icon star paper   News Update  
Back grey_arrow_rt.gif
 
 
New Recommended Fed AIDS Plan
 
 
  -AIDS health plan would cover poor-
-Institute of Medicine says 60,000 are not getting necessary drugs
 
Sabin Russell, San Francisco Chronicle Medical Writer
Friday, May 14, 2004
 
The prestigious Institute of Medicine on Thursday called for an overhaul of taxpayer-funded programs that care for people with AIDS, saying that nearly 60,000 Americans are failing to get the drugs they need.
 
Despite a climate of tight spending in Washington, the institute -- part of the National Academies, an independent scientific advisory group -- called for the creation of a new entitlement program for poor people with AIDS. It would pool most current state and federal AIDS care programs into a single national organization with streamlined rules and a larger budget.
 
The proposed nationwide HIV Comprehensive Care Program would add about $560 million to the $7.2 billion annual cost of state and federal programs, but it is projected to prevent the deaths of 20,000 Americans who would otherwise perish during the next 10 years because of inadequate AIDS care.
 
It would establish a national standard of care for low-income AIDS patients and would require the federal government to pay for it. States would run the programs with federal money. Currently, states share in the cost of AIDS care for the poor, and the extent of coverage varies by state.
 
"HIV-AIDS is a national epidemic, with consequences that spill over state borders,'' said Lauren LeRoy, a health foundation executive who headed the panel and released its findings at a Washington press conference.
 
The new program, she said, "would relieve state budgets from the majority of costs they currently assume for HIV care.''
 
LeRoy described the current system of paying for AIDS care as a patchwork of programs that create significant variations in the level of care. As a consequence, the panel estimates that nearly 60,000 AIDS patients who need the costly combination of anti-viral drugs to prolong their lives are not getting it. Over the course of 10 years, the new program not only would save thousands of lives but also would avert an estimated 2,000 to 3,000 new HIV infections because of stepped-up prevention services, according to the committee. That would save an estimated $140 million over a 10-year period.
 
The proposal comes at a time, however, when existing HIV prevention and care programs are being squeezed at both the state and federal level. Waiting lists are swelling in many states for the AIDS Drug Assistance Program, a federal and state-funded program that pays for medications for the uninsured.
 
Steve Morin, director of the UCSF AIDS Policy Research Center, said the plan had "no political viability'' under the current leadership in Washington but acknowledged the value of rethinking public financing should there be a change after the November election.
 
The panel decided to ignore politics. "We were aware of, but did not consider as a constraint, the issue of political feasibility,'' said panel member Dr. James G. Kahn, of the UCSF Institute for Health Policy Studies. The idea was to design a more workable system, and "put it out for public scrutiny, '' he said.
 
Using tools of policymakers to judge the cost-effectiveness of new medical innovations, Kahn calculated that the added expense of the new program would cost $43,000 for each year of "quality life gained'' by patients enrolled in the program. That compares favorably with the cost-effectiveness of current technologies, such as $31,000 per year of quality life gained for driver-side air bags in automobiles; or $143,000 for a common heart procedure known as a coronary angioplasty.
 
As much as $400 million of the added cost, Kahn noted, could be covered if the program sought steeper discounts for AIDS drugs from pharmaceutical companies. Because more patients would be taking the medications under the expanded program, drugmakers could absorb a 27 percent discount and still make the same level of profits they earn on the drugs today, Kahn said.
 
The panel chose its proposal over an alternative long sought by congressional Democrats: expanding the Medicaid program to offer care for all low-income people infected with HIV, not just those with an AIDS diagnosis. Kahn said that plan would save only a quarter as many lives, because such coverage would be optional, and many states would continue to opt out of it.
 
Panel member Dr. Paul Volberding, chief of Medical Service for the San Francisco Veterans Affairs Medical Center and an AIDS physician from the earliest days of the epidemic, said the plan drew from the success of comprehensive approaches used in the city.
 
"San Francisco has done a lot of the things we are calling for in this report," he said.
 
"This is a system of clearly identified benefits for people, regardless of where they live.''
 
 
 
 
 
  icon paper stack View Older Articles   Back to Top   www.natap.org