Untangling Health Care Reform in Time for ACTION!

All the media coverage of health care reform may be confusing but it’s certainly warranted: legislation is moving fast and the issue will affect each of us in some way. All of this health insurance jargon is being thrown around, and there are a ton of new acronyms and unfamiliar systems.  Why is this all so complicated?  Can’t we just take a page out of the Canadian handbook and have universal health care? I’ve really had to take some time to sit down and understand it. I’m going to break down what I’ve learned for all of us in the CHAMP Network, so you can effectively take action before final decisions are made in Washington in July.  

The House of Representatives and the Senate are each creating bills that will eventually be combined into legislation that will be put on President Obama’s desk in October (with luck). Senator Christopher Dodd (D-CT) is overseeing work on the bill in the Health, Education, Labor and Pensions (HELP) Committee, acting in place of Committee Chairman Edward Kennedy (D-MA), which is leading the crafting of health care reform legislation in the Senate. He’s relying on his on-going relationship with ranking minority member Charles Grassley (R-IA) to move the bill.  Senator Max Baucus (D-MT) is Chairing the Finance Committee, which has a jurisdiction over the appropriations process around healthcare reform legislation in the Senate. Representative Henry Waxman (D-CA) Chair of the Energy and Commerce Committee is working with Representative Frank Pallone (D-NJ), Chair of the Health subcommittee, to craft and pass legislation on the House side. 

Members are working in Washington now but heading to their home districts June 29th for the 4^th of July recess. After they return, the goal is to have the bills on the floor before the August summer recess.  Calls to members of Congress now and constituent visits to their district offices over the recess are vital. 

The HIV and AIDS community can push and protect several issues central to the care and treatment of people living with HIV and AIDS and to HIV prevention justice: 

1.  Expand Medicaid to all low-income adults, in particular childless adults who account for a large number of uninsured people living with HIV. Expanding Medicaid would reach 45% of uninsured people living with HIV. To ensure states in economic crisis are not forced to cut Medicaid budgets and limit access to critical health services, the Senate bill grants 100% federal medical assistance percentage until 2015 for individuals who are newly eligible under the expansion.

2.  Include the Early Treatment for HIV Act (ETHA), giving states the option to make Medicaid available to people living with HIV instead of being ineligible until an AIDS diagnosis as currently required. Inclusion of ETHA would reach more than 75% of uninsured people living with HIV.  This is a very important part of HIV prevention because early treatment is an integral part of promoting the overall wellness of someone living with HIV and lowering community viral load.

3. Include LGBTQ people in data collection and language defining health disparities.  Current proposals make no mention of the disparities suffered by lesbian, gay, bisexual, and transgender (LGBT) people and offer this community no place in the nation’s blueprint for a healthier future.

4. Increase eligibility for individuals with incomes up to 200% of the federal poverty level. In 2008, the poverty line was $14,000 for person with no children and $21,000 for a family of four with two children under the age of 18.  This legislated measure of poverty was developed in the 1950s and has not been fundamentally revised to reflect today’s economic realities.  Though it has been indexed for inflation, it is essentially the same poverty line developed 40 years ago. The current Senate version only extends benefits to people at 150% of the poverty level.  Too many vulnerable people will remain without coverage unless the eligibility level is raised. 

5. Create a strong public insurance option. This would offer a national standard for coverage and greater dependability, consistency and security for people with HIV than private plans, which can charge higher prices and/or close, merge or change benefits at will.  The poorest among us are most vulnerable to HIV infection and need access to comprehensive health care as part of the full spectrum of prevention, treatment, care and support.

 
It remains unclear what public plans will actually cover, and all of this potential progress is at risk. Republicans believe in small government and having federal health care kind of flies right in the face of that. The whole thing is really pissing off the private insurance companies, and, apparently, the American Medical Association isn’t big fans of the idea either. 

President Obama has defended the public plan. Accoring to the NY Times, in a conference addressing the issue, he said, “If private insurers say that the marketplace provides the best quality health care, if they tell us that they’re offering a good deal, then why is it that the government — which they say can’t run anything — suddenly is going to drive them out of business? That’s not logical." However, he has more or less stepped back from the actual legislation.  He put forth guiding principles to set expectations for comprehensive health care reform, which include investing prevention and wellness and assuring affordable, quality health coverage for all Americans.  In order to live up to this lofty framework, Congress has to work out the details and only grassroots pressure can make them do the right thing. 

Policy-makers in Washington must find a way to ensure every person in this country has access to health care.  Not only is it an essential human right but also the only way we’ll all be healthy enough to care for our families and communities and be the ready-to-work nation Obama called us in his inaugural address.   

If you are interested in planning a visit to your members of Congress over the 4^th of July recess to ensure healthcare reform promotes HIV prevention justice, please email Katie Crisona, CHAMP Fellow, at katie@champnetwork.org or call us at 718-926-5332. 

To call your members of Congress about healthcare reform today, please visit Project Inform at http://www.projectinform.org/advo/hc/061809.shtml.  

Go to www.taepusa.org for background information and analyses of various health care reform proposals and the impact on people with HIV/AIDS.