Ending assistance could cost communities millions in added ER care and hospitalization, advocates say
DAVID TAFFET | Staff Writer
Some of the more extreme budget cutters would like to eliminate the program that helps people without insurance receive life-sustaining medications, as the Texas Legislature struggles to pass a balanced budget.
“That would be called legalized murder,” said Don Maison, president and CEO of AIDS Services Dallas.
Among the more likely proposals being floated in Austin is to add only 400 to 500 people to the Texas HIV Medication Program (THMP) over the next two budget cycles, which runs four years.
Local HIV healthcare providers said the proposed number is low compared to the number who will need the program.
Texas is a direct purchase state, according to Bret Camp, associate executive director of health and medical services for the Nelson-Tebedo Clinic at Resource Center Dallas. Camp explained that the state buys HIV medications and distributes them through a network of about 400 pharmacies throughout the state.
To qualify for THMP, a client must be diagnosed HIV-positive, be a Texas resident, be uninsured or under-insured for drug coverage, have income below 200 percent of the poverty level, and not receive Medicare.
Medicare recipients get their medication through the State Pharmacy Assistance Program.
In 1996, 5,100 people in Texas received their medication through THMP. Last year, the estimated number was 14,000.
Camp said he is concerned that increasing the number of eligible people over the next four years by just 400 would leave too many without the medications they need.
Camp said he expects the number of people needing assistance to increase significantly.
“The state is being responsible and promoting HIV testing,” he said. “The more testing, the more cases we’re likely to see.”
Just how much the state is spending on providing drugs for about 14,000 Texans with HIV is not known. Camp said that the state negotiates a price with the drug companies but does not publish the negotiated price.
“Nobody really knows what the price is,” Camp said.
Randall Ellis is the senior director of government relations for Legacy Community Health Services in Houston, formerly known as Montrose Clinic. He said that Texas probably pays in the range of $6,000 per year for someone in the program.
Individuals who have to purchase the drugs themselves or have insurance cover part of the price would pay closer to $24,000 or more.
Camp said that eliminating the program would save little when compared to the overall budget shortfall. But he said that the cost of caring for people who would have to make multiple emergency room visits and have extended hospital stays would be much higher than keeping them healthy in the first place.
Ellis said another problem is that the oversight committee, made up of stakeholders from around the state, sunsetted last fall. To reinstate the committee, the commissioner of Health and Human Services would simply have to repost the rules.
The committee made recommendations to the health department such as what drugs should be included in the program and what the eligibility requirements should be.
The commissioner, Ellis said, usually followed the committee’s recommendations. But the commissioner didn’t always want that input, he said.
“They want our input when it looks good to have community input,” Ellis said. “But when we ask tough questions, they’d rather not have us.”
Ellis does not expect all funding for THMP to be cut. He said that the state receives some funding through the federal AIDS Drug Assistance Program.
Camp said other states have thousands of people on waiting lists for ADAP programs.
“Florida is sorry right now,” he said. “They have dis-enrolled people.”
Florida has more than 3,000 waiting for medication. Unless those people find another way to get their medication, most will become sick, Ellis said, adding that if they are left untreated, those people will die.
Camp said that after recent hearings in the Senate Finance Committee, senators “seemed to leave with questions” that were on a level he hadn’t heard since early in the AIDS crisis.
On Tuesday, Feb. 15, the Texas HIV-AIDS Coalition is sponsoring Advocacy Day at the Capitol in Austin. A Dallas contingency will join groups from Houston, San Antonio and other cities as far as El Paso to talk to legislators about the need to fund the program.
For more information or to register for Advocacy Day, go TexasHIV.org.