September was a busy month for ANAC in Washington, D.C.! Following is a summary of ANAC's advocacy activities last month:
ANAC was represented by Carole Treston, RN, MPH, ANAC's Policy Consultant, at the recent Presidential Advisory Council on HIV/AIDS (PACHA). There, she provided testimony on the role of nurses in implementing the Affordable Care Act (ACA) and reiterated the call for the appointment of qualified nurses to PACHA. In September, PACHA released a full report on their activities and recommendations.
The importance of Ryan White programs in conjunction with the Affordable Care Act (ACA) in meeting the goals of the National HIV/AIDS Strategy was noted by many during the PACHA meeting, including Dr. Laura Cheever, Administrator for the HIV/AIDS Bureau at HRSA, the home of the Ryan White (RW) programs. More than 60% of people known to be living with HIV in the US are seen in RW programs and of those, about 70% are currently insured, primarily through Medicaid, and may be considered “under-insured.” Of the 30% uninsured, about 2/3 will likely now get coverage through the ACA.
Many of those who will be left out of the ACA reside in the South. A sobering account of the economic and health disparities facing people living with HIV in the south was presented to PACHA by the Southern HIV/AIDS Strategy Initiative. A compelling picture of the impact of these inequalities in people’s lives was portrayed in the New York Times this week.
PACHA was reminded of the disproportionate impact of HIV on Black gay and bisexual men by a number of presenters. A recently released report by NMAC and the Ford Foundation highlights the impact of criminalization, stigma and social determinants on access to health care. The consensus at PACHA was that many HIV care programs may need to re-evaluate how they are serving this population so disproportionately affected by HIV.
On September 26, prior to the federal government shutting down, the unique perspective of nurses was represented in visits to members of the House and Senate. Carole was part of a delegation of advocates from around the country organized by AIDS United to educate Congress about the continued need for Ryan White programs and the impact of sequestration budget cuts on Ryan White programs. Carole described the real life impact of sequestration on ANAC members and shared stories about hiring freezes and decisions to not fill vacant positions and how they are beginning to impact patient care. She talked about how increasing wait times to get appointments increases the chance of missed visits leads to decreases in retention efforts described in the HIV care continuum.
HRSA HIV AIDS Bureau National Partners Meeting
ANAC was one of ten national organizations that attended a recent HRSA/HAB national partners meeting. Four priority areas for HAB were described: Transition to the ACA for Ryan White grantees, Improved "customer service” for grantees, Enhanced partnerships with other federal agencies such as CDC and SAMHSA, and Improved data analysis and dissemination. While the ACA will improve coverage for some people living with HIV, it was made clear that Ryan White funding will continue to at least partially pay for services not covered by insurance. However, the law's payer of last resort clause requires that RW dollars only be used when other sources are not available. Even with expanded insurance coverage, RW funding will be needed for many RW patients to meet out of pocket expenses, such as co-pays, deductibles and monthly insurance premium assistance. Allocating RW dollars for these costs is called “coverage completion services.” Care completion will be designed at the state and local leves, through RW planning bodies and may be managed through state ADAP programs. HAB has issued guidance on care completion and has a useful website, including an updated FAQ section. Grantees and providers and are strongly encouraged to continually refer to it and submit questions through the FAQ page.
Health Insurance Marketplace
Finally, there has been so much news about the Affordable Care Act and the opening of the on-line marketplace (healthcare.gov) this week. In September, ANAC (along with other national nursing groups and nurses from around the country) participated in national calls with the White House about ACA implementation. Nurses will continue to be important sources of information about many aspects of the ACA, including but not limited to enrollment. We know that the ACA is much more than the marketplace, and refer you to a robust HRSA website with information on many aspects of the ACA for guidance and questions. ANAC also has compiled important information, tools and resources about the ACA on our website.