by Lisa Keen - Keen News Service

Three U.S. House committees met this week (September 28) and combined four pieces of legislation into one health care reform bill to send to the floor in the next few weeks. That one bill, H.R. 3200, includes some provisions that could improve the health care of LGBT people specifically.

"There are many reasons why people in the LGBT community ought to be following the health care reform very closely," said U.S. Rep. Tammy Baldwin in a recent video message. "Our lives are very much going to be affected by this legislation, and certainly our health is."

Meanwhile, the clock is ticking down on the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. The measure, which provides medical help to people with HIV who have low incomes and/or no health care insurance, was set to expire September 30. But the House on Friday, September 25, passed a temporary extension of funding deadlines for federal programs and the Senate is likely to follow suit before September 30. The new deadline is October 31.

HEALTH REFORM RUCKUS
Most eyes on Capitol Hill these days are focused on health care reform efforts because that's where President Obama has drawn a line - he wants health insurance for those who don't have it now, and he wants "security and stability" for those who do have insurance. By "security and stability," he wants an end to insurance companies refusing to cover "pre-existing conditions" or dropping them from coverage for high-expense conditions, such as HIV and cancer. He wants "all Americans" to "have access to free preventive services" and he wants a cap on out-of-pocket expenses consumers must now pay for what coverage they do get.

Not surprisingly, there is a huge pushback from insurance companies and by those who fear the cost of such "security and stability" means fewer profits for the companies and more taxes for the many.

"It's great he wants to expand coverage for everyone, but it looks like someone's going to have to pay for it, and it's not easy for people to pay for it, especially people on low incomes," said Carl Schmid, deputy executive director of The AIDS Institute, a national advocacy group.

While the House is moving quickly to push through its version of health care reform, the Senate is wrestling with two versions. Senator Max Baucus (D-Mont.) introduced the latest version earlier this month, garnering much media attention but not much support. Now, it's bogged down in the Senate Finance Committee with 564 proposed amendments. Neither Senate bill, nor any of their amendments, are HIV or LGBT-related. But the Baucus measure does call for "fees" on various "medical devices," said Schmid. That means higher costs for such things as condoms, HIV testing kits, and syringes.

Most LGBT and HIV activists, including the AIDS Institute and AIDS Action, are behind the House bill. While under deliberation in the House Energy and Commerce Committee, the measure picked up language suggested by Rep. Tammy Baldwin (D-Wisc.), one of only three openly Gay members of Congress. Baldwin's language calls on Congress:

o to establish an Assistant Secretary for Health Information to promote the collection of data about sexual orientation and gender identity (along with a great many other categories) to help identify health issues and the need for programs;

o to prohibit discrimination based on sexual orientation and gender identity in the provision of health care; and,

o to enable people with HIV and low incomes to obtain Medicare coverage earlier in the course of their illness.

"A lot of attention has been paid to racial, ethnic, and geographical disparities" in health care, said Baldwin, in a videotaped message she released to LGBT news media last week, "but we also know the LGBT community has disparate access and disparate outcomes from the health care system." Baldwin said those disparities are exacerbated by the fact that the federal government does not collect data on LGBT health needs.

"We have many federally funded health research and survey tools that allow us to understand who is well served and who isn't well served by our current health care system," said Baldwin. "None of these federally funded surveys asks any questions about sexual orientation or gender identity. In fact, the only information that we have about the disparities that are felt by the LGBT community is from privately funded smaller or local health surveys."

Baldwin noted, too, that people in the LGBT community tend to be less insured than others because in many jurisdictions same-sex relationships aren't recognized, thus eliminating one route by which many people are able to obtain coverage - through their spouse's employee benefit plan.

But those LGBT people who are able to obtain health insurance coverage for their same-sex partner or spouse are then saddled with a "tax penalty" that straight married employees don't have to pay, noted Baldwin. They have to pay taxes on the value of the spousal insurance coverage as if it is part of their income.

Language in the House bill would seek to eliminate that tax penalty and seek to ensure that LGBT families are part of any family-based provisions of health care reform.

And President Obama hasn't gotten behind one bill.

Rebecca Haag, executive director of AIDS Action, a long-standing national group working for policies and laws to help people with HIV and AIDS, supports the House bill.

"By and large, we're looking for low-cost, quality health care," said Haag, "because more than 50 percent of people with HIV in the United States don't have adequate medical care. The Baucus plan will not fulfill that objective." Haag said her group supports the idea for a publically funded health insurance option because it aims at providing affordable coverage.

Schmid, at the AIDS Institute, says that, if people with HIV qualify for health care assistance under Ryan White, the federal government will help pay for their insurance premiums.

Many AIDS groups have signed onto a "Community Consensus" statement concerning Ryan White, asking Congress to approve at least a three-year extension of the programs, and that funding - distributed to states by a formula based on number of cases - not be diminished to any state.

© 2009 Keen News Service

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