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HIV / AIDS

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Statements and Letters

Speech to the International Association of Physicians in AIDS Care
Conference on Healthcare Resource Allocation
November 10, 1997

By Henry Waxman

I suspect all of us could agree right now on how to answer the question which has been put to this panel. "What is the government´s obligation to provide life-saving therapies to the poor?" Our answer would probably be, "It´s a moral imperative."

There has been progress in treating AIDS. Ten years ago, AZT was the only approved therapy for HIV infection. Three years ago, the most promising combination therapies consisted of just two drugs. Today, the state-of-the-art combination therapies consist of cocktails of drugs including new protease inhibitors.

But there is a gap between what is available and what is affordable. The typical three-drug cocktail costs $12,000 to $15,000 per year. There are three quarters of a million Americans with HIV who could benefit from this kind of treatment, but only a fifth of them have private health insurance.

This is why Art Ammann, the head of AmFAR, [American Foundation for AIDS Research] talks about the growing divide in our country between "therapeutic haves and have-nots."

International:

Of course, this is even more true when we compare our country with the rest of the world. This disparity was made clear by the World Bank study released last week, which pointed out that life expectancy in the Ivory Coast and Zimbabwe is ten years shorter now because of the AIDS epidemic.

This illustrates one of the greatest challenges the community of nations faces -- how to stop the world from being divided into "therapeutic haves and have-nots."

Medicaid:

In our country, the Federal government has several programs which attempt to fulfill this moral imperative. In fiscal year 1998, we spent $1.9 billion on treating HIV/AIDS through Medicaid and $1.4 billion through Medicare. This is one way our country attempts to fulfill its obligation to the poor and the elderly with HIV.

We are trying to find the best ways to reach the poor through Medicaid. I know there is strong congressional interest in what progress has been made in implementing the Administration´s Medicaid demonstration project, which extends the availabitlity of new HIV drugs to presymptomatic patients. I hope that Sally Richardson, who is on this morning´s panel, will be able to update us on this project.

Ryan White

In addition to Medicaid, there are the Ryan White programs. I am extremely proud to have been the original author of the Ryan White CARE Act. This law continues to be an essential part of this country´s response to the AIDS epidemic.

As you all know, Ryan White programs provide health care services through the States and cities, community-based organizations and primary care providers. Outpatient services are available as an alternative to expensive hospital care; prescription drugs are provided to people lacking coverage; and early interventions are helping to keep people healthy longer.

AIDS Drug Assistance Programs (ADAP):

An important part of the Ryan White programs are the ADAPs, the AIDS Drug Assistance Programs. Many of the States have suffered from funding crises, as drug utilization has risen and expensive protease inhibitors have become available.

ADAP programs step in when Medicaid is not available. Certainly, they should be fully funded. But we need to transition people from ADAP coverage to more comprehensive Medicaid coverage. And we must also ensure that the States are negotiating the best possible prices for AIDS drugs. If they aren´t, the funds could go farther and cover even more patients. Today, in spite of spending $385 million a year, we don´t know this for certain.

Needle Exchange:

Let me make a final observation. Today, there is no cure. And when we talk about "life-saving technologies," we talk about things like new drugs, vaccines and genetic research.

But the truth is, one of the most effective "life-saving technologies" is a clean needle. A few months ago, there was an amendment offered in the House to prohibit the use of federal funds for needle exchange programs. Even if a needle exchange program reduced the incidence of AIDS and did not increase substance abuse, it would have been cut off from federal funding.

To me, there would have been no clearer violation of the government´s responsibility to the poor. It is this kind of short-sightedness which has kept us from fighting the AIDS epidemic with every tool at our disposal. When science and experience suggest we should act, we must not be afraid to do so.