HOPWA funding preserved: Clinton unveils health plan

In his first veto as President, Bill Clinton preserved the full $186 million funding allocation for the Housing Opportunities for People with AIDS (HOPWA) program. Congressional Republicans had cut $30 million from the appropriation for fiscal 1995 as part of a package of $16.4 billion in funding rescissions. In other action, Clinton's plan to balance the Federal budget deficit in ten years leaves most AIDS programs intact. Both Clinton and the Republicans plan to reduce the growth in Medicaid spending, which provides medical care to about forty percent of people with AIDS and ninety percent of infants and children with AIDS. In addition, Clinton has proposed a health-care initiative in which insurers could not deny coverage to people with medical problems, would have to renew policies regardless of the subscriber's medical condition, and would have to offer coverage to small companies. Finally, Clinton proposes subsidies to make insurance more affordable to people who lose their jobs.     

Appropriations panels propose increase in Ryan White aid

In September, a Senate appropriations committee approved a 14.1 percent increase in funding for the Ryan White CARE Act for fiscal 2000, a part of the Labor/Health and Human Services (HHS)/Education bill. Results from the House committee are not available. The AIDS drug assistance programs (ADAP) received a $75 million increase in the Senate committee while the House subcommittee only gave a $39 million increase. The ADAP Working Group objected, saying a $90 million increase was needed to avoid delays in enrollment restrictions on drug use. The statuses of other key Federal HIV spending programs in the bill are shown in a chart. President Clinton may veto the Labor/HHS bill, if passed, because his funding initiative calling for 100,000 new teachers was excluded. Congress has until October to complete work on the appropriations bills.     

Congress has yet to act on key programs; HOPWA may take hit

The U.S. Congress went on recess without passing key HIV spending programs. Committees in both the House and the Senate delayed action on the Labor, Health and Human Services, and Education appropriations bill for fiscal 2000 until after the break. This bill covers 90 percent of discretionary HIV spending by the Federal government, including $1.4 billion for the Ryan White CARE Act and $1.8 billion for AIDS research at the National Institutes of Health. A $10 million spending cut for the Housing Opportunities for People with AIDS program was proposed. In addition, the House voted to prohibit the District of Columbia from spending any money to operate needle exchange programs. President Clinton has proposed $175.4 million in spending increases for discretionary HIV programs for the next fiscal year, which would be an increase of 3.2 percent over the current year.     

President seeks 4 percent increase in funding for 2000

President Clinton has proposed a 4 percent increase of $162 million in discretionary funding for HIV-specific programs for the fiscal year 2000 budget. The budget calls for a 7 percent increase for the Ryan White CARE Act funds and a similar increase for the Housing Opportunities for People with AIDS program. AIDS drug assistance programs would receive $35 million, or an 8 percent increase in funding. In 4 of the past 5 years, Congress has appropriated more funds to HIV programs than the President requested. A chart shows current funding levels and proposed increases for key HIV/AIDS programs.     

Clinton sets goal of having an AIDS vaccine in 10 years

During a May 18, 1997 commencement address at Morgan State University, President Clinton announced the establishment of a new AIDS vaccine research center within the National Institutes of Health (NIH) and called for accelerated development of an AIDS vaccine. Clinton appealed to foreign governments and pharmaceutical companies to find a vaccine for HIV. The president did not propose new Federal funding to support this development. The fiscal year 1998 budget includes a $39 million increase in AIDS research at the NIH, only a portion of which goes to vaccine development. Reactions to the president's statement range from hopefulness to skepticism. About 40 experimental vaccines are under development throughout the world.     

Hemophilia relief bill passes, but money won't arrive soon

The Ricky Ray Hemophilia Relief Act, signed by President Clinton, authorized up to $750 million in compensation to hemophiliacs infected with HIV through 1987 from contaminated blood products. That amount represents an estimated $100,000 per hemophiliac or survivor. The money will hopefully be available in fiscal 2000, subject to Congress passing a specific appropriations bill.     

Congress sends mixed signals on AIDS programs

Congress has sent mixed signals to AIDS activists about the latest developments regarding funding for AIDS programs for fiscal year 1996. The House Commerce Committee unanimously sent the Ryan White reauthorization measure (H.R. 1872) to the full House for action. Senate Majority Leader Bob Dole has scheduled a floor vote for July 24 on the legislation, which has attracted 61 co-sponsors. President Clinton has urged Dole and House Speaker Newt Gingrich to push for reauthorization. Total proposed funding of $655.9 million for fiscal 1996 compares to $633 million in the current year. The House Appropriations Subcommittee on Labor, Health and Human Services voted to eliminate funding for the Office of AIDS Research (OAR), which allocates money within the various Institutes of the National Institutes of Health (NIH) for AIDS-related studies. This plan would mark the first time that the Congress failed to dedicate specific funding for AIDS research. AIDS activists and the Clinton administration hope to restore OAR's funding when the appropriations measure goes to the Senate for passage. In addition, allocations for the Housing Opportunities for People with AIDS (HOPWA) program remains unsettled, however fiscal 1995 allocations may remain intact. Finally, the House Appropriations Subcommittee on Labor, Health and Human Services developed a plan that recommends eliminating the Education and Training Centers; the AIDS Training, Linkage and AIDS Outreach programs; and the National AIDS Program Office.     

Vaccine research

President Clinton dedicated a $30 million research center in June that is aiming to develop an HIV vaccine by 2007. The Dale and Betty Bumpers Vaccine Research Center will be finished next year on the campus of the National Institutes of Health (NIH) in Maryland. The research center will support 100 scientists and staff, and have a budget of $16.5 million in fiscal year 1999.     

Clinton's ADAP proposal seen as a 'starting point'

President Clinton proposed an additional $100 million for State-run AIDS drug assistance programs (ADAPs) for fiscal year 1999. AIDS policy advocates acknowledge the budget increase but note that the amount is just a starting point from which to engage Congress and will not be sufficient to meet the growing demand for medicines. Sandra Thurman, White House Office of National AIDS Policy director, explained that this budget increase illustrates the Administration's commitment to eradicating HIV/AIDS. The ADAP Working Group says it will require a $173 million increase to meet the current and projected need. President Clinton's administration is considering a plan to require all States to share the cost of AIDS drug assistance; the ADAP Working Group is asking for a $43.4 million increase in State ADAP spending.     

Ten years' experience using an integrated workers' compensation management system to control workers' compensation costs

This work presents 10 years of experience using an Integrated Workers' Compensation Claims Management System that allows safety professionals, adjusters, and selected medical and nursing providers to collaborate in a process of preventing accidents and expeditiously assessing, treating, and returning individuals to productive work. The hallmarks of the program involve patient advocacy and customer service, steerage of injured employees to a small network of physicians, close follow-up, and the continuous dialogue between parties regarding claims management. The integrated claims management system was instituted in fiscal year 1992 servicing a population of approximately 21,000 individuals. The system was periodically refined and by the 2002 fiscal year, 39,000 individuals were managed under this paradigm. The frequency of lost-time and medical claims rate decreased 73% (from 22 per 1000 employees to 6) and 61% (from 155 per 1000 employees to 61), respectively, between fiscal year 1992 and fiscal year 2002. The number of temporary/total days paid per 100 insureds decreased from 163 in fiscal year 1992 to 37 in fiscal year 2002, or 77%. Total workers' compensation expenses including all medical, indemnity and administrative, decreased from $0.81 per $100 of payroll in fiscal year 1992 to $0.37 per $100 of payroll in fiscal year 2002, a 54% decrease. More specifically, medical costs per $100 of payroll decreased 44% (from $0.27 to $0.15), temporary/total, 61% (from $0.18 to $0.07), permanent/partial, 63% (from $0.19 to $0.07) and administrative costs, 48% ($0.16 to $0.09). These data suggests that workers' compensation costs can be reduced over a multi-year period by using a small network of clinically skilled health care providers who address an individual workers' psychological, as well as physical needs and where communication between all parties (e.g., medical care providers, supervisors, and injured employees) is constantly maintained. Furthermore, these results can be obtained in an environment in which the employer pays the full cost of medical care and the claimant has free choice of medical provider at all times.     

Ryan White reauthorization runs into a snag

Senator Jesse Helms, R-N.C., reportedly is blocking the reauthorization of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act because he contends too much money is being spent on AIDS relative to more common illnesses. Lawmakers have until September 30, 1995 to reauthorize the bill, however, if the delay continues into the legislation's fiscal 1996 budgetary process, the resulting funding and policy issues created by the delay could cause further delays. At press time, 57 senators had signed on as co-sponsors to the reauthorization, including Majority Leader Robert Dole. Dole can force the bill to the floor for a vote, but instead has put the bill on hold. In other action, the House and Senate have yet to send President Clinton their bill to rescind $16.4 billion in Federal spending for fiscal 1995, including $30 million from the $186 million Housing Opportunities for People with AIDS (HOPWA) program. Clinton has vowed to veto the bill. Finally, a conference committee has begun ironing out differences in House and Senate plans to reduce the Federal budget deficit to zero by the year 2002 by cutting discretionary domestic spending, including cutting Medicaid by more than fifteen percent. About forty percent of people with AIDS depend on Medicaid for their health care.     

Congress approves 17 percent increase in CARE Act funds

On April 24, 1996, Congress and President Bill Clinton agreed on a stopgap spending bill that increases funding for the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act by 17 percent. The budget provides $738.4 million for the CARE Act in fiscal year 1996. Funding for all four titles of the Act will be increased. The final budget also approves $12 million for the AIDS education and training centers and $583.4 million for HIV prevention programs sponsored by the Centers for Disease Control and Prevention (CDC). HIV-related research programs sponsored by the National Institutes of Health (NIH) total $1.4 billion.     

Governor agrees to boost funding for some programs, but not all

California Governor Gray Davis has approved a budget that includes items from both his proposed budget for fiscal year 1999-2000 and the budget proposed by the State Legislature. The new budget will add $13.4 million for new HIV programs, most of them targeted at communities of color. He used his line-item veto to eliminate another $3.5 million that the Legislature had already approved. The governor accepted the Legislature's figures for prevention and education, surveillance programs, and support and prevention services among communities of color; he trimmed appropriations in early intervention programs and residential care facilities. Davis also eliminated funding for anonymous HIV testing at family planning clinics and for partner counseling and referral services. The budget also adds funding for research on kidney and liver transplants for people with HIV.     

Congress nears final action on fiscal 1996 funding

Congress and the Clinton administration are negotiating a continuing resolution to keep Federal AIDS programs funded and in operation through the remainder of the 1996 fiscal year. The House of Representatives approved a bill that includes $52 million in emergency appropriations for the AIDS Drug Assistance Program. The Senate is considering a bill that provides emergency funding if the administration cuts funding in another program. The House and the Senate differ on how funding for AIDS research will be allocated at the National Institutes of Health (NIH).     

Budget deal taps Medicaid to pay for new tax cuts

AIDS advocates are relieved that Congress and the White House have agreed on a $15 billion reduction in the Medicaid budget. While this cut is significant, a previously proposed plan would have cut Medicaid even further and instituted an annual cap on the amount of health-care dollars a patient could receive. It now appears that capping Medicaid spending per Medicaid beneficiary is no longer a component of the budget agreement. The Clinton Administration anticipates a 6 percent increase of the Federal share of AIDS-related medical costs to $1.9 billion. AIDS Action recommended increasing funding for the Ryan White CARE Act by $393.9 million; the Clinton administration suggests a $40 million increase. AIDS Action also proposed biomedical and behavioral research funded by the National Institutes of Health (NIH) to rise by $134.5 million; the Clinton administration proposes a $39 million increase. A recent survey found that almost 70 percent of Americans support the notion that Medicaid should extend AIDS drug therapies to low-income people in the early stages of HIV infection. These findings will be used to bolster AIDS Action's argument that the Federal Health Care Financing Administration should extend Medicaid to more low-income people who lack private insurance.     

The president's child immunization initiative--a summary of the problem and the response.

After only 24 days in office, President Bill Clinton announced a comprehensive childhood immunization initiative designed to assure that all children in the United States lead healthier lives by receiving age-appropriate immunizations against preventable diseases such as polio, mumps, measles, whooping cough, and diphtheria. As part of his economic stimulus proposal, the President requested $300 million for Fiscal Year 1993 to reinforce the nation''s immunization infrastructure by providing funding for communities to extend clinic hours, provide more staff, and increase information and education efforts and for the planning and implementation of a national immunization tracking system. In its Fiscal 1994 budget request, the Administration asked for a doubling of the Centers for Disease Control and Prevention''s immunization program funding to $667 million. In cooperation with key congressional committees, the Administration has also prepared legislation that would provide recommended childhood vaccines to States for free distribution to health care providers who serve children enrolled in Medicaid or who don''t have health insurance that covers immunization services. Providers could not charge for the vaccine but could charge a fee for administration. State Medicaid programs would also be required to reimburse providers reasonably for vaccine administration. This measure is designed to improve universal access to immunization services by helping to remove financial barriers that impede children from being immunized at the appropriate age.     

Good times. New accounting rules mean fewer stock options for healthcare CEOs, but the highest paid execs are still raking it in

Healthcare CEOs are getting fewer stock options, thanks to new accounting rules, but that doesn't mean the top-paid executives are doing without. UnitedHealth's William McGuire led the pack with total compensation of $124.8 million in fiscal 2004. Even the second-highest paid hospital exec, Triad Hospitals' Denny Shelton, left, added $17.9 million to his personal bottom line in 2004.     

Enhancing mental health services for homeless persons: state proposals under the MHSH Block Grant Program

The Mental Health Services for the Homeless Block Grant Program has made available more than $57 million to the States in fiscal years 1987-89 to encourage States to develop and strengthen community services for homeless mentally ill persons. Funds were provided for five basic services, which include outreach, case management, mental health treatment, residential support services, and training for service providers. State applications for funds reflected considerable diversity among the services proposed. The manner in which States proposed to use the funds is described, including methods used to identify high need areas and distribute funds and plans for delivering services.     

Study underscores need for increased ADAP funding

A study conducted by the National Alliance of State and Territorial AIDS Directors and the AIDS Treatment Data Network for the Kaiser Family Foundation determined that state-run AIDS drug assistance programs (ADAPs) are in the midst of financial crisis. The number of new ADAP clients was growing at the rate of 1,000 per month during the final six months of 1996. The study also found that 23 States have imposed cost-containment regulations because of the growing need for the protease inhibitor cocktails that have become the standard of care for HIV treatment. While the House Appropriations Committee recommended allocating $2 million more than the $297 requested, the Senate approved $217 million in Title II ADAP funding under the Ryan White CARE Act. President Clinton did not propose a funding increase. The study also found that where a patient lives impacts upon his or her treatment; only New York and North Carolina currently cover all approved antiretroviral drugs.     

The United States and the United Nations Population Fund: a rocky relationship

30 years ago, the US played a major, constructive role in creating the UN Population Fund (UNFPA), the largest multilateral population assistance agency in the world. Today, however, the US, led by Congressional opponents to family planning, opposes the activities of the UNFPA and has suspended its entire contribution to the agency for fiscal year (FY) 1999. UNFPA involvement in China is being used as an excuse for the US's most recent pullback from the agency. UNFPA's new 4-year program in China reflects the core principles of the 1994 International Conference on Population and Development, including the absolute rejection of coercion in the use of family planning methods. The program will provide $20 million in aid directly to 32 Chinese counties, not to the central government, and focuses upon expanding the range of available contraceptive methods; training health workers in interpersonal counseling skills, informed consent procedures, and family planning methods; expanding and improving maternal and child health services; and strengthening efforts to prevent STDs. Safeguards against coercive practices are an integral part of the program. The Clinton administration's FY 2000 budget request includes $25 million for UNFPA. Efforts are also being made to restore the US's contribution to UNFPA for FY 1999.