Health Policy Reform in America: Innovations from the States

By Howard M. Leichter | Go to book overview

Because HIV infection is new, spreads so rapidly, and is expensive to treat, it reveals more clearly than most illnesses the flaws in the collection of laws and customs we call our health policy. Recognizing flaws, as everyone in public life knows, creates both problems and opportunities. There is no lack of solutions to the problems of health policy. There is, however, no politically effective coalition at present willing to pay the price of legislating any of the more fundamental solutions.


Acknowledgments

A number of people provided data and informed opinions that have been essential to preparing this article. Their names follow in alphabetical order. It is important to emphasize that none of them is responsible for the author's opinions, including his conclusions about the organization or the jurisdiction for which they work.

The author is indebted to: Lawrence Bartlett, A.E. Benjamin, Stephen Boese, Charles Bruner, Richard Chambers, Benny Clark, Georgia Cleverly, Marianne C. Fahs, Ira Feldman, Rashi Fein, Larry Gostin, Katie Hammer, David C. Hollister, Robert Hummel, Kenneth W. Kizer, Carol Levine, Richard Merritt, Frank Pistella, Lori Preschuk, Stephen Rose, Kevin Seitz, Elmer Smith, Sandra Tannenbaum, Emily H. Thomas, and Robert Wardwell. An earlier version of this chapter appeared as "Financing Health Care for Persons With HIV Infection: Guidelines for State Action," American Journal of Law ­ Medicine 16 ( 1990): 223-247. The author would like to thank the journal for permission to reproduce that material here.


Notes
1.
At least thirteen cases of AIDS have been reported in each of the states. Centers for Disease Control, HIV/AIDS Surveillance Report 5 ( July 1989) [herein- after HIV/AIDS Surveillance]. At least 60 percent of these patients were financed under either Medicaid or state-only programs of indigent care. See note 5 below and accompanying text. For a discussion of non-Medicaid spending for AIDS in 42 states, see Monica Rowe and Stephanie Keintz, "National Survey of State Spending for AIDS," Intergovernmental State Reports ( September-October, 1989): 1-10.
2.
These figures were provided to the author by staff of the Health Care Financing Administration [hereinafter HCFA Staff Information]. For a different number, see Intergovernmental Health Policy Project, State AIDS Reports ( February-March, 1989): 8.
3.
Social Security Appropriations Act of 1988/89, 1989 Michigan Legislative Service 322, § 1626 (West). The author is grateful to the Hon. David C. Hollister of the Michigan legislature for calling his attention to this initiative and providing him with a history of it. See also Department of Social and Health Services, State of Washington, "New HIV/AIDS Insurance Continuation Program" (Memorandum June 26, 1989); Department of Health Services, State of California, Medi-Cal's

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