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Our Beliefs

The future healthcare environment for those living with HIV, STDs, and Hepatitis across the United States and around the world is variable, unstable, and lacks leaders with vision.  Public Health principles call for adequate focus on screening, testing, education, and linking those in need to appropriate care and services.   This view is far from realized given the inadequate resources for all levels of care to help a predominately-impoverished population (those accessing Medicaid, Medicare, and ADAP) with chronic disease.  The various systems that cover prevention, care, and treatment for this population continue to be in jeopardy for a variety of reasons.
  

• Medicaid – Existing mechanisms would allow for dramatic Medicaid eligibility expansion to include, for example, all those living with HIV under 300% of the Federal Poverty Level ($31,200 for a single individual ).  However, this expansion still requires state match (ranging from 25% to 50% state match) to achieve a higher level of care.  ETHA  (Early Treatment for HIV ACT) has been introduced to Congress to make federal the opportunity for Medicaid expansion for HIV, however right now states can opt to do this.  The challenge – the housing market, financial turmoil, and shifting state tax revenues, among several other economic factors, have left states to budget deficits and find new state dollars for matching funds.  Medicaid’s federal/state blend is hard for states to prioritize when it means other vital existing programs may have to be de-funded.  Finally, Medicaid programs are looking at their highest drug expenditures, often Antivirals.  This view has led to some states announcing the review of antivirals at some point in the future.  This will mean rather than blanket coverage of all antivirals for HIV, some may require a prior authorization each month and on Part D plans could result in dramatically higher patient co-pay requirement.
   
• Ryan White – The Care Act is slated to end September 30, 2009.  Most involved believe the only possible next step is to continue the Act with minor changes for an additional 3 years.  The $2 billion from this important legislation, however, is inadequate in it’s size, funding formula, and over-burdensome data collection.
   
• Hepatitis – underreporting due to lack of comprehensive screening programs leads to avoidable cases being transmitted and entry into care too late in disease progression.  Hepatitis A and B vaccines and treatments, along with Hepatitis C (growing case counts of other types of Hepatitis are also on the rise) are at epidemic levels in many parts of the country.
   
• Sexually Transmitted Diseases continue to challenge state public health systems that are woefully underfunded to focus on prevention, care, surveillance, and treatments across a multitude of disease states that are unpopular to talk about.
   
• Medicare Part D – January 1, 2006 started a new era in prescription drug coverage by offering a new plan that covered prescriptions after a deductible, called the True Out of Pocket (TRooP), was met in an on again off again fashion.  Many people with HIV qualify under the disabled eligibility for this program.   There are many plans across the country and the beginning rumblings of formulary management by Part D Plans.  This will mean much higher co-pays for drugs not prioritized on the numerous formularies.
   
• National AIDS Strategy – While this vision is still taking shape, there are funds that have been made available to contribute to this national view.  There is an opportunity to combine the government, community, consumer, and industry members together to make sense out of all of the moving parts of prevention, care, and treatment to not just plan for the future; but rather to base funding formulas and program designs with a methodology that can work year to year in the best interests of all concerned.
    
• The new CDC case reporting and testing recommendations – While the new numbers of 55,300 per year that become HIV-positive instead of 40,000 per year are frightening in their documentable growth, perhaps the more challenging news is the continued high disproportionate rates in people of color, men who have sex with men, and those in more impoverished situations.
   
• Limited but steady increases in HOPWA – the federal fund distribution from multiple federal departments continues to create silos that negatively impact those living with diseases.  Enhanced collaboration from the community, regional, and national levels are mandatory to reduce and eliminate disease transmission.
   
• Disconnect between the broad array of healthcare payer systems, provider streams, points of entry, and complex insurance programs.  The broader government, community, corporate, and consumer involvement will be needed to even tackle a more streamlined system of care.

 brings 20+ years of direct, successful experiences from multiple perspectives:

• Front-line worker in pubic health
• Nonprofit agency
   -establishment
   -leadership
   -management
   -capacity building
   -planning
• Regional and national advocate
• Access & reimbursement specialist in the pharmaceutical industry