Posted by: Randy Allgaier | September 2, 2006

Governmental Disconnect

I spent the last week of August at a conference for grantees of the federal Ryan White CARE Act which funds services for people living with HIV/AIDS who are uninsured or underinsured.  The conference was organized by the HIV AIDS Bureau (HAB) within the Health Resources Service Administration (HRSA) which is an agency of the Department of Health and Human Service (HHS).  With all those acronyms there is no disputing that this is a federal program. 

In their attempt to make the attendees feel warm and fuzzy about the work of the CARE Act grantees (state health departments, local health departments and an array of clinics) the conference organizers (HRSA/HAB) stated some statistics for this $2.1 Billion program.  According to 2006 Ryan White CARE Act Progress Report: On the Frontlines, people living with HIV/AIDS are poorer than the general population, and CARE Act clients are poorer still. More than 50 percent of CARE Act clients have household incomes equal to or below the federal poverty level and only 11 percent have any private health insurance. Findings in the report summarize program data from 2004.   In a HRSA press release, agency administrator Dr. Elizabeth M. Duke stated, “The report reminds us of our mission in administering the CARE Act: to ensure that we address the needs of those living with HIV/AIDS who otherwise would have no access to care.”

Am I the only one struck by the disconnect between a government agency touting their service to an impoverished population without health coverage that is operating in a government that is adamantly opposed to universal health coverage and does not support any economic and tax policy that would work towards lessening poverty?

While HRSA was patting itself on the back for serving a population that our leaders leave behind on a regular basis, the Census Bureau released some sobering statistics.  The new data also showed continuing erosion in the percentage of Americans covered by health insurance. In 2005, an estimated 46.6 million people had no coverage, up 1.3 million since 2004 and increasing the percentage of Americans without health coverage from 15.6 percent of the population to 15.9 percent.  After recent decreases in the numbers of children without health insurance, this year’s data found that their numbers grew between 2004 and 2005, rising from 10.8 percent of those under 18 to 11.2 percent. 

Simultaneously the California Legislature passed a bill that would make
California the only state to offer all its residents government-operated health care. Of course it should be no surprise to anyone that the state Republican party has cozied up to the insurance industry in opposing this bill and Republican Governor Arnold Schwarzenegger is likely to veto the legislation.

The health care bill “will make quality health care available to each of us while preserving our freedom of choice as consumers and patients,” the bill’s author, Senator Sheila Kuehl, (D-Santa Monica), said after the Senate agreed to Assembly amendments on a 24-12 party-line vote.  Under the amended bill,
California residents essentially would pay their health insurance premiums, copays and deductibles into a state-funded health insurance program. Money the state spends on health care also would go into the new system. Kuehl modeled her bill on a private study that found billing each resident and business an annual premium based on income would be enough to pay for universal health care.  Kuehl said her bill guarantees that patients can choose their own doctors and would allow the state to cut prescription drug costs by negotiating bulk purchases. It also would help cut health care costs through increased efficiencies and reduced administrative costs, she said. In April, Massachusetts passed a plan that would require all residents to buy health insurance or face legal penalties, in much the same way California requires motorists to buy auto insurance.

The recently released census figures show Californians are more likely to be uninsured than residents of other states, said Anthony Wright, executive director of Health Access California. The Legislature’s approval of Kuehl’s plan shows that California’s health care system needs immediate improvement, he said.

San Francisco Chronicle business columnist David Lazarus has said that a single payer health system that would mix current federal programs (Medicaid and Medicare) with tax revenues that would raise corporate taxes by a little more than 7% and individual income taxes by a little over 3% would save more than $8 billion to the state, corporations and individuals in the first year.  Health care economists everywhere agree that public sector health care (i.e. Medicare and Medicaid) are much more administratively efficient than health care in the private sector. 

I vigorously support the CARE Act and other programs that cobble together some resources for those in our society that are poor, living with disabilities and have no health coverage.  I have spent a great deal of my professional life advocating for the CARE Act and for appropriations to its programs.  I am a staunch supporter for reauthorization of this legislation in a way that ensures thoughtful health policy and not a political agenda.  As a person living with AIDS I have benefited from the CARE Act’s ADAP program but admittedly- it is California’s generosity to this state/federal program that benefits me the most.  However Americans – including people living with HIV/AIDS – would be best served by universal health care.  It would reduce the strain on our economy (health care costs our economy about $2 trillion annually), ensure a healthier population and benefit those least likely to have health coverage- our children.


  1. The most importans as usual inthe end

  2. good job

    Think you are on track with this post

  3. carisoprodol

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