At this point, there is little impetus in the House to end the sequester in the 2014FY budget; the Senate, however, paints a much rosier picture, as their budget proposal ends sequestration. Realistically, however, neither bill is likely to make it through both houses as the ideological divide is so deep that there is little room for negotiation.
What does this mean for the over 50% of people living with HIV/AIDS (PLWHA) and their access to comprehensive medical care and treatment?
The answers to this most basic question are a mixed bag of mainly neutral to negative outcomes, from my perspective. As someone who is directly affected by this question, and has experienced care and treatment in four vastly different states with wildly different approaches, I must admit that I have a vested interest in moving away from the way we currently address these issues.
To better explain how we currently address the issues of low-income HIV (and the greater Medicaid/Medicare model, overall), allow me to take a few moments to bring you up to date:
Under the current model, each state and territory is basically left to their own devices when it comes to providing care for their low-income citizens. At first glance, this seems like a good way to address the myriad regional disparities in terms of each state's individual needs, allowing the state to best determine the approach that best works for them. This, however, has largely proven to be untrue for those in need of the greatest assistance.
The great divide occurs between those who work in healthcare and those who work in policy and politics. By every metric of health, the states who present the greatest concern are almost exclusively in the South. The elected representatives and executives of those states are, unfortunately, those most opposed to providing those services.
The Southern states have the highest rates of literally every disease, from heart disease, renal disease, obesity, every single STD/STI, and every single type of cancer, and yet, they are the least likely to have access to testing, care, and treatment for various reasons - sheer geography (literally not being able to get to it), mistrust if medical authorities, cultural stigma against identifying as someone with a disease...trying to address these issues requires many more resources and actions than what these states are either willing or able to deliver, and they are in no way interested in asking the Federal government to step in, nor would that be welcome by those states' residents.
So, what does that mean?
Honestly, I don't know.
Beyond the basic fear of what will happen to Ryan White/AIDS Drugs Assistance Program (ADAP) program after the Affordable Care Act (ACA) goes into effect, there is an even more terrifying fear of what might happen if we attempt to get Ryan White reauthorized after it expires in September 2013 in the current political climate.
While the AIDS Healthcare Foundation (AHF) has a vested interest in reauthorizing it immediately in order to address the crisis well into development in the South, most HIV/AIDS advocates are more wary of the high probably that, given the current influence of austerity drunk Republicans (Teatards) and their tinfoil hat(e)-wearing constituents in Congress, whatever attempts to reopen the bill to adjust the formula so that more funds could be reallocated would result in a partial or wholesale gutting of what we currently have.
Right now, the reality of the situation from my perspective is that, despite all of the hopeful optimism and worry management being done by those "in the know," there is very little good news for those low income PLWHA who fall through the cracks.
That having been said, I think anyone who reads what I write understands that I am particularly realistic/pessimistic when it comes to the direction our country and specifically our healthcare system are heading. The levels of confusion, dismay, and lack of information all combine to create a precarious path for advocates and educators to attempt to traverse.
I don't have the answers to several of these problems that will please everyone, or even anyone. When it comes to developing new ideas, Democracy has proven to be successful; when it comes to implementing ideas effectively, a dictatorship is infinitely better.
Right now, we're living in what I believe to be the waning days of theRoman American Republic - as monied interests have taken a terrifying amount of control over our politicians and political process, we are often faced, as voters, neither with choices between Good vs. Evil, nor even between the lesser of two evils; rather, we find ourselves forced to choose between candidates and constituents who are increasingly uninterested in maintaining any sort of control over our system of government and our election process.
We have entered into a frightening era when one candidate can win their primary by averring to "not being a Union guy" (thereby being a corporate shill), while another can win their primary by promising more than can ever be conceivably delivered, while really being...yet another corporate shill.
At this time, there is only one Senator in Congress who has gone out of her way to ensure that she represents actual people (Elizabeth Warren, D-MA); as for Congress, Alan Grayson (D-FL) is one of a handful of Congressmen who will actively (though not always effectively) step into a fray with the intention not of honoring his enemies, but in order to set them aflame and put them out with a bag filled with their own words.
Ultimately, we have no idea who are our allies and enemies - the old battle lines no longer apply, primarily because we are no longer playing a chessboard, but in a minefield. We cannot rely upon the vast majority of our currently elected representatives for support or opposition, because they are often so preoccupied with ensuring their own reelection that they are incapable of achieving any real positive goal.
And so...here we are. We are stuck in an unfortunate holding pattern on the ground, while those in the sky are circling the airport on quickly exhausted fuel supplies, and those most in need of service are stuck in the terminal waiting for an open seat on an overcrowded plane.
Beyond the basic fear of what will happen to Ryan White/AIDS Drugs Assistance Program (ADAP) program after the Affordable Care Act (ACA) goes into effect, there is an even more terrifying fear of what might happen if we attempt to get Ryan White reauthorized after it expires in September 2013 in the current political climate.
While the AIDS Healthcare Foundation (AHF) has a vested interest in reauthorizing it immediately in order to address the crisis well into development in the South, most HIV/AIDS advocates are more wary of the high probably that, given the current influence of austerity drunk Republicans (Teatards) and their tinfoil hat(e)-wearing constituents in Congress, whatever attempts to reopen the bill to adjust the formula so that more funds could be reallocated would result in a partial or wholesale gutting of what we currently have.
Right now, the reality of the situation from my perspective is that, despite all of the hopeful optimism and worry management being done by those "in the know," there is very little good news for those low income PLWHA who fall through the cracks.
That having been said, I think anyone who reads what I write understands that I am particularly realistic/pessimistic when it comes to the direction our country and specifically our healthcare system are heading. The levels of confusion, dismay, and lack of information all combine to create a precarious path for advocates and educators to attempt to traverse.
I don't have the answers to several of these problems that will please everyone, or even anyone. When it comes to developing new ideas, Democracy has proven to be successful; when it comes to implementing ideas effectively, a dictatorship is infinitely better.
Right now, we're living in what I believe to be the waning days of the
We have entered into a frightening era when one candidate can win their primary by averring to "not being a Union guy" (thereby being a corporate shill), while another can win their primary by promising more than can ever be conceivably delivered, while really being...yet another corporate shill.
At this time, there is only one Senator in Congress who has gone out of her way to ensure that she represents actual people (Elizabeth Warren, D-MA); as for Congress, Alan Grayson (D-FL) is one of a handful of Congressmen who will actively (though not always effectively) step into a fray with the intention not of honoring his enemies, but in order to set them aflame and put them out with a bag filled with their own words.
Ultimately, we have no idea who are our allies and enemies - the old battle lines no longer apply, primarily because we are no longer playing a chessboard, but in a minefield. We cannot rely upon the vast majority of our currently elected representatives for support or opposition, because they are often so preoccupied with ensuring their own reelection that they are incapable of achieving any real positive goal.
And so...here we are. We are stuck in an unfortunate holding pattern on the ground, while those in the sky are circling the airport on quickly exhausted fuel supplies, and those most in need of service are stuck in the terminal waiting for an open seat on an overcrowded plane.
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