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Author Topic: How does Obamacare affect HIV patients on meds?  (Read 7072 times)

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Offline newbieguy

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How does Obamacare affect HIV patients on meds?
« on: June 28, 2012, 12:23:07 PM »
I am a recent college graduate, and due to the bad economy have so far been unable to find employment, despite aggressively looking. I agree with Obama for what he's done for gay rights, but not the economy and jobs. I have been on Atripla since 2010 and thankfully Ryan White grant has enabled me to get my meds free of charge. So here's my question...exactly how does the Supreme Court's upholding of the Obama healthcare law affect those of us with HIV and who are on Ryan White? I also have insurance, but it hardly would make a dent in the cost of my HIV medication without Ryan White...theres a lot of bullshit and spin comng out of the mouths of politicians. So how does the healthcare law affect people like me who have HIV, and are on meds?
« Last Edit: June 28, 2012, 12:25:24 PM by newbieguy »

Offline thunter34

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  • His name is Carl.
Re: How does Obamacare affect HIV patients on meds?
« Reply #1 on: June 28, 2012, 12:29:10 PM »
As fate would have it, I am due to go down to my clinic today for an appointment and some pills, so I am planning to ask about this directly today.  I am also on RW and ADAP.  I am wondering how this might change things up through my IDP. 

I imagine others will have some feedback for you, but I'll try to post what I'm told later today or tomorrow. 
AIDS isn't for sissies.

Offline Dachshund

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Re: How does Obamacare affect HIV patients on meds?
« Reply #2 on: June 28, 2012, 12:36:51 PM »
Right now it has no effect on Ryan White and ADAP. As long as you meet the requirements you can continue with that program.

Offline leatherman

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Re: How does Obamacare affect HIV patients on meds?
« Reply #3 on: June 28, 2012, 04:53:43 PM »
RW/ADAP was renewed up until 2014, after that things may/probably will change

the American Academy of HIV Medicine explains it well on their site
Quote
Starting in 2014 thousands of Ryan White patients who previously received care and treatment through the Ryan White program will begin to receive coverage through other programs created under the ACA. A majority will become part of the new Medicaid expansion; another portion are likely to gain coverage through the State Insurance Exchanges and the new state Pre-Existing Condition Plans (PCIPs).

Because Ryan White is a “payer of last resort” program, those patients who will have access to the new programs must use them first.
However, since the states will have significant flexibility in establishing the new programs, it is possible that some former Ryan White patients may end up with insufficient benefits, inadequate access to medications, or possibly even less than adequate access to care. They may also see new or increased co-pays, deductibles, or other cost-sharing. It is possible that the Ryan White Program may be able to aid in supplementing some of these areas.

Ryan White providers and clinics will likely help transitioning into these new systems, and ensuring inclusion in the new networks of care. Providers need to pay attention to the requirements and opportunities in their state to be included in the billing networks, referral networks, and care networks for their state’s Exchanges and state Medicaid program.
 
Most of the provisions of the ACA do not take effect until 2014, and their overall effects of ACA implementation will not become clear until sometime after that. The Ryan White Program as a whole will likely see many changes. Some of these may include the types of patients accessing services, to what services are provided, how those services wrap around the new systems. However, it seems as though there will ultimately be a significant need for the Ryan White safety net after 2014.

The Ryan White Program was reauthorized in 2009 through September 30, 2013. One positive change in the 2009 reauthorization was the removal of the “sunset” provision that had existed under previous reauthorizations.
http://www.aahivm.org/ryanwhite
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline Oceanbeach

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Re: How does Obamacare affect HIV patients on meds?
« Reply #4 on: June 29, 2012, 07:03:40 PM »
My pharmacy bill is just over $3600 each month which is 3X my SSDI income.  It is paid by Medicare Part D, and other insurances.  The other insurances are Medi-Cal and ADAP. 

A few years ago the Medi-Cal budget was cut so hard our ASO had to terminate Nurse visits.  The ASO was also hit with the loss of RWCA Title I funding and struggle to serve a growing list of clients.  In addition, Medi-Cal cut alternative medical practices, dental, vision and chiropractic.  Our ASO had to close it's Russian River office and their main office which was once thriving with program, support services and staff, now looks like ghost town parade. I have been self case managed for about 5 years.  That was Sonoma, they didn't put up much of a fight for their funding.

In San Francisco, which remains a Title I EMA, 6 million was taken from the budget.  Mayor Ed Lee has replaced the Title I funds for AIDS services in San Francisco for 2 years.

Being already more than 133% below the poverty level, a 1/2 price reduction in the cost of medications are still not affordable.   I will be really old in 2020 and wonder, who is going to pay for my medications then?   8)  Have the best day
Michael

Offline denb45

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Re: How does Obamacare affect HIV patients on meds?
« Reply #5 on: June 29, 2012, 07:10:32 PM »

In San Francisco, which remains a Title I EMA, 6 million was taken from the budget.  Mayor Ed Lee has replaced the Title I funds for AIDS services in San Francisco for 2 years.

Being already more than 133% below the poverty level, a 1/2 price reduction in the cost of medications are still not affordable.   I will be really old in 2020 and wonder, who is going to pay for my medications then?   8)  Have the best day
Michael

Micheal honey, by the yr. 2020 I'll probably be DEAD ( I'm 55+ now) so I'm not worried about whats happened then, I can't even think past next-week, the thought of it makes my head-swell  ???
"it's so nice to be insane, cause no-one ask you to explain" Helen Reddy cc 1974

Offline Jeff G

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Re: How does Obamacare affect HIV patients on meds?
« Reply #6 on: June 29, 2012, 07:21:27 PM »
Being already more than 133% below the poverty level, a 1/2 price reduction in the cost of medications are still not affordable.   I will be really old in 2020 and wonder, who is going to pay for my medications then?   8)  Have the best day
Michael

Its a sobering thought isn't it . While I'm very happy for all the people the health care law will impact in a positive way Im aware that for some of us on medicare who still face the same problems shouldn't count on much more happening for a long time in regards to any new reforms in heath care , its a great start but we sure have a long way to go before we feel the relief . No pun intended but we must stay positive .     

Offline Oceanbeach

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Re: How does Obamacare affect HIV patients on meds?
« Reply #7 on: June 29, 2012, 09:11:02 PM »
Micheal honey, by the yr. 2020 I'll probably be DEAD ( I'm 55+ now) so I'm not worried about whats happened then, I can't even think past next-week, the thought of it makes my head-swell  ???
 

Oh Dennis, I'm older than you... Just a few months ago, a stranger on my street referred to be as "the old guy at the bottom of the hill."  I moved...
  8)  Have the best day
Michael
« Last Edit: June 30, 2012, 04:10:50 AM by Oceanbeach »

Offline Oceanbeach

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Re: How does Obamacare affect HIV patients on meds?
« Reply #8 on: June 29, 2012, 09:35:57 PM »
Its a sobering thought isn't it . While I'm very happy for all the people the health care law will impact in a positive way Im aware that for some of us on medicare who still face the same problems shouldn't count on much more happening for a long time in regards to any new reforms in heath care , its a great start but we sure have a long way to go before we feel the relief . No pun intended but we must stay positive .     

Hey Jeff,

He has the tenacity, I read the President's books last year and was impressed with his Senate campaign.  He walked neighborhoods, knocked on doors, stopped people on the street and spoke at every opportunity to find out what the American people want and need.  Access to healthcare for all!  The President has my vote and I am just looking at the possible details and how they concern me.    8)  Have the best day
Michael

 

Offline Pilot

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  • Posts: 126
Re: How does Obamacare affect HIV patients on meds?
« Reply #9 on: July 05, 2012, 08:24:35 PM »
I am not sure how any of this will work out. My new case workers is so green behind the ears she actually believes we have laws that protect people.  lol....Anyway, she told me they are under great pressure to get people off RWhite and onto the high risk pool for the state.  I looked it up and you can not get a straight answer from their own web site.  It will be anywhere from 199 to 600 per month for limited coverage and a one million dollar cap. There will be co-pays for everything.

She informed me that under the risk pool that R.White would pay the premiums and co-pays and still save money over the old method.  This made no sense to me, how can they save money by paying the premiums and co-pays. They also will allow a total income of 32 thousand gross and remain in the pool.

Under R White I am currently allowed two doctor visits per year and they pay for my meds.

I am going to give it one more try possibly with someone who is older and has more experience in the system but this may prove difficult as the case workers tend to hang around for a year or two at the max and then you get the nice letter saying they have moved up in the organization and I would be getting a new case worker.

Offline leatherman

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Re: How does Obamacare affect HIV patients on meds?
« Reply #10 on: July 05, 2012, 10:04:12 PM »
She informed me that under the risk pool that R.White would pay the premiums and co-pays and still save money over the old method.  This made no sense to me, how can they save money by paying the premiums and co-pays.
Right now, RW often pays the premium and co-pays for people who are financially eligible for ADAP. Since many HAART regimens cost around $2500 to $3000 per month, covering someone's insurance premium and co-pays is a lot less expensive than having to purchase the meds outright.

I am going to give it one more try possibly with someone who is older and has more experience in the system but this may prove difficult as the case workers tend to hang around for a year or two at the max and then you get the nice letter saying they have moved up in the organization and I would be getting a new case worker.
you may not get many answers right now. AHA won't be going into full effect, especially in regards to RW, until the RW act comes up for renewal in 2014. By then many things will have changed as some states will have created high risk pool, expanded their medicaid programs and created health care exchanges; while other states won't have any of that and won't be accepting any federal funds.

if you re-read the large quote I posted from the American Academy of HIV Medicine website, and realize that it was just this last week the Supreme Court finally upheld the AHA so that it can now aggressively move forward, you'll understand that many of the details you're looking to find are probably just now starting to be worked out for a hopeful transition in 2014. I hope you can find out more about your situation; but in the middle of an transition from RW to AHA there may not be many answers for you quite yet.
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline Oceanbeach

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Re: How does Obamacare affect HIV patients on meds?
« Reply #11 on: July 07, 2012, 05:38:38 PM »
As a person who uses Medicare, Medi-Cal and ADAP for prescription services, I totaled my current retail amounts and referred to BC/BS web site to find the current cost of insurance.

I take: Truvada and Norvir (Drug Tier 2)
Presista (Drug Tier 5)
Pravastatin, Lisinopril and Gabapentin (Drug Tier 1)

BC/BS offers 3 plans Basic, Enhanced, and Premium.  I can not afford any of them today.  I called the toll free number for a quote from an Agent.  She said:  Nothing is in the works now because the election is close and Obamacare will be replaced with whatever Mitt Romney has planned.

The advantage to being on Medicare/Medi-Cal for prescription coverage, over the person who already has private insurance is... The Medi/Medi client can change coverage any time of the year, while the private insurance client can only change vendors at the beginning of the year.

The Formulary, plan pricing, premiums and deductibles will be available to the Sales Staff on October 1st for the year 2013.  On October 1st, 2013, the plan with pricing for 2014 will be available.  We know nothing on this for 2 years.   8)  Have the best day
Michael

 

Offline denb45

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Re: How does Obamacare affect HIV patients on meds?
« Reply #12 on: July 07, 2012, 07:34:37 PM »
As a person who uses Medicare, Medi-Cal and ADAP for prescription services

Micheal.......what is the current-cut-off level for Medical, I had it for about 2 yrs. when I 1st got my SSDI back in 98...is it still 20k a yr. last i recall it was 17K or 18K a yr. but that was almost 12 yrs ago when I had it in Nor-Cal  :-[

EDITED TO ADD:  I did have ADAP also back then, but in Cal, Adap has no income level cut-off, as far as I know they don't, and they have a very nice Formulary, way better than in any other State except maybe NY-State..........duuno  :-\
« Last Edit: July 07, 2012, 07:41:26 PM by denb45 »
"it's so nice to be insane, cause no-one ask you to explain" Helen Reddy cc 1974

Offline DavidinCA92284

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Re: How does Obamacare affect HIV patients on meds?
« Reply #13 on: July 07, 2012, 11:36:16 PM »
Micheal.......what is the current-cut-off level for Medical, I had it for about 2 yrs. when I 1st got my SSDI back in 98...is it still 20k a yr. last i recall it was 17K or 18K a yr. but that was almost 12 yrs ago when I had it in Nor-Cal  :-[

EDITED TO ADD:  I did have ADAP also back then, but in Cal, Adap has no income level cut-off, as far as I know they don't, and they have a very nice Formulary, way better than in any other State except maybe NY-State..........duuno  :-\

-----------

As I know of things, ADAP in CA has an income level cut-off of one's Federal Adjusted Gross Income of $50,000. 

Offline Oceanbeach

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Re: How does Obamacare affect HIV patients on meds?
« Reply #14 on: July 08, 2012, 03:23:25 PM »
Gentlemen,  I have saved files for years and at this point can not find the income guidelines for Medi-Cal or ADAP.  I have found a scale w/ 1-10 member families, where a 1 person family has to make $903.00 per month (last year).  That same 1 person family may not have over $3000 in property but... I can not find a maximum income amount to qualify in the documents I have filed.   8)  Have the best day
Michael 


Offline denb45

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  • "1987 Classic Old School POZ+"
Re: How does Obamacare affect HIV patients on meds?
« Reply #15 on: July 08, 2012, 07:54:40 PM »
Medical is still as confusing as it was 12yrs ago  :-\


Once I got medicare A, B in 2000, medical told me, that you are on your own, I only got that when I didn't have any health Ins. after my Cobra & Obra run out, due to having a per-exstsing condition...Full-Blown-AIDS

My guess ( If I wanted to move back to Nor-Cal) I would still get ADAP, but NOT medical, and I would probably have to sign all of my medicare over to an HMO, County Hospital, or something else to get Health care, like Labs, and Doctors Visits, I had Kaiser Permanente back then with co-pays for these such things....

If things go really south & downhill for me, I can always use the VA  ;)


dunno, I feeling very home-sick for Nor-Cal, and kinda done with ABQ, I don't wanna die here, as I'm not a real native of New Mexico, Nor-Cal is my home and I miss my family  :'(
"it's so nice to be insane, cause no-one ask you to explain" Helen Reddy cc 1974

Offline Oceanbeach

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Re: How does Obamacare affect HIV patients on meds?
« Reply #16 on: July 10, 2012, 09:25:49 PM »
Today, I was at the Pharmacy picking up my monthly refills.  The Pharmacist meets me once each month for less than 5 minutes and always remembers my name.  Not bad in a city of 722,000 people... She does not know how much will be paid by whom in 2014 but will contact all of the client/patients when they do know.  Not much more can be done until October 1, 2013.   8)  Have the best day
Michael

 

Offline cardsfan69

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  • Posts: 49
Re: How does Obamacare affect HIV patients on meds?
« Reply #17 on: July 16, 2012, 03:13:18 AM »
U dont agree with what Obama has done with the economy and jobs?????

Ridiculous. He's created almost 4 million jobs in the last 24 months.

Plus GW Bush dug a hole for 8yrs. If someone took a shovel out to your backyard and dug for 8yrs how long do u think it wuld take to fill that hole back in? Not the 3.5yrs Obama has been in office.

Americans are so fickle and impatient. Obama has been one of the best presidents we have had.

 


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