Older Americans will suffer if White House cuts HIV funding

President Trump’s latest proposal would allow health insurance plans to limit the HIV/AIDs medications they cover through Medicare Part D. 

Patients relying on Medicare Part D, would be one of six “protected classes” now denied access to their needed medicines. The proposal is shortsighted, as it surely will not save the costs projected in the proposed budget. This is because of the rise in health costs, hospitalization and far more expensive acute treatment and strains on health systems, including in the mental health arena.

{mosads}This can be cited in the AJMC 2018 study, which found roughly $2.28 billion in additional costs, which was a result of HIV more restrictive formularies not unlike those being proposed now.

The more interesting idea that emerges from this regulatory blunder is what it represents in regard to the relationship between health policy and our aging society.

The mere fact that we are debating whether to pay for newer, more effective, innovative HIV/ AIDS medications under Medicare Part D is a serious and profoundly significant moment. 

Have we forgotten that it was only 30 years ago that HIV/AIDs was a certain death sentence, but now we have aging HIV patients and patients who are able to lie fulfilling lives with the disease.   

This stunning reality means we have now entered the third phase, where HIV Infected patients have joined the rest of us to, “become old.”

An HIV patient can qualify for this Medicare program is a big deal and it reflects the miracle of our national and global medical-scientific journey of discovery, innovation and treatment.

It wasn’t that long ago that President Ronald Reagan first talked publicly about the unspeakable and stigmatized disease. He began the funding process, which led Congress to allocate almost three times more than what he requested. 

Why would we now threaten to cap the progress we’ve made for aging HIV patients?  It is something every administration — in the past 35-years — has done to give hope people through access to innovative medicines and enabling them to have the possibility of a long life. 

It is a particular ironic that this proposed regulation stands in the way of further progress and threatens to push us backward.

Denying access through clever, if misinformed tactics — such as prior authorization and step-therapy — will not only adversely affect the progress we have seen, it will become a version of the most reviled and ultimately defeated parts of the Affordable Care Act: those death panels that we feared would decide who does and does not get access to medical and health interventions.

This proposal is not consistent with the cross-aisle claims for supporting funding to pre-existing conditions. AIDs has always been a sort of social barometer for moral clarity, one fears these steps backward also represent the proverbial slippery slope for other tragic disease areas from cancer to Alzheimer’s.

President Trump, his HHS Secretary Alex Azar and their Administrator of Center for Medicare and Medicaid Services Seema Verma should intervene. Congress could take a position — one that surely would be bi-partisan — both following in the tradition of Ronald Reagan and all who followed. There is no reason to not stay on the right side of history on this issue.

Michael W. Hodin, PhD is the CEO of the Global Coalition on Aging; a managing partner, High Lantern Group; and a fellow at Harris Manchester College at Oxford University.