America Living With AIDS

AM E R I C A Living Wit

IMPROVING HEALTH
CARE FINANCING
irst thing FOR PEO PLE
Scomes to WITH HIV DISEASE
we have is a The Commission believes
iealth care. that universal health care
a health coverage is a necessary
is just not step toward addressing
Zealth care these obstacles and ensuro don't have ing access to quality
*ance. health care for all people
living in the United
D., L.L.M. States. This coverage
0 should be comprehensive
and should include prescription drugs. In the
interim, the Commission
recommends a series of immediate
short-term steps to close the gaps in
health care financing for those with
HIV disease. In developing these recommendations, the Commission has
sought to make incremental steps consistent with longer-term comprehensive reform. It has placed primary
emphasis upon:
* encouraging greater access to health
care, especially through early intervention and outpatient primary
care;
* providing financing for a sufficiently broad range of health care benefits to avoid distortions and inefficiencies in patterns of patient care;
* assuring provider participation by
setting payment rates at adequate
levels, while avoiding large profits
and open-ended escalating health
care costs; and
* promoting equity and fairness by

giving the greatest assistance to
those most in need-the poor and
those with catastrophically expensive illnesses.
These incremental recommendations focus primarily on the expansion
of existing public health care financing
programs rather than the expansion of
employer-provided private insurance
coverage. The Commission does not
believe that an employer-based
approach will be successful in meeting
the needs of all people living with HIV
disease. In part this is because many
affected persons are outside the work
force or are unable to continue working once the disease reaches an
advanced stage. Furthermore, private
insurers have been reluctant to shoulder a greater proportion of the financing burden, and regulatory attempts to
force this burden on employers and
insurers in the absence of more comprehensive reforms are likely to be circumvented.
Medicaid Expansion
The Commission recommends that
legislation be enacted to expand Medicaid eligibility for low-income people
with HIV disease. Currently, many
people with HIV disease are not eligible for Medicaid even if they are poor.
In addition to its poverty requirement,
Medicaid is further limited to people
who are (1) over 65; (2) members of
families with dependent children; or
(3) totally disabled. With HIV disease,
this requirement generally limits Medicaid coverage to only those individuals
who have a clinical diagnosis of AIDS.
People who have tested HIV positive
but have not advanced to a diagnosis

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