Cutting Ryan White program would cost more than it saves, say officials.

By Kirsten Stewart
The Salt Lake Tribune
April 15, 2010

Utah's Ryan White program may no longer be at risk of falling casualty to Republican angst over "Obamacare."

Legislative leaders held off on reauthorizing the grant program while they pondered why the state should subsidize health care for low-income HIV/AIDS patients, reasoning such patients will eventually be covered under the federal health overhaul.

But Utah doesn't subsidize the program -- not with hard cash.

And knowing that, Senate President Michael Waddoups now says he sees no reason to discontinue it.

"I was just trying to make sure we're spending our money in the most prioritized way," said the Taylorsville Republican.

Were the program to expire, state health officials predict they would save $45,000 Utah tax dollars. But Utah would lose $3.8 million in federal funds.

And that doesn't account for the human costs, say health advocates, citing unnecessary hospitalizations and lost wages that would mount as some of Utah's 450 Ryan White beneficiaries fall off their medications.

"I can't conceive of any reason to turn down this grant money," said Stan Penfold, executive director of the Utah AIDS Foundation. "We've been accepting it since 1992, and for good reason."

Penfold would like the program continued until 2014, when key provisions of health reform kick in. That's when insurers will be forced to cover people with pre-existing conditions, many of whom will get subsidies to buy coverage.

But in another wrinkle, the program comes up for reauthorization by the U.S. Congress in 2013.

"I'm hopeful it will be extended for a year," said Penfold. "The feds have always been good about funding this program."

Congress created the Ryan White grant pool 20 years ago to help people with HIV/AIDS -- a population routinely deemed uninsurable -- pay for anti-viral drugs and medical care. It was named after Ryan White, a teenage hemophiliac who contracted the HIV virus through a blood transfusion and died in the 1980s from AIDS complications.

The program funnels money to all 50 states, supports half-a-million patients each year and is the third largest source of public financing for HIV/AIDS care after Medicaid and Medicare, according to a report by the Henry J. Kaiser Family Foundation.

To draw down their share of the money, states have to pony up some of their own cash. But under a special allowance, Utah calculates its $1.3 million "state match" using in-kind dollars, or services the state already provides, said state epidemiology director Jennifer Brown.

Most of those services, said Brown, will continue even if the Ryan White program lapses:

» $611,000 in Medicaid-paid HIV/AIDS health care.

» $388,000 of drug assistance for HIV-positive prisoners.

» $361,000 in administrative costs, including supplies and salaried workers who run the program in addition to their other duties.

Were the program to expire, Utah would save $45,000, the state's investment in one of the salaried workers who runs the program, said Brown. "If we lost the grant, we'd lose the federal money needed to keep this person employed."

Hearing that, Waddoups said Wednesday, "If it's something they can do with matching services than I have no problem with the grant continuing."

The matter will come before the Executive Appropriations Committee next month.

Meanwhile, the health department is keeping the program going by tapping other budget areas. And enrollees report no disruption in services.

"I think with programs like this, policy makers tend to think they're throwing good money after bad," said Sean Camp, an assistant professor of social work who has been HIV-positive for 14 years.

Camp enrolled in the program for two months last year to cover gaps in coverage that he didn't anticipate when he took a teaching job at Utah State University.

"If it hadn't been for Ryan White, I would have gone without anti-virals for two months," he said. "And had I gotten sick, I could have lost my job and wound up on the state's [assistance] roll."


Utah's Ryan White Program

The program subsidizes the purchase of health coverage and anti-viral medications for HIV/AIDS patients with incomes below 250 percent of the federal poverty level, about $27,000 for a single-person household.

Republican lawmakers were considering letting the program lapse. But new information has them leaning toward preserving the program at an Executive Appropriations Committee session next month.

www.sltrib.com