STATEMENT: Key Treatment Program At Risk
Washington Lawmakers Plan to Slash Medicaid Spending While Boosting Tax Cuts
Two-thirds of Blacks in treatment for AIDS pay for it with public insurance programs
Congressional leadership and the Administration have colluded to pass a plan for cutting Medicaid by $10 billion over the next five years. Medicaid is the largest payer for HIV treatment in the nation, accounting for half of all people in treatment. Sixty- four percent of African Americans being treated for HIV/AIDS pay for it with Medicaid or Medicare. The fiscal year 2006 budget plan that a House- Senate committee agreed to last week would hold all domestic spending flat and slash spending on programs that form a safety net for America's poor. At the same time, the plan racks up another $106 billion in tax cuts for wealthy Americans over the next five years. The budget plan suggests that much of the budget reductions come from Medicaid. Ideas for cutting the program's spending that are already being discussed include increasing patient co-pays and tightening restrictions on who qualifies for enrollment. Earlier this year, the Senate voted to remove all Medicaid cuts from the budget plan and to instead establish an independent commission to study ways to reduce costs. The Republican leadership and the White House, however, reinserted the cuts during the conference negotiations that were needed to reconcile the House and Senate proposals. President Bush's budget proposal had recommended $14 billion in Medicaid cuts over the next five years. The budget resolution is just the first step in Congress' annual budgeting process. Between now and the start of the fiscal year--October 1--the House and Senate will each hammer out the details of what each government program can spend next year. Members of the Senate Finance Committee, which has jurisdiction over Medicaid, are believed to support at least keeping Medicaid spending level. The National Governor's Association has also expressed concerns over cutting the program, but has now begun negotiating ways to reduce spending with key House members. The African American community must engage both our state leaders and our representatives in Washington to let them know how crucial Medicaid is to our community's health. Already, African Americans living with HIV are seven times more likely to die from the virus than infected whites. If Washington guts Medicaid, even as it hands out billions of additional dollars in tax cuts, more of us may be driven out of treatment or required to accept lower-quality care--and the AIDS death gap is likely to grow.
OP-ED: For the Progressive Media Project op-ed syndicate
The Administration is Finalizing Conservative Politicos' Decades-Old Assault on Medicaid
The Bush administration is not trying to make Medicaid run well but to force its collapse. In the process, states are left to deal with the mess. And the poor and disabled are bearing the brunt.
Medicaid was crafted as one of a suite of programs that defined America as a place of opportunity, a "Great Society" where children born into poor families weren't doomed to poor health.
As an entitlement program, Medicaid has always been structured as an open-ended partnership. The feds pay an agreed upon share of each state's costs, no matter how high they go, and the states remain bound by certain rules in shaping their programs -- rules meant to protect beneficiaries.
But Bush wants Medicaid remade as a block grant, meaning the feds pay only a fixed amount each year. The White House has been pushing versions of this plan since early in the first Bush term, and governors have stood against it, realizing that they were getting stuck with the bill.
From coast to coast, state budgets are reeling under Medicaid's burgeoning costs. On average, state Medicaid budgets have increased by 11 percent a year throughout the 1990s, and in some states by as much as 15 percent. As the spending has spiraled upwards, governors and legislatures have fought losing battles to control it. Almost every state has instituted some sort of cost-control restriction. This fiscal year, 43 states limited access to prescription drugs, 15 tightened eligibility and nine cut benefits.
Unable to sell governors on its block grant, the White House has instead tightened the screws.
Under Administration pressure, Congress has passed a budget blueprint that would force $10 billion in Medicaid cuts over the next five years. The same budget would rack up another $106 billion in tax cuts over that time. States are now scrambling to find ways to come up with the reductions themselves, rather than leaving it to Congress.
To achieve the sorts of Medicaid savings the congressional budget plan would force, states will have to take from those who need it most.
Medicaid's true cost driver is not its cadre of newly enrolled working poor--largely healthy people earning incomes just above the federal poverty level and using the program to get basic care. The real money is spent on care for seniors and people with disabilities. And to make a difference, this is where governors and legislators are going to have to wield their unforgiving budget knives.
In 2000, Medicaid spent nearly $10,000 per disabled enrollee, compared to just $1,600 per adult beneficiary. It is the nation's top payer for AIDS treatments, shelling out more than $4 billion a year. Overall, seniors and people with disabilities account for 71 percent of the program's costs.
These are savage cuts. And a nation committed to the greater good cannot let them stand.
Kai Wright is the editor of BlackAIDS.org. This op-ed was syndicated to daily newspapers around the country through the Progressive Media Project.
STATEMENT: "Baby Mama" Debate Misses the Real Enemy
Pop Songs Don't Threaten Youth Sexual Health; Inadequate Sex Education Does
Attacks on American Idol star Fantasia’s hit song “Baby Mama” miss the real enemy: abstinence-only education.
"American Idol" star Fantasia's hit single "Baby Mama" is stirring controversy among those concerned about teen sexuality in the Black community. A 20-year-old Black woman, Fantasia Barrino is a single mother with a 3-year-old child. Remarkably, she's balanced an exploding career with the responsibilities of parenthood; her song honors that achievement, boldly challenging the stigma attached to her place in life by calling her success "a badge of honor." Critics, however, say the song perversely celebrates a tragic outcome: babies having babies, as the phrase goes. (To hear the song and reactions to it, check out an NPR "Morning Edition" segment, aired on May 24.) Fantasia has simply made a beautiful song that affirms those like her, of any age, who face the mammoth challenge of single motherhood and don't give up. As Fantasia sings, "There should be a holiday for single mothers, but until then here's your song." No one, including Fantasia, wants to promote teen pregnancy. But ignoring young mothers or further stigmatizing them only exacerbates the problem. The real threats to the sexual health of young Black people come neither from pop music nor brave mothers like Fantasia; they are found in the aggressive assault on comprehensive sex education currently underway in our nation's schools. To be clear, whether it is HIV or pregnancy, sexual activity comes with consequences at all ages. And there is ample proof that a conversation about that fact is desperately needed among Black youth. We account for 56 percent of annual new infections among 13 to 24 year olds. Infections among young Black women are of particular concern. Through 2001, African Americans accounted for nearly three quarters of diagnosed HIV infections among 13- to 19-year-old girls and two thirds of 20- to 24-year- old women. The youth epidemic is primarily a sexual one. The U.S. Centers for Disease Control and Prevention tracks youth sexual behavior in an annual survey. In the most recent survey, Black youth reported the highest rates of having ever had intercourse: 67 percent compared to 42 percent of whites. They also reported having more sexual partners: Almost 30 percent of African-American youth reported more than four lifetime partners, compared to just under 11 percent of whites. Most startlingly, almost a fifth of Black youth reported having had sex by the age of 13, compared to 4 percent of white youth. Simply censuring youth who speak about their sexual lives will not change these realities. To the contrary, research shows that teens exposed to honest and comprehensive dialogue on sexuality are no less likely to have sex at an early age but are more likely to be safe when they do. Comprehensive sex education includes both conversations about abstaining from sex and information on how to avoid diseases and unintended pregnancies when being sexually active. As both the CDC and former Surgeon General David Satcher have noted, the spread of comprehensive sex education throughout the 1990s contributed to a steady increase in condom usage, even as the CDC's surveys charted a decline in sexual "risk." Yet, Washington is now forcing unproven "abstinence-only" sex education programs down schools' throats. These programs bar any discussion of safer sex strategies. Under the Bush administration, health department funding for abstinence-only education has doubled. A recent congressional review of the programs this money has funded found "false, misleading or distorted" information in the vast majority of the curricula being used. One taught that HIV can be transmitted through tears, another listed "financial support" and "domestic support" as among the five main things women need from a relationship. Teen sexuality is a topic that adults both inside and outside of the Black community are too eager to censure rather than discuss openly and from a place grounded in the realities young people are living. One newspaper columnist uneasy with Fantasia's song harked back to the days when teen moms were looked upon shamefully. But stigmatizing people has never accomplished anything other than undermining their self-worth. Fantasia has thrown open the door to her life's challenges. If we don't like what we see, we must confront the public policy decisions that make it more likely that others will have to face those challenges as well.
STATEMENT: The National HIV Prevention Conference
New South, New Problems
More than 3,000 AIDS experts have come together this week in Atlanta, Ga., to talk about the future of HIV prevention. The meeting’s location is appropriate. Much has been made in recent years of vibrant African-American communities that typify New South cities like Atlanta, with its burgeoning upper-middle class. But there’s another new reality to Black life below the Mason-Dixon Line: A rapidly-spreading epidemic that neither local communities nor the nation at-large has begun to adequately address. Forty-one percent of people living with AIDS are in the Southeast and the region is home to twice the number of positive Black women as the Northeast. In states like Alabama and North Carolina—where AIDS Drug Assistance Programs boast waiting lists in the hundreds—the need has far outpaced the resources. As new infections pile up, overloading a teetering care network, prevention efforts remain scant. This reality is part of a woeful national trend: The White House proposed a $4 million cut to the federal HIV prevention budget for the coming year. Washington would like us to have a zero-sum debate--either keep the status quo or redirect money from the large urban centers where the epidemic first erupted. We must reject this sort of thinking. There are more people living with HIV/AIDS today than ever before, yet our federal AIDS budget has remained all-but-flat since 2001. If we don’t want the numbers to continue rising, we must dedicate more money to the prevention programs that we know work, everywhere. The responsibility is not the government’s alone. One community group that can really make a difference is the church. Last month, more than two-dozen Black religious leaders met with Secretary of State Condoleezza Rice to discuss providing Black churches money to do AIDS work in sub-Saharan Africa. It was a historic meeting that must be applauded; hopefully the Bush Administration will follow through. But those religious leaders must also speak to both the Administration and their own communities about HIV. The group AIDS Alabama recently surveyed TK of its clients and found two thirds pray at least six times a week—the ground is fertile for ministries that help people take care of themselves. Throughout the summer and fall BlackAIDS.org will feature new reporting on the Southern epidemic, with investigative reports, columnists and profiles of the innovative prevention campaigns that have limited resources but are making a difference. Be it in our own communities or in government, Black America can no longer accept either/or distinctions when it comes to HIV. It’s not the North or the South, global or domestic; it’s both. HIV does not quibble over such distinctions, and neither can we.
STATEMENT: The National HIV Prevention Conference
Same Song, Second Verse
Another AIDS meeting and another batch of gloomy data show the continued blackening of this epidemic. The U.S. Centers for Disease Control and Prevention told us yesterday that African Americans now make up 47 percent of people living with HIV in the nation. We’re just 13 percent of the overall population. Black gay and bisexual men were once again a woefully remarkable group. Forty-six percent of Black “men who have sex with men” in a new five-city CDC study were positive, and two-thirds didn’t know it.
These numbers come as Washington prepares another year of budget cuts for HIV prevention programs. The CDC’s HIV and STD prevention budget was $738 million in fiscal year 2004—an already inadequate sum given the challenges the epidemic presents. Congress cut it to $731 million in fiscal year 2005, and the White House has proposed yet another $4 million cut for the coming year.
Federal public health officials are frantically searching for ways to interrupt this epidemic, but Congress and the White House have steadily undermined them. As study after study presented in Atlanta has shown, we already know that targeted, intensive HIV prevention works. That sort of program doesn’t come cheap.
The administration has rightly stressed the need for more accountability in HIV prevention. If we invest in a program—both financially and communally—we need to know whether it works. As the CDC’s new data shows, we no longer have the luxury of guess work. We must find ways to evaluate prevention programs, qualitatively and quantitatively.
The need for responsibility and accountability, however, does not stop with those who are crafting prevention programs. The administration must be accountable as well.
Time and again, small, community-based organizations have complained that they are overwhelmed with paper work and auditing, which limits their ability to actually run the programs they’ve been funded to execute. These small, grassroots groups are too often those working in Black and Latino neighborhoods. As we demand more proof of that their work is effective, we must also make sure they have the resources necessary to provide it. Otherwise, we merely insure that community-based organizations get crowded out of the prevention process—a development certain to undermine our efforts in the end.