Bill Tracker

ADAP and Minnesota’s HIV Insurance and Drug Assistance Program

Updated: May 31, 2005

Testimony on HH Bill heard in Conference Committee

At a Health conference committee last week, testimony was given on behalf of the proposed changes to the HH Program (SF 1836), the AIDS Drug Assistance and Insurance Reimbursement Program. These MAP-supported changes will improve the accountability of the program by acknowledging that the legislature should have a role in the implementation of any future changes. While the Department of Human Services did a great job of explaining the program and giving the justification for the bill, there were a number of pointed questions from some members of the committee. The nature of these questions suggest there is some lingering political motivation from some legislators seeking an opportunity to wage an assault on folks living with HIV. Your phone call to conference committee members is needed to insure that these recommendations are included in the final omnibus bill. Click here for more for contact information for committee members.

Updated: May 9, 2005

The HH Bill Added to Senate Health Omnibus Bill Now Awaits Approval in Conference Committee

A proposal to improve accountability of the state-administered ADAP program, a.k.a. the HH Program has been included in the Senate health omnibus bill and will now move forward to the Conference Committee. The House version of the health omnibus bill does not include the HH bill provisions. As introduced, MAP’s proposal to reform the HH program included a roll-back of cost-share provisions that were implemented in 2004. In order to pass the HH bill there must be bi-partisan support in conference committee, which is possible since the Department of Human Services supports the compromise language.

Updated: May 3, 2005

The HH Bill Moves Forward on a Compromise

MAP and DHS struck a compromise on a bill to bring more openness and accountability to the operation of the state HIV insurance and drug assistance program [a.k.a. Program HH]. These provisions will be included in the Senate health omnibus bill and have a decent chance of adoption when that bill goes to conference committee. As introduced, MAP’s proposal to reform the HH program included a roll-back of cost-share provisions that were implemented in 2004. Neither the Pawlenty administration nor legislators supported this provision due to “no new taxes” budget constraints.

Click here to read the revised version of the HH bill.

Updated: April 20, 2005

Senate Panel Continues to Consider State ADAP Reforms


The HIV Prevention and Health Care Access Bill [SF 1836], a.k.a. "the HH" bill is still alive in the Minnesota Senate’s health budget committee. The bill seemed doomed once the Department of Human Services released a $22 million cost report. MAP revised the bill to remove all new costs, while still making significant policy reforms that will prevent DHS from acting unilaterally, as it did last year, when making changes in the State’s HIV drug and insurance assistance program. Read the revised bill on the MAP Bill Tracker.

Read Representative Thissen's Speech From the AIDS Action Day Press Conference


THANK YOU FOR COMING TODAY. YOUR PRESENCE HERE AT YOUR CAPITOL AND CONTINUED ADVOCACY AND ENGAGEMENT IS MORE IMPORTANT THAN YOU KNOW.

THE PROMISE OF OUR COUNTRY – THAT EVERY PERSON’S VOICE IS IMPORTANT AND WORTHY – IS ONLY ACHIEVABLE IF PEOPLE IN FACT DO SHOW UP, STAND UP AND SPEAK OUT. THANKS FOR DOING YOUR PART TO BRING REASON, REALITY AND HONESTY TO THE PUBLIC DISCUSSION OF HIV AND AIDS.

THERE IS MUCH TO BE DONE. PEOPLE NEED ACCURATE INFORMATION ABOUT SEXUALLY TRANSMITTED DISEASES. WE MUST ENSURE ALL PEOPLE HAVE ACCESS TO HIGH QUALITY HEALTH CARE. BUT I WANT TO TALK SPECIFICALLY TODAY ABOUT THE HIV PREVENTION AND HEALTH CARE ACCESS BILL.

I AM SO PROUD TO BE CARRYING THIS LEGISLATION IN THE HOUSE OF REPRESENTATIVES AND TO PLAY A SMALL PART IN MOVING THE DISCUSSION OF EFFECTIVE HIV TREATMENT FORWARD. IT IS NOT EVERYDAY A PERSON GETS TO WORK ON SUCH A SMART AND COMPASSIONATE PIECE OF LEGISLATION.

THE IDEA OF THE BILL IS SIMPLE: TO MAKE INVESTMENTS THAT ENSURE THAT EVERY PERSON LIVING WITH HIV OR AIDS HAS ACCESS TO THE MOST EFFECTIVE AND MOST CURRENT TREATMENT AVAILABLE.

WE ARE LIVING IN A DIFFERENT ERA. PEOPLE WITH HIV AND AIDS ARE LIVING LONGER. THAT HAPPY FACT SHOULD NOT BE TURNED ON ITS HEAD AND MADE A JUSTIFICATION FOR REFUSING TO MAKE NEEDED COMMUNITY INVESTMENTS TO ENSURE ALL PEOPLE HAVE ACCESS TO EFFECTIVE TREATMENT.

UNFORTUNATELY, THAT IS WHAT IS HAPPENING. THE PRESSURE OF GOV PAWLENTY’S REFUSAL TO RAISE TAXES TO HELP SOLVE OUR MASSIVE BUDGET DEFICIT HAS FORCED THE DEPARTMENT OF HEALTH TO START CHARGING PREMIUMS AND COPAYS TO PEOPLE THAT CAN NOT AFFORD THEM. AS A RESULT, MANY PEOPLE LIVING WITH HIV AND AIDS SIMPLY CANNOT GET THE REGULAR TREATMENT THEY NEED TO EFFECTIVELY FIGHT THE INFECTION.

WHY DOES THAT MATTER?

IT MATTERS BECAUSE FAILURE TO EFFECTIVELY TREAT HIV AND AIDS WILL IN THE LONG RUN COST THE STATE MORE MONEY BECAUSE IT WILL LEAD TO SERIOUS HEALTH COMPLICATIONS.

IT MATTERS BECAUSE IRREGULAR TREATMENT CAUSES THE DISEASE TO SPREAD MORE EASILY AND TO MUTATE INTO MORE VIRULENT STRAINS. EFFECTIVE TREATMENT OF HIV AND AIDS MUST BE A TRUE PUBLIC HEALTH PRIORITY.

AND IT MATTERS ABOVE ALL, BECAUSE WE ALL HAVE A MORAL OBLIGATION TO ATTEND TO THE LIFE AND HEALTH OF ALL OUR FELLOW CITIZENS.

BY PASSING THE HIV PREVENTION AND HEALTH CARE ACCESS BILL, MINNESOTA WILL MAKE A CLEAR AND PROPER COMMITMENT TO THE HEALTH OF ALL MINNESOTANS. WE CANNOT AFFORD TO DO OTHERWISE.

Updated: April 5, 2005

Sarah Rybicki's Testimony to the Senate Health and Family Security Committee:

Madame Chair and Members

I am here today because I am concerned about rationing of HIV care in Minnesota and to support the HIV Prevention and Healthcare Access Program bill.

Introduce yourself
Sarah Rybicki Public Health Social Worker
Co-Direct the Midwest AIDS Training and Education Center at the University of Minnesota in the School of Public Health
Served two years as Co-Chair of Minnesota’s HIV Services Planning Council (RWPC) and approximately 8 months as the Co-Chair of the ADAP Ad-Hoc Committee of the RWPC.
I am a resident of the Eastside of Saint Paul

How I see the problem: WHY IS HIV CARE SO EXPENSIVE?
A Clear and Positive Message
As HIV/AIDS treatment has improved we have been able to use medications and medical care to help people live longer healthier lives. Popular wisdom is that these advances come with a very high price tag. But how high and compared to what? Does HIV care really cost more than it used to when people sickened and died quickly of AIDS related illnesses? The answer might surprise you. The cost of helping a person living with HIV/AIDS (PLWH/A) maintain their health has not gone up significantly since 1996 with the availability of highly active antiretroviral therapy (HAART). What has driven up the cost of the epidemic is the increasing numbers of persons with HIV who are living longer and more productive years and requiring medication to do so. Hospital costs have gone down and long-term medication costs have gone up. Additionally, approximately 40,000 newly infected persons are added to the service delivery system nationally every year, resulting in an epidemic with steeply rising costs.

ADAPs STRESSED ON A NATIONAL LEVEL
These dynamics stress programs like the AIDS Drug Assistance Program or ADAP, program HH. ADAP is essentially designed to meet the health care and medication access needs of low income working people. We know that long-term HIV care continues to be expensive, because of the high cost of drugs, potentially lifelong treatment and increasing number of persons requiring treatment. What is missing in this equation is the contribution to society that PLWH/As make when they are healthy, and able to work decreasing the cost of long term care.

PUBLIC HEALTH IMPLICATIONS & PREVENTION/DRUG RESISTANT VIRUS
Also missing from this picture is the devastating impact that untreated HIV could have on the public health. Untreated HIV is far more infectious increasing the chance that the person living with HIV/AIDS will transmit the infection. In addition inconsistent adherence to HIV medications can create virus resistance to those medications making the HIV even harder and more expensive to treat. A growing body of evidence supports the fact that these multi-drug resitant strains can be transmitted to others making even newly infected HIV patients difficult to treat. In many ways HIV is like other chronic manageable diseases and in many ways it is not. HIV is a special exception because it can be transmitted. Optimal treatment of HIV, including reducing barriers to obtaining healthcare and medications that HIV infected persons face, is critical to containing the epidemic.

COST SHARES AND CO-PAYS ILL-ADVISED POLICY FOR CHRONIC ILLNESSES, ESPECIALLY HIV
In Spring of 2004 the increasing costs of HIV care and shrinking resources led decision makers at the Minnesota Department of Human Services (DHS) to institute a cost-share requirement. The purpose of the cost-share was to reduce a projected deficit in the ADAP program and avoid the creation of a waiting list. Access to CARE Act funded services is limited based on income guidelines the federal government establishes. The new cost-sharing policy for Minnesota ADAP is based on the idea that current ADAP recipients have low enough incomes to qualify for ADAP, but enough money to share the cost of accessing drugs and insurance by making payments for them. At this time DHS has indicated that it may not be finished making changes and further rationing HIV-related insurance and medication related services. Again evidence indicates that the healthcare system has saved enormous amounts of money by implementing cost shares and co-pays appropriately. A cost share or co-pay works when it limits access among a generally healthy population by encouraging appropriate use of medical care. In the case of those with chronic diseases an entirely different strategy works best. That strategy is aggressive management, including implementation of best practices in disease management, and removal of barriers to accessing care. This approach has been shown to save money in treating chronic diseases.

My message is this: evidence exists that ADAP programs with the most generous benefits for low income PLWH/As (paying for drugs and/or insurance to cover HIV care) actually save money for the states that pay for them. Essentially, the more generous a state is in covering the drugs and medical care of low income persons living with HIV, the more money it will save on their long-term care. This financial investment insures that PLWH/As are healthy and productive members of our state. Paying for PLWH/As to live healthy years of life instead of ill and disabled ones just makes good sense.

What I’d like you to do is this.
Minnesota should build on its successes by protecting and strengthening the AIDS Drug Assistance Program also called ADAP and program HH. It must remain an essential component of our approach to guaranteeing access to HIV care.

It is not the government’s role to determine who should be receiving access to lifesaving HIV medication. The government cannot be in the business of rationing of care through ADAP’ and denying life-saving medicines from anyone living with HIV. State government must do all in its power to guarantee that people living with HIV have access to care and treatment services.

We must find a way together to guarantee that ADAP resources are not limited or that a hierarchy is established to determine who is entitled to receive life-saving medications through ADAP. I believe the HH bill before you is key to that guarantee.

(Portions of this testimony were taken from my article for the Planning Council Newsletter published in March 2005 “Ethics of Rationing ADAP.” The final paragraph of the testimony borrowed heavily from the remarks of Dr. Marsha Martin, executive director of AIDS Action to the CDC/HRSA AIDS Advisory Committee Meeting November 18 & 19, 2004 as published in AIDSACTION.ORG’s online “Weekly Update.”)
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There are many good reasons to support the HIV Prevention and Treatment Access Bill -- the HH reform bill introduced by MAP [SF1836/HF1892], among them are some practical considerations:

1. The bill updates current state policy on HIV prevention and treatment to reflect the impact that HIV drug treatments have had since introduced in 1995. Today the emphasis in HIV policy should be on both access to health care and on prevention of new infections. This bill
addresses both concerns.

2) If enacted, the legislation would roll back the cost share provisions that were implemented by the Department of Human Services in 2004 without legislative authority.

3) The bill establishes a clearer role for the legislature as a partner in forming state policy in regards to the HH program and how it promotes HIV prevention and access to care.

4) The bill proposes to restore the funding to a level that is adequate enough to provide services through the next two-year, state budget cycle. 75 percent of the proposed funding is already available in the form of federal Ryan White CARE Act dollars, state general fund appropriations that are part of the base budget, and anticipated funding from drug rebates.

Updated: March 28, 2005

The HIV Prevention and Health Care Access Program bill (SF1836 and HF1892) has been introduced in the House and the Senate. The bill proposes uninterrupted access to HIV treatment without cost shares for low-income persons living with HIV. The bill also proposes full funding for the state’s HH Program. The lead authors are Sen. John Hottinger [DFL – St. Peter] and Rep. Paul Thissen [DFL – Minneapolis]. Encouraging Senate health committee members to support the bill is an immediate priority. Promoting broad legislative support will be the focus for MAP’s AIDS Action Day on April 12. Click here to read a copy of the bill.

It’s crunch time at the State Capitol. The first committee deadline is Tuesday, April 5. Bills that have not been approved by committees in at least the House or Senate are dead for the session. The best shot at getting changes made to Minnesota’s crippled HIV Insurance/Drug Program, a.k.a. Program HH or ADAP is to win the approval of the Senate Health and Family Security Committee. Contact committee members now. Right now! Because in this hectic rush to meet the April 5 deadline, the bill could come up for a vote as early as this Wednesday night, March 30.

Updated: March 9, 2005

MAP is coordinating introduction of legislation this week that would ensure continuous access to HIV treatment without cost shares for low-income persons living with HIV. The bill will also propose funding the state’s HIV insurance and drug assistance program at $12 million over the next two years. Lead authors will be Sen. John Hottinger [DFL – St. Peter] and Rep. Paul Thissen [DFL – Minneapolis]. Encouraging lawmakers to support the bill in order to provide uninterrupted access to HIV treatment will be the focus for MAP’s April 12th AIDS Action Day. Click here to read a draft copy of the bill.

Updated: Summer, 2004

An open letter to Assistant Commissioner Loren Coleman regarding ADAP

An open letter to Commissioner Kevin Goodno regarding ADAP

An open letter regarding HIV Insurance and Drug Assistance Programs

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Last Updated: Friday, March 30, 2007
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