The government should pick up more of the costly medical tab for low-income Americans with HIV and create a new federal benefits program to do it, a scientific panel recommended Thursday.

Such expanded coverage could cost $5.6 billion over 10 years, says the report by the Institute of Medicine, which suggests streamlining HIV/AIDS care by shifting current federal spending, including Medicaid funds, to a single entitlement program.

Despite the advent of new and improved AIDS drugs, thousands of people are left with inadequate treatment because government programs are hampered by shortfalls in state budgets and confusing eligibility standards that vary among states, says the report.

“Failing to provide these cost-effective, lifesaving drugs to all Americans who need them - including individuals who lack insurance or cannot afford them - is indefensible,” said Lauren LeRoy, chair of the committee ordered by Congress to examine the public finance structure of HIV care for low-income, uninsured and underinsured people.

The Department of Health and Human Services, which sponsored the study at Congress’ request, suggested the panel’s recommendations were overreaching.

The “committee has recommended fundamental changes, in effect arguing that existing cooperative programs should be replaced by a new federal entitlement program. Such an approach would require sweeping legislative changes,” the agency said in a statement.

The department added that it is reviewing its existing programs.
Relief for states

LeRoy acknowledged it is unlikely Congress or the administration will soon move forward on their recommendations at a time of severe federal budget constraints. The added costs of the proposed program would include more services such as assistance for mental health and substance abuse.

The study’s authors argue that a single public financing arrangement - including uniform eligibility requirements across the country and a federally defined set of services - would address gaps and a lack of coordination in the current system, where, for example, a single patient can lose benefits after moving to another state.

“The current federal-state partnership for financing HIV care is unresponsive to the fact that HIV/AIDS is a national epidemic with consequences that spill across state borders,” the panel wrote.

The panel also stressed that having the federal government take on HIV/AIDS costs for lower-income people would relieve cash-strapped state Medicaid programs.

Under the proposed program, as many as 58,000 more people would receive treatment for HIV, the report estimates, and immediate access to drug therapy could prevent some 20,000 deaths over a 10-year period.

The Centers for Disease Control and Prevention estimates 850,000 to 950,000 Americans have HIV or AIDS, and some 40,000 more are infected each year.

The Institute of Medicine, an arm of the National Academy of Sciences, is a nonprofit organization created by Congress to provide scientific advise to improve health.