supplementing medication coverage, these programs also subsidize support services and hospice centers. For instance, the support services provided under Ryan White often help people adhere to their treatment programs and address racial and ethnic disparities in care. With the burden eased on these programs, Ryan White and others programs that offer support services will be able to better address the non-medication needs of people living with HIV and AIDS. The cost estimate for the increased coverage is $393 million, not taking into account the savings in previously mentioned programs. 3

The tragedy of HIV/AIDS is hardly confined to the United States. The Presbyterian Washington Office has followed and continues to advocate for improved HIV/AIDS treatment and prevention throughout the world and assistance for those countries and peoples disproportionately affected by this disease. However, people living with HIV/AIDS in the U.S. must also have advocates, and passage of this legislation will greatly improve and prolong the lives of low-income people living with HIV/AIDS in the U.S.

Suggested Action

Congress is heavily involved with legislation surrounding the events of the last two months and will need to spend much time addressing these concerns throughout the foreseeable future. However, advocates for people living with HIV and AIDS are committed to keeping this bill in view when Congress resumes in 2002. While H.R.2063 has much support in the House, its counterpart in the Senate (S.987) has only two cosponsors. When Congress returns to Washington in January, they need to hear that their constituents support positive action on the Early Treatment for HIV bills.

When Congress reconvenes after the first of the year 2002, write your legislators to let them know you support Early Treatment for HIV (H.R. 2063/S. 987). If he or she is already a cosponsor, thank them for their support of this legislation. If they are not, express your support of this bill and ask them to become a cosponsor. Address letters to:

The Honorable (full name)
United States Senate
Washington, D.C. 20510

Dear Senator_______,

The Honorable (full name)
U.S. House of Representatives
Washington, D.C. 20515

Dear Representative_______,

In addition to writing to your legislators, subscribe to the Presbyterian Washington Office's E-serve Network on Health (if you are not receiving Health e-serve alerts already) to receive updates on this and other health-related legislation. Email washhealth-request@halak.pcusa.org and include just the single word subscribe in the message area. There is no cost for enrolling.

House Co-sponsors
Rep. Neil Abercrombie (1-HI)
Rep. Gary L. Ackerman (5-NY)
Rep. Thomas H. Allen (1-ME)
Rep. Robert E. Andrews, Robert E. (1-NJ)
Rep. Brian Baird (3-WA)
Rep. John Elias Baldacci (2-ME)
Rep. Tammy Baldwin (2-WI)
Rep. Ken Bentsen (25-TX)
Rep. Shelly Berkley (1-NV)
Rep. Howard Berman (26-CA)
Rep. Rod R. Blagojevich (5-IL)
Rep. Earl Blumenauer (3-OR)
Rep. David E. Bonior (10-MI)
Rep. Robert A. Borski (3-PA)
Rep. Robert Brady (1-PA)
Rep. Corrine Brown (3-FL)
Rep. Sherrod Brown (13-OH)
Rep. Lois Capps (22-CA)
Rep. Michael E. Capuano (8-MA)
Rep. Brad Carson (2-OK)
Rep. Julia Carson (10-IN)
Rep. Donna M. Christensen (V.Islands)
Rep. Wm. Lacy Clay (1-MO)
Rep. Eva M. Clayton (1-NC)
Rep. Bob Clement (5-TN)
Rep. James E. Clyburn (6-SC)
Rep. John Conyers, Jr. (14-MI)
Rep. Jerry F. Costello (12-IL)
Rep. Joseph Crowley (7-NY)
Rep. Elijah E. Cummings (7-MD)
Rep. Danny K. Davis (7-IL)
Rep. Susan Davis (49-CA)
Rep. Peter A. DeFazio (4-OR)
Rep. Diana DeGette (1-CO)
Rep. William D. Delahunt (10-MA)
Rep. Rosa L. DeLauro (3-CT)
Rep. Norman D. Dicks (6-WA)
Rep. Eliot L. Engel (17-NY)
Rep. Anna G. Eshoo (14-CA)
Rep. Lane Evans (17-IL)
Rep. Eni F. H. Faleomavaega (Am.Samoa)
Rep. Sam Farr (17-CA)
Rep. Bob Filner (50-CA)
Rep. Harold Ford, Jr. (9-TN)
Rep. Barney Frank (4-MA)
Rep. Martin Frost (24-TX)
Rep. Richard A. Gephardt (3-MO)
Rep. Charles A. Gonzalez (20-TX)
Rep. Bart Gordon (6-TN)
Rep. Gene Green (29-TX)
Rep. Luis V. Gutierrez (4-IL)
Rep. Tony P. Hall (3-OH)
Rep. Jane Harman (36-CA)
Rep Alcee L. Hastings (23-FL)
Rep. Earl F. Hilliard (7-AL)
Rep. Maurice D. Hinchey (26-NY)
Rep. Joseph M. Hoeffel (13-PA)
Rep. Rush D. Holt (12-NJ)
Rep. Michael M. Honda (15-CA)
Rep. Darlene Hooley (5-OR)
Rep. Stephen Horn (38-CA)
Rep. Jay Inslee (1-WA)
Rep. Jesse L. Jackson, Jr. (2-IL)
Rep. Sheila Jackson-Lee (18-TX)
Rep. William J. Jefferson (2-LA)
Rep. Stephanie Tubbs Jones (11-OH)
Rep. Dale E. Kildee (9-MI)
Rep. Carolyn C. Kilpatrick (15-MI)
Rep. Gerald D. Kleczka (4-WI)
Rep. Dennis J. Kucinich (10-OH)
Rep. Tom Lantos (12-CA)
Rep. John B. Larson (1-CT)
Rep. Barbara Lee (9-CA)
Rep Zoe Lofgren (16-CA)
Rep. Nita M. Lowey (18-NY)
Rep. Carolyn B. Maloney (14-NY)
Rep. James H. Maloney (5-CT)
Rep. Edward J. Markey (7-MA)
Rep. Robert T. Matsui (5-CA)
Rep. Carolyn McCarthy (4-NY)
Rep. Karen McCarthy (5-MO)
Rep. Betty McCollum (4-MN)
Rep. Jim McDermott (7-WA)
Rep. James P. McGovern (3-MA)
Rep. Cynthia A. McKinney (4-GA)
Rep. Michael R. McNulty (21-NY)
Rep. Martin T. Meehan (5-MA)
Rep. Carrie P. Meek (17-FL)
Rep. Juanita Millender-McDonald (37-CA)
Rep. George Miller (7-CA)
Rep. Patsy T. Mink (2-HI)
Rep. Dennis Moore (3-KS)
Rep. James P. Moran (8-VA)
Rep. Constance A. Morella (8-MD)
Rep. Jerrold Nadler (8-NY)
Rep. Grace F. Napolitano (34-CA)
Rep. Richard E. Neal (2-MA)
Rep. Eleanor Holmes Norton (DC)
Rep. John W. Olver (1-MA)
Rep. Major R. Owens (11-NY)
Rep. Frank Pallone, Jr. (6-NJ)
Rep. Donald M. Payne (10-NJ)
Rep. David E. Price (4-NC)
Rep. Charles B. Rangel (15-NY)
Rep. Silvestre Reyes (16-TX)
Rep. Lynn N. Rivers (13-MI)
Rep. Ciro Rodriguez (28-TX)
Rep. Lucille Roybal-Allard (33-CA)
Rep. Bobby L. Rush (1-IL)
Rep. Loretta Sanchez (46-CA)
Rep. Bernard Sanders (ATL-VT)
Rep. Janice D. Schakowsky (9-IL)
Rep. Adam B. Schiff (27-CA)
Rep. José E. Serrano (16-NY)
Rep. Brad Sherman (24-CA)
Rep. Rob Simmons (2-CT)
Rep. Louise McIntosh Slaughter (28-NY)
Rep. Hilda L. Solis (31-CA)
Rep. Fortney Pete Stark (13-CA)
Rep. Ellen O. Tauscher (10-CA)
Rep. Bennie G. Thompson (2-MS)
Rep. Karen L. Thurman (5-FL)
Rep. John F. Tierney (6-MA)
Rep. Edolphus Towns (10-NY)
Rep. Tom Udall (3-NM)
Rep. Robert A. Underwood (Guam)
Rep. Nydia M. Velázquez (12-NY)
Rep. Maxine Waters (35-CA)
Rep. Melvin L. Watt (12-NC)
Rep. Henry A. Waxman (29-CA)
Rep. Anthony D. Weiner (9-NY)
Rep. Robert Wexler (19-FL)
Rep. Lynn C. Woolsey (6-CA)
Rep. Albert Russell Wynn (4-MD)

Senate co-sponsors include: Torricelli (NJ), Feinstein (CA), Kerry (MA), and Smith (OR).

Footnotes:

1. The Body: AIDS Action. "Policy Facts: Medicare Matter for People Living with HIV/AIDS." April 2001.
2. From "Medicaid Coverage for People Living with HIV: The Early Treatment for HIV Act (H.R. 2063)" Scott Boule, Office of Rep. Nancy Pelosi. June 2001.
3. Estimates from Researchers at University of California, San Francisco.

General Assembly
As Christians we are called to work for the health and wholeness of all people. The following is from Life Abundant: Values, Choices and Health Care. The Responsibility and Role of the Presbyterian Church (U.S.A.), a report from the Task Force on Health Costs/Policies adopted by the 200th General Assembly (1988):
"Health and healing are central dimensions of the faith we profess. We must reclaim the power and promise of God' s gifts of wholeness for our life and work in fresh ways . . . . Preventive Care. The indispensable foundation on which both individual and societal responsibility for health rests is a consistent major focus on health promotion and maintenance and on preventive care services, such as pre-natal care, disease control, early detection and diagnosis, mental health services, sex education, and suicide and substance-abuse counseling." --Minutes, pp.523-524.