Remarks to the National Rural Health Association

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U.S. Department of Health & Human Services
Health Resources and Services Administration
HRSA Press Office: (301) 443-3376


by HRSA Administrator Mary K. Wakefield

January 25, 2010
Washington, D.C.

Let me begin by congratulating Deborah (Parham-Hopson, associate administrator, HIV/AIDS Bureau) and Laura (Cheever, deputy associate administrator) and everyone in the HIV/AIDS Bureau for your leadership in addressing HIV/AIDS and in supporting some of the world’s best care for people living with HIV/AIDS here in the United States and around the world.

HRSA’s work to combat HIV/AIDS is, of course, centered in HAB, but every part of HRSA has a role to play in this fight. 

After all, HRSA’s programs are structured to help Americans who have too few assets and too little access to health care.  And HIV/AIDS in the United States has become, through the decades, increasingly a disease that strikes hardest at those in poverty and at minorities and medically underserved populations. That means that the populations most affected by HIV/AIDS line up more closely now than ever before with the populations that HRSA traditionally serves. 

This extension of HIV/AIDS work into more of HRSA’s programs is a “natural” evolution for us as we track the virus and do our best to treat it, contain it, and eliminate it.

So one of my greatest challenges as HRSA administrator is to make sure that we apply all of our assets – and not just those located in HAB – in the fight against HIV/AIDS.

Luckily, we have a President who is fully engaged in this arena.  And because of his work – and the work of this Congress – we have three reasons why we should be more optimistic about our ability to address HIV/AIDS than ever before.

They are:

  • first, passage of the Affordable Care Act in March;
  • second, President Obama’s announcement of a National Strategy to Fight HIV/AIDS in July; and
  • third, our own efforts to re-organize resources here at HRSA in response to the President’s strategy.

Let me make a brief comment about each of these areas. 

First, the Affordable Care Act.  The Act will help people living with HIV/AIDS in the same way it helps all Americans – by improving access to private health insurance and by limiting insurance industry abuses that previously denied or revoked coverage.

Historically, people living with HIV/AIDS have had a particularly difficult time obtaining private health insurance, and they have been especially vulnerable to insurance industry abuses – denial of coverage because of pre-existing conditions and so on.

But as of September 23 of this year, on the six-month anniversary of the Affordable Care Act, insurers could no longer deny coverage to children living with HIV or AIDS.

Also effective then, the ACA prohibited insurers from cancelling or rescinding coverage to adults or children except in cases of fraud.

And insurers no longer can impose lifetime caps on insurance benefits.

All of these changes will begin to improve access to insurance for people living with HIV/AIDS and other disabling conditions and help people with these conditions retain the coverage they have.

These changes are a very important bridge to the more sweeping changes in insurance that will be made in 2014 as the Affordable Care Act is fully implemented. Beginning in 2014, insurers will not be allowed to deny coverage to anyone or impose annual limits on coverage.  People with low and middle incomes will be eligible for tax subsidies that will help them buy coverage from new state health insurance exchanges.

The Affordable Care Act also broadens Medicaid eligibility to include individuals with income below 133% of the Federal poverty line ($14,400 for an individual and $29,300 for a family of 4), including single adults who have not traditionally been eligible for Medicaid benefits before. As a result, a person living with HIV who meets this income threshold no longer has to wait for an AIDS diagnosis in order to become eligible for Medicaid.

Additionally, the Affordable Care Act phases out the Medicare Part D prescription drug benefit “donut hole,” giving Medicare enrollees living with HIV/AIDS the peace of mind that they may be able to afford their medications.  And next year, in 2011, these beneficiaries will receive a 50% discount on brand-name drugs while they are in the “donut hole,” a considerable savings for people taking costly HIV/AIDS drugs.

Here at HRSA, the Affordable Care Act expands the healthcare workforce and dramatically increases funding for HRSA’s health center network.  By 2015 we hope to double the number of patients treated at health centers each year.  Last year health centers treated about 19 million patients, so we’re talking about an enormous increase in access to primary and preventive health care.

And we’re doing so at the same time that health centers themselves are involved in a major push to improve the care they provide by emphasizing patient-centered medical homes for patients and managing chronic diseases, including HIV/AIDS.

The new law also will increase the health care workforce.  Funds from the Affordable Care Act and the Recovery Act will support the training and development of more than 16,000 new primary care providers over the next five years.

And the ACA alone will boost the ranks of the National Health Service Corps to almost 11,000 clinicians by the end of 2011.  That’s more than triple the size of the Corps in 2008.

To wrap up, here’s what the Affordable Care Act means for people living with HIV/AIDS: better access to care; more health care professionals to deliver that care; expanded Medicaid eligibility; and help with prescription drug costs for people on Medicare.  That’s real progress.

The second major advance in the fight against HIV/AIDS occurred this past July, when President Obama announced his National HIV/AIDS Strategy.  It has three primary goals:

  • To reduce the number of people who become infected with HIV,
  • To reduce HIV-related health disparities, and
  • To increase access to care and optimizing health outcomes for people living with HIV.

One of the key steps we need to take to reach those goals is to “achieve a more coordinated national response to the HIV epidemic in this country.”

The president wants us to increase the coordination of HIV programs across the Federal government and between Federal agencies and state, territorial, tribal, and local governments.

To do that, he directs us to “create a seamless system to immediately link people to continuous and coordinated quality care when they are diagnosed with HIV.”

And so, that’s what we’re working to make happen here at HRSA.

We’ve set up an agency workgroup, with Deborah as the lead, to implement the President’s strategy here.  All of our bureaus participate in the workgroup.  The process involves workgroup members developing recommended actions and bringing them to Senior Staff meetings for discussion.  Once approved, the bureaus begin to implement them.

In addition, HAB and the Bureau of Primary Health Care also participate on the Department’s implementation committee convened by Secretary Sebelius.  Both HAB and BPHC have central roles at the Department level in moving the implementation plan forward.

Let me share some of the actions that HRSA’s bureaus are taking to implement the President’s strategy and involve more of HRSA in the fight against HIV/AIDS:

At the Bureau of Primary Health Care, the health center system Jim Macrae and his staff oversee has long been deeply involved in delivering health care to people living with HIV/AIDS.

In 2009, HRSA’s 1,100 health center grantees treated 95,000 patients whose primary diagnosis was HIV/AIDS and gave HIV tests to almost 700,000 patients.

And now, to implement the President’s strategy, BPHC is making doubly sure that care for people with HIV/AIDS is built into their work.

For example, BPHC is sending program advisories to all health centers informing them of PHS guidelines on routine HIV testing and HIV/AIDS care and treatment.

Through BPHC, we’re promoting the establishment of formal referral arrangements when complex HIV-related care and treatment is not provided directly by the health center.

And we are encouraging HRSA-funded Primary Care Associations to develop specific activities to increase health centers’ capacity to provide HIV/AIDS services.

In addition, BPHC is working with grantees, HAB, and other Federal agencies to improve data collection on health center patients with HIV/AIDS.

At the Bureau of Clinician Recruitment and Service, staff is making sure that all 7,500 NHSC clinicians currently on board know how to access the PHS HIV Prevention and Treatment Guidelines and other related resources.  And BCRS will make sure the thousands who will enter the Corps in 2011 are aware as well.

In our Office of Rural Health Policy, staff developed a manual that helps HIV/AIDS-affected rural populations in the Southeast find resources available to them.  At the Ryan White grantee meeting this past August, ORHP convened a workshop to educate people on programs and funding opportunities that can help rural organizations dealing with HIV/AIDS issues.  And they are currently working to increase the number of ORHP grants that focus on helping rural people living with HIV/AIDS.

In our Maternal and Child Health Bureau, 56 of 59 states and territories that receive Title V MCH Block Grant funds report some HIV-related activity or include HIV/AIDS among the MCH issues that are addressed in their programs.

Some states have developed performance standards that directly address HIV issues.  For example, the Arizona MCH program collects information on the percentage of pregnant women counseled for HIV testing.  In New Jersey, MCH providers track the percentage of HIV-exposed newborns who receive appropriate antiviral treatment to reduce perinatal transmission.  And Puerto Rico counts the number of HIV-positive pregnant women treated with AZT.

In addition, in HRSA’s Healthy Start program, which works to lower infant mortality rates in 101 high-risk communities, our grantees regularly counsel pregnant women about HIV testing and refer women for testing and treatment.

In our Bureau of Health Professions, many programs have grantees that are working to improve the ability of health care professionals to deliver HIV/AIDS care.  These programs include:

  • the Advanced Nursing Education program;
  • the Residency Training in Primary Care Program;
  • the Physician Faculty Development Program;
  • the Physician Assistant Training Program; and
  • Postdoctoral and Predoctoral Training Programs in General, Pediatric and Public Health Dentistry and Dental Hygiene.

Let me just give you two examples of how those programs work:

  • In Boston, a Residency Training program grantee has developed a training track that prepares residents to improve their delivery of HIV primary care to lesbian, gay, bisexual and transgender patients.
  • And in Alabama, a Physician Assistant program is increasing the number of physician assistants trained in the diagnosis and treatment of acute and chronic HIV disease and the STDs that often accompany it.

In addition, BHPr is encouraging its Public Health Training Centers Program grantees to align their activities in support of the President’s National HIV/AIDS Strategy.  These centers offer a broad range of training on public health issues.  Already they have sponsored dozens of training sessions on topics such as women and HIV, pediatric AIDS, HIV and intimate partner violence, and housing health and HIV.

My point in sharing all of this with you is to affirm that HRSA is stretching to apply more of our resources in the fight against HIV/AIDS.  And now is the time to really push it forward.

The Affordable Care Act gives us a once-in-a-lifetime opportunity to expand access to care and improve the quality of that care for all Americans. 

And President Obama’s National HIV/AIDS Strategy provides a roadmap to follow in using those and existing resources to bring more and better care to groups traditionally served by Ryan White programs.

With HAB’s guidance, and with the leadership of the HRSA workgroup, I am determined to build a more coordinated federal response to HIV/AIDS and a more just America in 2011 and years to come.

I look forward to engaging this important agenda with you.

Thank you.

Date Last Reviewed:  April 2017