WASHINGTON, March 30 (UPI) -- HIV/AIDS patients are caught between tight state budgets and Medicaid payments to the physicians they depend on to ensure they get the lifesaving, anti-retroviral drug cocktails that make the diagnosis a chronic illness rather than a death sentence.
The American Foundation for AIDS Research's 16th National HIV/AIDS Update Conference is underway in Miami this week and Sandra Thurman, president of the International AIDS Trust, told a Webcast of the meetings, "Public policy is the linchpin that allows us either to make progress or prevents us from making progress" on HIV and AIDS.
Yet every state has faced and continues to face challenges funding its Medicaid program -- 43 of the 50 have reduced drug coverage to make up for extremely tight budgets. Some states, such as Arkansas and Oregon, she said, are reducing or eliminating coverage for the "medically needy" category -- a key way in which people with AIDS qualify for Medicaid.
On the other end, Lubinski said low physician reimbursement by Medicaid also is a major problem -- not specifically related to one doc's income, but rather the overall ability of an HIV/AIDS clinic to stay open or for a hospital to maintain special programs.
She said the more complex the care -- which certainly describes current HIV/AIDS therapies -- the worse Medicaid tends to reimburse its caregivers. For example, for a high-complexity office visit, Medicaid pays only about 50 percent to 80 percent of what Medicare would pay for the same service -- seriously jeopardizing the program's ability to get and keep a physician network to treat patients.
"So the financing is certainly is not sustaining the level and complex care that HIV patients need and deserve," Lubinski told the conference.
HEALTHCARE AFFORDABILITY A DIVERSE PROBLEM
Business, labor and consumers all agree there is a problem of healthcare affordability in the United States -- they just differ in their approaches to it.
On the consumer end, the Commonwealth Fund's latest survey, released Monday, finds 57 percent of respondents said views on health reform held by the presidential candidates would be a "very important" factor in how they vote.
About 62 percent of the 4,052 adults said they would support giving up President Bush's recent tax cuts if doing so would guarantee health insurance security and 69 percent supported the idea of limiting the tax cut and earmarking dollars for wider health insurance coverage. There was wide support for a range of proposals to help reduce the number of uninsured.
The document, "The Affordability Crisis in U.S. Health Care: Findings from The Commonwealth Fund Biennial Health Insurance Survey," shows more people facing rising out-of-pocket healthcare costs or reductions in coverage but most still believe insurance should continue to provided via employers, private health plans and the government.
Helen Darling, president of the National Business Group on Health in Washington, told a Commonwealth Fund news conference, "From the business perspective we certainly agree that this is a crisis of affordability. We also think it is a crisis of quality."
Darling said half of the healthcare Americans buy is "not what we'd like to have based on science and evidence." With health insurance premiums for employers rising by an estimated 12 percent to 14 percent again this year and no end in sight to the key cost drivers fueling them, corporate America is struggling to find a solution.
Darling said healthcare spending is out of whack -- proportion wise -- compared to what is spent on wages and retirement benefits. Employees are not getting the wage hikes and other benefits they deserve -- because healthcare is eating up so much of the corporate personnel budget.
"We have to control costs -- business is committed to do that," she said.
Labor also considers current healthcare cost increases -- on the worker end -- "an unsustainable situation," said Gerry Shea, assistant to the president for Governmental Affairs at the AFL-CIO.
He said healthcare costs for workers cannot continue to rise while wages remain low. In the past year the track record had been pretty good -- workers by and large were able to maintain health benefits even if they did pay more -- but that all was put in jeopardy by the California grocery workers' strike.
"That highlights why this is the number one issue in collective bargaining," he told the news conference.
Half of cases that went before federal mediators last year had healthcare as an issue -- if not the major issue.
CRITICAL CARE IN CRITICAL CONDITION
First it was a nursing shortage, then an emergency room capacity problem, and a shortage of surgeons -- now critical care is heading toward the ICU.
A special White Paper in the April issue of the medical journal Chest says professional groups representing critical care providers want the federal government to step in and deal with a shortage of staff and other issues before a crisis erupts.
A report by the Critical Care Workforce Partnership -- made up of the American College of Chest Physicians, American Association of Critical-Care Nurses, American Thoracic Society and the Society of Critical Care Medicine -- recommends the adoption of common standards within the specialty, use of information technology to promote standardization and efficiency, development of incentives to attract professionals to critical care and research to determine the best role for critical care specialists.
"The limited number of physician residency and fellowship trainee opportunities combined with increasing medical school costs and decreasing Federal funds for physician training, will have a severe impact on the future number of critical care physicians," Dr. Richard. S. Irwin, President of the American College of Chest Physicians, wrote. "Although the United States government has acknowledged the impending shortage of critical care providers, policy makers must begin public discussions on this issue and support the redesign of critical care practice and improve the supply of its professionals."
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