HIV financing: backwards and deadly

As Michael Moore puts it, there is a lot “sicko” with our health care system. In many cases, it is with the AIDS epidemic where our system’s most profound injustices and inefficiencies are brought fully into the light.

According to the Kaiser Family Foundation, there are 1.2 million people in the United States living with HIV/AIDS and 40,000 new infections every year. In 2005, 17,000 people died from AIDS complications. Given that one year of antiretroviral therapy costs from $8,000 - $15,000, it is not surprising that between 42 percent and 59 percent of HIV-positive people are not receiving care. The scariest statistic, perhaps, is that one-quarter of HIV-positive people do not know they are sick and continue to pose a risk to their partners. While there is no cure for HIV (yet), the disease is eminently preventable and treatable. How is it that so many people remain untreated?

The sicker the person and the more HIV present in her/his blood, the easier it is for their partners to become infected. Therefore, HIV treatment is not only life-saving for the individual patient; it is a crucial strategy in an HIV prevention program.



Barriers to access

Today in America, low-income people with HIV have tremendous difficulty accessing life-saving drugs. Generally, they only become eligible for Medicaid once they are too sick to work and file for disability.

Plus, there is a particular racist edge to funding/treatment, since African Americans, Latinos and other people of color face higher rates of being uninsured or underinsured. And African Americans face a higher infection rate of HIV/AIDS than their white counterparts.

The Medicaid program was created in 1965 under Title XIX of the Social Security Act. It is an entitlement program that is jointly funded by the federal government and the states. Medicaid covers primarily three groups of low-income Americans: the elderly, the disabled, and parents and children. Services covered vary from state to state, but generally include hospital, out-patient, nursing home, prescription drug and long-term services.

Medicaid is the most important provider of care to HIV-positive people, covering 55 percent of adults and 90 percent of children living with HIV. In 2003, the federal government spent $4.8 billion through Medicaid on HIV/AIDS.

Not all low-income people living with HIV are eligible, however, because income is not the only criteria for eligibility. Most people who qualify for Medicaid do so because they have become so sick that they cannot work, as defined by Supplemental Social Security (SSI) eligibility. The criteria imposed by the Social Security Administration mandates that an individual must be unable to work due to a physical or mental condition expected to result in death, or that has lasted or can be expected to last for a continuous period of at least 12 months. This means that most people living with HIV only become eligible for services when their immune systems have declined to the point of an AIDS diagnosis.



Early Treatment Act

The Early Treatment for HIV Act (S 860, HR 3326) is a bill in Congress that would begin to address this situation. Introduced in the Senate by Sen. Gordon Smith of Oregon and in the House by Rep. Eliot Engel of New York, the bill would allow individuals living with HIV to become eligible for Medicaid coverage as soon as they are diagnosed with HIV. They no longer would have to wait until their disease progressed to AIDS in order to become eligible for crucial medicines. This is the third session of Congress where this bill has been introduced.

The notable fact is not that such a bill has been introduced; it is that it has not yet been passed. A bill that would allow over a million people access to life-saving medications and fund a critical strategy in combating the spread of this epidemic ought to have been adopted early in the epidemic, not 26 years into it.



Ineffective system

In our system, we are willing to pay for more expensive, less effective treatment once people are sicker. We are willing to leave 47 million people uninsured and millions more underinsured. And we are willing to allow the continuation of an epidemic that we have the technology and the means to control. AIDS exemplifies what is most wrong and most unjust in the way we pay for health care in the United States, and clearly shows the human, the material, and the public health cost of what happens when we do not provide affordable, quality health care for all.

Flávio Casoy works on universal health care with the American Medical Student Association.