America Living With AIDS

Health Care Financing

ment to care. For example, some states
did not cover the cost of AZT under
their Medicaid program even after the
drug became licensed. Now all states
cover AZT, but in some cases it took
well over a year before the only available treatment for people with AIDS
was covered under Medicaid.
THE SCOPE OF THE PROBLEM
It is currently estimated that at least
one million individuals in the United
States are HIV infected. The Centers
for Disease Control (CDC) estimated
that in 1990 there were between
111,000 and 122,000 people with
AIDS living in the United States, and
the projection for 1993 is between
151,000 and 225,000 people. These
alarming figures necessitate immediate action. The primary recommendation of the Commission is that universal health care coverage should be
provided for all persons living in the
United States. However, in the interim, the Commission recommends a
series of immediate short-term steps
to address the urgent problem of inadequate coverage for people with HIV
disease. These steps should build on
existing programs such as Medicare,
Medicaid, and the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, which already provides limited assistance. Such steps
are well within the nation's economic
and administrative capability and
should be a top priority for policy
attention.
Similarly, the Commission encourages long-term reform of the private
health insurance industry. However,

in this report the Commission has
focused primarily on recommendations that can result in immediate
changes in publicly funded programs.
These changes will provide prompt
assistance to those who are poor and
seriously disabled and who are therefore in most urgent need.
This chapter provides a
summary of the current
health care financing system and highlights gaps ma
in health care financing as n
experienced by individu- car
als with HIV disease. The cot
recommendations in this ca
report are set forth with wj
the objective of extending t
current health care
financing coverage to C
more people and improving the benefits provided.
In view of the charge to
this Commission, our
recommendations apply specifically to
people living with HIV disease, but
they could reasonably be implemented
incrementally for all people with serious chronic illnesses requiring expensive, recurring care.
CURRENT ESTIMATES OF THE
COST OF CARING FOR A
PERSON WITH HIV DISEASE
There have been a number of efforts
to delineate the costs of caring for
people with AIDS. Most such studies
have reviewed costs and charges for
cohorts of gay male patients from the
time of an initial AIDS diagnosis until
death. The most recent and realistic
estimate of the annual direct medical
care cost for treating an individual

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