Federal Policy

The following is a summary of some of the most pressing current federal issues affecting people living with or at risk of contracting HIV/AIDS. APLA’s Government Affairs Division is engaged in many of these policy initiatives. The Division also provides background, research and other valuable educational resources to elected officials regarding these and other issues of importance to the HIV/AIDS community.

Policy at the Federal Level

● Implementation of the Ryan White HIV/AIDS Treatment Extension Act of 2009.

The Ryan White CARE Act, first enacted in 1990, has been the primary source of federal funding for care, treatment and support services for the estimated 550,000 low income, un-insured and under-insured people living with HIV/AIDS in the United States. Treatment programs, medications and services funded by the CARE Act are essential for those who otherwise would have to go without. On October 30, 2009, President Obama signed the Ryan White HIV/AIDS Treatment Extension Act of 2009, legislation that re-authorized the CARE Act through October 30, 2013.

► Ryan White HIV/AIDS Treatment Extension Act of 2009.

The New Federal Law

Ryan White Program Home Page (HRSA)

► Summary of Major Ryan White Program Changes.

Treatment Extension Act of 2009: At-a-Glance

The following is a summary of select provisions in the 2009 legislation, with references to key changes from the 2006 legislation:

• The 2009 Ryan White legislation continues the Ryan White HIV/AIDS Program through fiscal year 2013. Authorization levels increase 5 percent for each fiscal year but are dependent on annual appropriations.
• Minority AIDS Initiative (MAI) funds under Parts A and B will be distributed according to a formula (based on the distribution of populations disproportionately impacted by HIV/AIDS), a change from the former competitive process.
• Part A and Part B grantees must develop comprehensive plans that include a strategy for identifying individuals with HIV/AIDS who do not know their status and linking them to medical services. The strategy must focus on reducing barriers to routine testing and disparities in access to services for minorities and underserved communities. One-third of Part A supplemental grants are to be based on the area’s ability to demonstrate its success in identifying this population and bringing them into care.
• Part A and B grantees currently using code-based HIV data reporting will have three more years to convert to names-based data. Penalties will remain for Part A and Part B areas that report code-based data in fiscal years 2009 through 2012. In fiscal year 2013, only name-based data will be accepted.

●National HIV/AIDS Strategy

President Obama prioritized and has now signed (on July 13, 2010) a National HIV/AIDS Strategy (NHAS). There are three primary goals for this strategy:

• Reducing HIV incidence
• Increasing access to care and optimizing health outcomes
• Reducing HIV-related health disparities

► Summary of the Completed National HIV/AIDS Strategy

National HIV/AIDS Strategy for the United States

National HIV/AIDS Strategy – Executive Summary

National HIV/AIDS Strategy – Federal Implementation Plan

The NHAS enumerates a short list of major goals for the next five years. Jeff Crowley, Director of the Office of National AIDS Policy (ONAP) crafted the plan in collaboration with a broad range of community organizations and government agencies, with significant input from people living with HIV/AIDS. By 2015, the White House seeks to:

• Reduce new HIV infections by 25%.
• Cut the rate of the virus' spread by 30%, from five people a year infected per every 100 people living with HIV to 3.5 per 100.
• Increase from 79% to 90% the percentage of HIV-positive people who know they're HIV positive.

The Strategy does not call for increased funding, but instead indicates money will be redirected to areas with the greatest need and population groups at greatest risk, including gay and bisexual men and African-Americans. Gay men currently account for over half the new infections each year.

Currently, an estimated 1.1 million people are living with HIV/AIDS in the U.S. The Centers for Disease Control and Prevention (CDC) estimated 56,000 new infections each year in the U.S.

► National Feedback on HIV/AIDS Policy and Strategy

A Report on a National Dialog on HIV/AIDS

The Administration has maintained a commitment to developing the NHAS through a process that is inclusive of a broad range of perspectives and stakeholders, and the Office of National AIDS Policy (ONAP) has engaged public involvement via multiple channels, including public forums in cities across the nation and opportunities for Internet-based feedback.

Health Care Reform

On March 23, 2010 President Obama signed the Patient Protection and Affordable Care Act, known more generally as Health Care Reform. This comprehensive healthcare reform package is an historic milestone in the effort to provide high-quality, affordable health insurance to all Americans, including those with chronic illness or pre-existing conditions. The bill, as well as Health Care and Education Reconciliation Act of 2010, includes a range of provisions that will likely improve healthcare access for Americans living with HIV/AIDS.

► Patient Protection and Affordable Care Act of 2010

The New Federal Law

HealthCare.gov Website

► Summary of Major Health Care Delivery and Insurance Changes

Provisions in the overhaul that address health insurance coverage for people with HIV/AIDS include:

• Improved access to secure and affordable healthcare for people who are HIV-positive. Key are prohibitions on the denial or rescission of insurance coverage due to pre-existing conditions or chronic conditions like HIV.
• Expanded access to Medi-Cal for thousands of low-income Californians living with HIV who previously were forced to wait until they were disabled by AIDS before they could qualify for the state coverage

The bill will also reduce costs in the now-struggling state AIDS Drug Assistance Programs (ADAP), which offer life-saving medications to low-income, uninsured or underinsured people living with HIV/AIDS, by:

• Closing the “donut hole” in the Medicare Part D prescription drug program -- a nearly $3500 per-person gap in drug coverage that ADAP must now cover.
• Allowing ADAP expenditures to count toward individual out-of-pocket expenses used to meet the donut hole.
• Expanding Medi-Cal coverage to unmarried individuals who earn less than 133 percent of the federal poverty level.

Advocates were unsuccessful in winning inclusion of the Early Treatment for HIV Act – an HIV/AIDS-specific Medicaid expansion. Other language addressing healthcare costs, data and disparities in the lesbian and gay communities also failed to make it into the bill.

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