Ryan White AIDS/HIV Treatment Modernization Act

AIDS and HIV are severely misunderstood diseases. When many people hear the condition "HIV," they picture the stereotypical victims: Africans and gay men. But that simply isn't true. HIV and AIDS affect can every race, every age, every person. The Ryan White act began in 1990 as the Ryan White Comprehensive AIDS Resources Emergenc Act. This act was designed to amend the Public Health Service Health Act to provide grants to improve the quality and availability of care to individuals and families with HIV disease. In the formal legislation, the purpose is stated that the act is to "provide emergency assistance to localities that are disporportionately affected by the HIV epidemic and to make financial assistance available to states and other public or private entities to provide for the development, organization, cooperation, and operation of more effective and cost efficient systems for the delivery of essential services to individuals and families with HIV disease."

The U.S. Department of Health and Human Services describes the new Ryan White Act as:

"The Ryan White HIV/AIDS Treatment Modernization Act of 2006 provides the Federal HIV/AIDS programs in the Public Health Service (PHS) Act under Title XXVI flexibility to respond effectively to the changing epidemic.
The new law changed how Ryan White funds can be used, with an emphasis on providing life-saving and life-extending services for people living with HIV/AIDS across this country.
The Ryan White HIV/AIDS Program was enacted in 1990 and, in addition to 2006, was reauthorized in 1996 and 2000."

The Key Changes to the 1990 act that came about it 2006 included:

- New method for determining eligibility for Part A (formerly called Title I) funds gives priority to urban areas with the highest number of people living with AIDS while also helping mid-size cities and areas with emerging needs.
- New method for distributing Part A funds directs money to metropolitan areas with the highest number of people who are HIV-positive. It also encourages outreach and testing, which will get people into treatment sooner and save more lives.
- More money will be spent on direct health care for Ryan White clients. Under the new law, grantees receiving funds under Parts A, B, and C (formerly called Titles I, II and III) must spend at least 75 percent of funds on “core medical services.”
- The new law recognizes that HIV/AIDS has had a devastating impact on racial/ethnic minorities in the U.S. African Americans accounted for 49 percent of all HIV/AIDS cases diagnosed in 2005. The new law codifies the Minority AIDS Initiative for HRSA's Ryan White programs.

The Crumbling State of Healthcare

As America's Union Movement shares on its website, "Some 47 million U.S. residents have no health insurance, and the numbers keep growing. Because employers increasingly are moving in the direction of providing Wal-Mart-style health coverage by shifting health care costs to employees, America’s workers struggle to pay higher premiums, deductibles and co-payments—if they can afford such coverage at all. Of the 47 million Americans without health insurance, 8.7 million are children."

As one of the wealthiest nations with the highest standard of living, we should all be concerned about this. In addition to the dire straights of health insurance, "Working families are experiencing double-digit increases in the costs of health insurance, more out-of-pocket costs for doctor visits and skyrocketing prices for prescriptions, forcing many to delay getting needed medical care or worse—to decline coverage for themselves or their families because of cost. Health care costs are rising at five times the rate of inflation. According to the Center for Studying Health System Change, health care spending rose 10 percent in 2002 and that followed a slightly more than 10 percent increase in 2001—the largest jump in more than a decade. In the first six months of 2003, health spending rose another 8.5 percent. Premiums for employer-sponsored coverage increased nearly 13 percent in 2002. As employers refuse to pay their fair share, this trend may result in millions of workers losing their employer-based coverage."

Medicare Fracture Prevention And Osteoporosis Testing Act of 2007

The name of this bill certainly is a mouthful. While lobbying, we generally called it "The DXA Bill."

The DXA Bill was introduced by Representative Shelley Berkley (D-NV). This legislation restores funding that is vital to preventative service in health care. DXA, also called bone density scanning, is a machine used to measure bone density and bone strength, thus identifying patients who have or are at risk for developing osteoporosis. DXA is also capable of measuring bone density and change over time. Osteoporosis is the only rheumatic disease that is preventable. Knowledge of bone density and other risks for fracture allows patients and their health care providers to choose preventative or treatment options to reduce risk of future fracture.

Background:
In the last 5 year review, a bill was passed that lowered the physician reimbursement on expensive medical scans such as CT scans, MRIs, and CAT scans. The use of these thousand dollar scans was being overused and abused, so by lowering the reimbursement, legislators hoped that, by decreasing the profits made off of these tests, physicians would stop using them when unnecessary. However the DXA scan, the only one of its kind, was incorrectly bundled in with these other medical scans in the cut. Unlike the other scans, DXA only takes 5 minutes, it is not invasive to patients at all, it gives instant feedback, and most of all, it only costs $135 to run, which is usually covered by insurance.

As it stands, physicians who offer the DXA scans only make a few dollars off of each test, but they keep the equipment around because it is such an important test for everyone to have. Many doctors even require their patients to have the scan when they reach a certain age, so if medication such as Fosamax or Boniva is required to prevent osteoporosis or rebuild bone growth, those actions can be taken immediately.

When the reimbursement cuts continue on these medical scans in 2010 (another 75%) a DXA scan will only cost $35 and physicians will actually lose money each time they give the test. There will be no incentive to keep the equipment and patients will not have access to the scans.

Osteoporosis and low bone mass affect an estimated 44 million Americans. The only other way to find out if you have osteoporosis is when a fracture occurs. If the cuts continue on the DXA scans, this is how many Americans will discover that they have thinning bones. It is in legislators' best interests to prevent osteoporosis. Prevention of osteoporosis is critical. Underutilization of bone mass measurement will strain the Medicare budget.More than 61 million people in the US are projected to have osteoporosis or low bone mass in2020 as compared to 43 million in 2002. A woman's risk of dying from the consequences of a hip fracture is equal to her combined risk of death from breast, uterine, and ovarian cancer. If physicians cannot perform bone density scans, the early recognition of this horrifying and expensive disease will be impacted.

Choosing Healthcare

This is the third policy area that I've chosen for this project, and honestly, I never thought that I would pick Healthcare. I've never been interested in the Healthcare industry or profession before, much less the legislation behind it.

Never, that is, until I traveled to Washington D.C. to lobby for 4 bills all concerning the healthcare industry with the American College of Rheumatology, an association of rheumatologists and rehumatology health professionals (physical therapists, psychiatrists, physicians, nurses, etc.) that promotes the education, treatment, and research of rheumatic diseases.

What is rheumatism, you ask? Rheumatism is defined as "any of several pathological conditions of the muscles, tendons, joints, bones, or nerves, characterized by discomfort and disability." There are many rheumatic diseases including fibromyalgia, scelroderma, and the most commonly known rheumatic disease, arthritis; but even that isn't saying much as there are over 150 different kinds of arthritis. Many people also think that rheumatism is an "old person's disease" and while the risk for developing several types of arthritis, like osteo-arthritis, increases with age, every form of arthritis can affect children as well as adults.

We traveled to Washington to educate congressmen and senators about this extremely prevalent disease and (hopefully) persuade them to pass legislation to help this fantastic association. I learned so much from the trip about lawmaking and some of the current healthcare issues, I decided to share some of the bills we lobbied for as well as some others I research.