[Congressional Record Volume 151, Number 12 (Tuesday, February 8, 2005)]
[Senate]
[Pages S1119-S1123]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. SMITH (for himself, Mrs. Clinton, Ms. Collins, Mr. 
        Bingaman, Ms. Cantwell, Mr. Coleman, Mr. Corzine, Ms. Snowe, 
        Mrs. Feinstein, Ms. Landrieu, Mrs. Murray, Mr. DeWine, Mr. 
        Bayh, Mr. Reed, Mr. Kerry, Mr. Schumer, Mr. Dayton, Mr. Wyden, 
        Mrs. Lincoln, Mr. Lieberman, Ms. Mikulski, Mr. Nelson of 
        Florida, Ms. Stabenow, Mr. Johnson, Mr. Leahy, Mr. Kennedy, Mr. 
        Feingold, and Mr. Sarbanes):
  S. 311. A bill to amend title XIX of the Social Security Act to 
permit States the option to provide medicaid coverage for low-income 
individuals infected with HIV; to the Committee on Finance.
  Mr. SMITH. Mr. President, I rise today to introduce the Early 
Treatment for HIV Act, ETHA, of 2005. Senator Clinton joins me in 
introducing this bill, and I want to thank her for her steadfast 
support for people living with HIV. HIV knows no party affiliation, and 
I am pleased to say that ETHA cosponsors sit on both sides of the 
aisle.
  Simply stated, ETHA gives States the opportunity to extend Medicaid 
coverage to low-income, HIV-positive individuals before they develop 
full-blown AIDS. Today, the unfortunate reality is that most patients 
must become disabled before they can qualify for Medicaid coverage. 
Nearly 50 percent of people living with AIDS who know their status lack 
ongoing access to treatment. In my home State of Oregon, there are 
approximately 4,500 persons living with HIV/AIDS. It is estimated that 
approximately 40 percent of these Oregonians are not receiving care for 
their HIV disease. Not being in care puts these people's own health at 
risk, and also makes them more infectious. We can do better, and we 
should do everything possible to ensure that all people living with HIV 
can get early, effective medical care.
  Oregon's Ryan White funded AIDS Drug Assistance Program is nearing 
maximum enrollment and may need to wait list eligible clients in the 
near future. The fact of the matter is that safety net programs all 
over the country are running out of money, and are generally unable to 
cover all of the people who need assistance paying for their medical 
care. As other programs are failing, ETHA gives States another way to 
reach out to low-income, HIV-positive individuals.
  With approximately 150 newly detected HIV infections in Oregon 
annually, my state desperately needs to provide early treatment to 
these individuals. It has been shown that current HIV treatments are 
very successful in delaying the progression from HIV infection to AIDS, 
and help improve the health and quality of life for millions of people 
living with the disease.
  Studies conducted by Pricewaterhouse Cooper have found that providing 
early intervention care significantly delays the progression of HIV and 
is highly cost-effective. ETHA reduces by 60 percent the death rate of

[[Page S1120]]

persons living with HIV who received coverage under Medicaid. Disease 
progression is significantly slowed and health outcomes improved. 
Medicaid offsets alone reduce gross Medicaid costs by approximately 70 
percent due to the prevention of avoidable high cost medical 
interventions. Research determined that over 5 years the true cost of 
ETHA is $55.2 million. Over 10 years, ETHA saves $31.7 million. It 
shows that preventing the health of people living with HIV, preventing 
opportunistic infections, and slowing the progression to AIDS, will 
save taxpayers dollars. Ultimately, its clear that in implementing 
ETHA, the United States will take an important step toward ensuring 
that all Americans living with HIV can get the medical care they need 
to stay healthy and productive for as long as possible.
  Importantly, ETHA also offers States an enhanced Federal Medicaid 
match, which means more money for States that invest in treatments for 
HIV. This provision models the successful Breast and Cervical Cancer 
Treatment and Prevention Act of 2000, which allows States to provide 
early Medicaid intervention to women with breast and cervical cancer. 
Even in these difficult times, 45 States are now offering early 
Medicaid coverage to women with breast and cervical cancer. We can 
build upon this success by passing ETHA and extending similar early 
intervention treatments to people with HIV.
  HIV/AIDS touches the lives of millions of people living in every 
State in the Union. Some get the proper medications, but too many do 
not. This is literally a life and death issue, and ETHA can help many 
more Americans enjoy long, healthy lives.
  I want to thank Senators Clinton, Collins, Bingaman, Coleman, 
Cantwell, Snowe, Corzine, Feinstein, Murray, Wyden, DeWine, Bayh, Reed, 
Kerry, Dayton, Schumer, Lincoln, Lieberman, Mikulski, Nelson, Stabenow, 
Johnson, Sarbanes, Leahy, Kennedy, Feingold and Lautenberg for joining 
us as cosponsors of ETHA. I also wish to thank all of the organizations 
around the country that have expressed support for this bill. I have 
received numerous support letters from those organizations, and I ask 
unanimous consent that those letters be printed in the Record. In 
particular, I want to thank the Human Rights Campaign, The AIDS 
Institute, ADAP Working Group and the Treatment Access Expansion 
Project, for helping bring so much attention to ETHA. I hope all of my 
colleagues will join us in supporting this critical, life-saving 
legislation.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:


                                                  AIDS Action,

                                 Washington, DC, February 2, 2005.
     Hon. Gordon Smith,
     Russell Senate Office Building,
     Washington, DC.
       Dear Senator Smith: On behalf of the AIDS Action Council 
     board of directors and our diverse, nationwide membership of 
     community-based service providers and public health 
     departments working with people living with or affected by 
     HIV, I would like to thank you for introducing the Early 
     Treatment for HIV Act (ETHA) with Senator Clinton and offer 
     my strong support for this important piece of legislation.
       As you know, ETHA is a means to eliminate barriers to early 
     drug therapy and comprehensive care for people living with 
     HIV. This important legislation would give States the option 
     of allowing HIV positive people with low incomes to qualify 
     for Medicaid coverage earlier in the course of their 
     infection, permitting them to receive greater benefits from 
     anti-retroviral therapy.
       Access to pharmaceuticals and quality health services is 
     vital for people living with HIV. Advancements in treatment 
     and the development of anti-retroviral (ARV) therapy have 
     enabled HIV positive individuals to lead longer and healthier 
     lives. However, ARV therapy is often prohibitively expensive, 
     costing approximately $10,000 to $12,000 annually, making it 
     virtually impossible for low-income people, who are often 
     uninsured or underinsured, to access these life-prolonging 
     medications.
       Current Federal treatment guidelines recommend the 
     initiation of ARV therapy early in the course of HIV 
     infection. With early initiation, the efficacy of ARV therapy 
     increases, boosting the effectiveness of other available HIV 
     drugs and staving off disability. Initiated early on, ARV 
     therapy ultimately saves costs associated with delayed 
     medical treatment. Unfortunately, many uninsured and 
     underinsured people living with HIV cannot afford ARV therapy 
     on their own. Further, Americans living with HIV do not 
     qualify for Medicaid until they have received an AIDS 
     diagnosis and are sick enough to meet Medicaid's categorical 
     requirements for disability--a point at which it is too late 
     for ARV treatment to be optimally effective. These barriers 
     to early treatment must be eliminated so that low income 
     people living with HIV can access the health care they need.
       During this time of shrinking Federal budgets and economic 
     downsizing, savings in Federal HIV programs, whether in 
     mandatory or discretionary spending, are beneficial to all 
     parties involved. By allowing HIV positive individuals to 
     qualify for Medicaid earlier in the course of HIV infection, 
     ETHA will create significant savings for the Federal 
     Government in overall health care funding.
       AIDS Action looks forward to working with you on passage of 
     this bill. Together we can ensure that people living with HIV 
     have access to the treatments and health services they need 
     to stay healthy.
           Sincerely,
                                                 Marsha A. Martin,
     Executive Director.
                                  ____



                                           The AIDS Institute,

                                 Washington, DC, February 2, 2005.
     Re the early treatment for HIV Act (ETHA).

     Senator Gordon Smith,
     U.S. Senate,
     Washington, DC.
       Dear Senator Smith: The AIDS Institute applauds you for 
     your continued leadership and commitment to those people 
     living with HIV/AIDS in our country who are in need of 
     lifesaving healthcare and treatment. While the HIV/AIDS 
     epidemic in sub-Sahara Africa and other parts of the world 
     often overshadow the epidemic in the United States, we must 
     not forget about the approximately 900,000 people living in 
     the U.S. who have HIV or AIDS.
       Those infected with HIV are more likely to be low-income, 
     and it disproportionately impacts certain populations, 
     particularly minorities. In fact, the AIDS case rate per 
     100,000 population for African Americans was 9.5 times that 
     of whites in 2003.
       According to a recent Institute of Medicine report titled, 
     ``Public Financing and Delivery of HIV/AIDS Care: Securing 
     the Legacy of the Ryan White CARE Act'', 233,000 of the 
     463,070 people living with HIV in the U.S. who need 
     antiretroviral treatment do not have ongoing access to this 
     treatment. This does not include an additional 82,000 people 
     who are infected but unaware of their HIV status and are in 
     need of antiretrovira1 medications.
       One reason why there are so many people lacking treatment 
     is that under current law, Medicaid, which is the single 
     largest public payer of HIV/AIDS care in the U.S., only 
     covers those with full blown AIDS, not those with HIV.
       The Early Treatment for HIV Act (ETHA), being re-introduced 
     in this Congress under your leadership and Sen. Hillary 
     Clinton, would correct an archaic mindset in the delivery of 
     public health care. No longer would a Medicaid eligible 
     person with HIV have to become disabled with AIDS to receive 
     access to Medicaid provided care and treatment. Providing 
     coverage to those with HIV can prevent them from developing 
     AIDS, and allow them to live a productive life with their 
     family and be a healthy contributing member of society.
       ETHA would provide States the option of amending their 
     Medicaid eligibility requirements to include uninsured and 
     under-insured, pre-disabled poor and low-income people living 
     with HIV. No State has to participate if they choose not to.
       As all States have participated in the Breast and Cervical 
     Cancer Prevention and Treatment Act, on which ETHA is 
     modeled, we believe all States will opt to choose this 
     approach in treating those with HIV. States will opt into 
     this benefit not only because it is the medically and 
     ethically right thing to do, but it is cost effective, as 
     well.
       A recent study prepared by PricewaterhouseCoopers found 
     that if ETHA was enacted, over 10 years:
       --the death rate for persons living with HIV on Medicaid 
     would be reduced by 50 percent;
       --there would be 35,000 more individuals having CD4 levels 
     above 500 under ETHA versus the existing Medicaid system; and
       --result in a savings of $31.7 million.
       The AIDS Institute thanks you for your bipartisan 
     leadership by introducing ``The Early Treatment for HIV Act 
     of 2006''. It is the type of Medicaid reform that is 
     critically needed to update the program to keep current with 
     the Federal Government's guidelines for treating people with 
     HIV.
       We look forward to working with you and your colleagues as 
     it moves to enactment.
           Sincerely,
                                              Dr. A. Gene Copello,
     Executive Director.
                                  ____

                                                 February 2, 2005.
     Hon. Gordon Smith,
     404 Russell Senate Office Building,
     Washington, DC.
       Dear Senator Smith: The American Academy of HIV Medicine is 
     an independent organization of HIV Specialists and others 
     dedicated to promoting excellence in HIV/AIDS care. As the 
     largest independent organization of HIV frontline providers, 
     our 2,000 members provide direct care to more than 340,000 
     HIV patients--more than two thirds of the patients in active 
     treatment for HIV disease.
       The Academy, particularly those HIV Specialists in the 
     state of Oregon, would like to thank and commend you for co-
     sponsoring the Early Treatment for HIV Act (ETHA).

[[Page S1121]]

       ETHA addresses a cruel irony in the current Medicaid 
     system--that under current Medicaid rules people must become 
     disabled by AIDS before they can receive access to Medicaid 
     provided care and treatment that could have prevented them 
     from becoming so ill in the first place. ETHA would bring 
     Medicaid eligibility rules in line with the clinical standard 
     of care for treating HIV disease. ETHA helps address the fact 
     that increasingly, in many parts of the country, there are 
     growing waiting lists for access to life-saving medications 
     and limited to no access to comprehensive health care. 
     Particularly in Oregon, we have been witness to difficulties 
     in access to care for some of our patients, having endured a 
     severe strain on our AIDS Drug Assistance Program (ADAP) for 
     quite some time.
       The Academy believes this legislation would allow HIV 
     positive individuals access to the medical care that we 
     recognize as vital towards postponing or avoiding the onset 
     of AIDS and towards enormously increase the quality of life 
     for people living with HIV disease.
       As a provider at a public health clinic (the Multnomah 
     County Health Department HIV clinic), I see patients from a 6 
     county area, with a growing number of uninsured. The 
     difficulties in obtaining medication coverage have been 
     growing monthly, and have become a major part of the 'medical 
     care' we provide. A more equitable system of coverage and 
     medication access would help tremendously, and allow us to 
     focus on what we are trained to do. Thank you for your 
     efforts in this area.
           Sincerely,
     Michael S. MacVeigh.
     James E. McDonald.
     Joan Reeder.
     Maria Kosmetatos.
                                  ____



                                         Cascade AIDS Project,

                                   Portland, OR, February 1, 2005.
     Senator Gordon Smith,
     U.S. Senate,
     Washington, DC.
       Dear Senator Smith: As you know, Cascade AIDS Project is 
     the largest AIDS service organization in Oregon. For two 
     decades we have served and advocated for people living with 
     and at risk for HIV/AIDS. We strongly urge you to support the 
     Early Treatment of HIV Act.
       The Early Treatment for HIV Act will allow low-income 
     individuals living with HIV to qualify for Medicaid coverage 
     earlier in the course of their disease instead of waiting 
     until they are disabled by full-blown AIDS.
       Healthcare advocates have long been arguing that to treat 
     an individual's illness at its earlier stages costs less than 
     waiting until the individual is significantly disabled by 
     further progression of the illness.
       There are many Americans--those in the low income bracket 
     and in underserved communities--who do not have access to 
     drug treatment regimens because they have not progressed to 
     fullblown AIDS. The ACT would make access to those drugs 
     possible.
       Medicaid is a lifeline to HIV care for roughly half of 
     those living with AIDS, and 90% of all children living with 
     AIDS. All Medicaid programs cover some prescription drugs, 
     but with the improved drug therapy of today, it is crucial 
     that individuals infected with HIV receive access to these 
     drugs as soon as their conditions call for it.
       Passage of the Early Treatment for HIV Act will save 
     countless lives and must be viewed as a priority. We know 
     that passage of the Act is the right thing to do.
           Sincerely,
                                                    Thomas Bruner,
     Executive Director.
                                  ____



                                                     TII-CANN,

                                 Washington, DC, February 2, 2005.
     Hon. Gordon Smith,
     U.S. Senate,
     Washington, DC.
     Subject: ETHA (The Early Treatment for HIV Act)

       Dear Senator Smith: I wanted to express our appreciation 
     and support for your introduction of ETHA in the 109th U.S. 
     Congress together with Senator Clinton and the other original 
     co-sponsors.
       Having been working since day one on the ETHA process and 
     having closely studied the potentially lifesaving--and cost 
     savings--potentials of this bill we feel it's particularly 
     crucial that this important legislation be passed into law as 
     soon as possible.
       The across the board potential cost savings inherent in 
     providing early access to HIV treatment over 10 years are a 
     compelling fiscally responsible story and of course treating 
     sick Americans as soon as possible is simply the correct 
     moral and ethical course of action for the world's most 
     powerful country. The value of increasing life span and 
     quality of life to tens of thousands of affected individuals, 
     and their families, has a tremendous value to society at 
     large, as well.
       Once again we extend our thanks to you and Senator Clinton 
     for your leadership and we look forward to helping this 
     Important private and PublIc health legislation to work its 
     way through our congressional process.
           Sincerely,
                                                William E. Arnold,
     CEO.
                                  ____



                                               Project Inform,

                              San Francisco, CA, February 2, 2005.
     Hon. Gordon Smith,
     U.S. Senate,
     Washington, DC.
       Dear Senator Smith: I am writing to thank you and Senator 
     Clinton for introducing the Early Treatment for HIV Act. 
     Project Inform, a national HIV/AIDS treatment information and 
     advocacy organization serving 80,000 people nationwide, 
     strongly supports this legislation.
       This bill would allow, states to extend Medicaid coverage 
     to pre-disabled people living with IV. It represents a 
     breakthrough in assuring early access to care for thousands 
     of low-income people living with HIV. Current HIV treatments 
     are successfully delaying the progression from HIV infection 
     to AIDS, thus improving the health and quality of life for 
     many people living with the disease. However, without access 
     to early intervention health care and treatment, these 
     advances remain out of reach for many non-disabled, low-
     income people with HIV.
       Project Inform is acutely aware of the need for early 
     access to lifesaving medications and healthcare for people 
     living with HIV/AIDS. Discretionary programs such as the AIDS 
     Drug Assistance Program (ADAP) are simply unable to meet the 
     growing need. If ETHA is passed and implemented by the 
     states, a great burden will be lifted off these safety net 
     programs and people living with the disease will be able to 
     get the care and treatment needed to live longer, more 
     productive lives.
       A recent report by PricewaterhouseCoopers found that if 
     ETHA is passed and implemented by the states, the death rate 
     of people living with HIV on Medicaid would be cut in half 
     over a ten-year period. It also revealed that over a ten-year 
     period, ETHA would save money in the Medicaid program. It is 
     a humane and cost-effective bill and I thank you again for 
     your leadership in introducing it. Please let me know how 
     Project Inform can help make it become law.
           Sincerely,
                                                       Ryan Clary,
     Senior Policy Advocate.
                                  ____



                                          Partnership Project,

                                   Portland, OR, February 1, 2005.
     Hon. Gordon Smith,
     U.S. Senate,
     Washington, DC.
       Dear Senator Smith: I am writing to thank you for 
     introducing the Early Treatment for HIV Act with Senator 
     Clinton, and to offer my strong support for this legislation.
       This bill would allow states to extend Medicaid coverage to 
     pre-disabled people living with HIV. It represents a 
     breakthrough In assuring early access to care for thousands 
     of low-income people living with HIV. Current HIV treatments 
     are successfully delaying the progression from HIV infection 
     to AIDS, thus improving the health and quality of life for 
     many people living with the disease. However, without access 
     to early intervention health care and treatment, these 
     advances remain out of reach for many non-disabled, low-
     income people with HIV.
       The more people who are on Medicaid the more the pressure 
     will be relieved on ADAP, CareAssist, and other programs that 
     serve Oregon residents.
       A recent report by PricewaterhouseCoopers found that if 
     ETHA Is passed and implemented by the states, the death rate 
     of people living with HIV on Medicaid would be cut in half 
     over a ten-year period. It also revealed that over a ten-year 
     period, ETHA would save money in the Medicaid program. It is 
     a humane and cost-effective bill and I thank you again for 
     your leadership in introducing it. Please let me know how I 
     can help make it become law.
           Sincerely,
                                                     Rick Stoller,
     Clinical Manager.
                                  ____



                                                       NASTAD,

                                 Washington, DC, February 2, 2005.
     Hon. Gordon Smith,
     Russell Senate Office Building,
     Washington, DC.
       Dear Senator Smith: On behalf of the National Alliance of 
     State and Territorial AIDS Directors (NASTAD), I am writing 
     to offer our support for the ``Early Treatment for HIV Act.'' 
     NASTAD represents the nation's chief state and territorial 
     health agency staff who are responsible for HIV/AIDS 
     prevention, care and treatment programs funded by state and 
     federal governments. This legislation would give states an 
     important option in providing care and treatment services to 
     low-income Americans living with HIV.
       The Early Treatment for HIV Act (ETHA) would allow states 
     to expand their Medicaid programs to cover HIV positive 
     individuals, before they become disabled, without having to 
     receive a waiver. NASTAD believes this legislation would 
     allow HIV positive individuals to access the medical care 
     that is widely recommended, can postpone or avoid the onset 
     of AIDS, and can enormously increase the quality of life for 
     people living with HIV.
       State AIDS directors continue to develop innovative and 
     cost-effective HIV/AIDS programs in the face of devastating 
     state budget cuts and federal contributions that fail to keep 
     up with need. ETHA provides a solution to states by 
     increasing health care access for those living with HIV/AIDS. 
     ETHA will also save states money in the long-run by treating 
     HIV positive individuals earlier in the disease's progression 
     and providing states with a federal match for the millions of 
     dollars they are presently spending on HIV/AIDS care.

[[Page S1122]]

       Thank you very much for your continued commitment to 
     persons living with HIV/AIDS. I look forward to working with 
     you to gain support for this important piece of legislation.
           Sincerely,
                                                Julie M. Scofield,
     Executive Director.
                                  ____



                                   AIDS Foundation of Chicago,

                                    Chicago, IL, February 2, 2005.
     Hon. Gordon Smith,
     U.S. Senate,
     Washington DC.
       Dear Senator Smith: I am writing to thank you for 
     introducing the Early Treatment for HIV Act with Senator 
     Clinton, and to offer the AIDS Foundation of Chicago's (AFC) 
     strong support for this legislation.
       Founded in 1985, the mission of AFC is to lead the fight 
     against HIV/AIDS and improve the lives of people affected by 
     the epidemic. In order to accomplish this, AFC collaborates 
     with community organizations to develop and improve HIV/AIDS 
     services; funds and coordinates prevention, care, and 
     advocacy projects; and champion's effective, compassionate 
     HIV/AIDS policy. AFC is the sole AIDS advocacy organization 
     monitoring and responding to AIDS-related state legislation 
     and public policy in Illinois.
       This bill would allow states to extend Medicaid coverage to 
     pre-disabled people living with HIV. It represents a 
     breakthrough in assuring early access to care for thousands 
     of low-income people living with HIV. Current HIV treatments 
     are successfully delaying the progression from HIV infection 
     to AIDS, thus improving the health and quality of life for 
     many people living with the disease. However, without access 
     to early intervention health care and treatment, these 
     advances remain out of reach for many non-disabled, low-
     income people with HIV.
       A recent report by PricewaterhouseCoopers found that if 
     ETHA is passed and implemented by the states, the death rate 
     of people living with HIV on Medicaid would be cut in half 
     over a ten-year period. It also revealed that over a ten-year 
     period, ETHA would save money in the Medicaid program. It is 
     a humane and cost-effective bill and I thank you again for 
     your leadership in introducing it. Please let me know how I 
     can help make it become law.
           Sincerely,
                                                      Jim Pickett,
     Director of Public Policy.
                                  ____



                                  AIDS Action Baltimore, Inc.,

                                  Baltimore, MD, February 3, 2005.
     Hon. Gordon Smith,
     U.S. Senate,
     Washington, DC.
       Dear Senator Smith: On behalf of AIDS Action Baltimore, 
     Inc. (AAB) I am writing to thank you for introducing the 
     Early Treatment for HIV Act with Senator Clinton, and to 
     offer my strong support for this legislation.
       This bill would allow states to extend Medicaid coverage to 
     pre-disabled people living with HIV. It represents a 
     breakthrough in assuring early access to care for thousands 
     of low-income people living with HIV. Current HIV treatments 
     are successfully delaying the progression from HIV infection 
     to AIDS, thus improving the health and quality of life for 
     many people living with the disease. However, without access 
     to early intervention health care and treatment, these 
     advances remain out of reach for many non-disabled, low-
     income people with HIV.
       AAB has been engaged in research advocacy and providing 
     valuable medical, financial and emotional support to 
     thousands of people with HIV infection since 1987. Access to 
     care and treatment is of the utmost importance to someone 
     living with HIV disease. Medicaid will not only help improve 
     the quality of life for an individual with HIV disease by 
     will also help to relieve pressure on the AIDS Drug 
     Assistance Programs in all of our states.
       A recent report by PricewaterhouseCoopers found that if 
     ETHA is passed and implemented by the states, the death rate 
     of people living with HIV on Medicaid would be cut in half 
     over a ten-year period. It also revealed that over a ten-year 
     peiod, ETHA would save money in the Medicaid program. It is a 
     humane and cost-effective bill and I thank you again for your 
     leadership in introducing it. Please let me know how I can 
     help make it become law.
           Sincerely,
                                                        Lynda Dee,
                                               Executive Director.
                                  ____
                                  


                                                  AIDS Action,

                                                 February 2, 2005.
     Hon. Gordon Smith,
     Russell Senate Office Building,
     Washington, DC.
       Dear Senator Smith: On behalf of the AIDS Action Council 
     board of directors and our diverse, nationwide membership of 
     community-based service providers and public health 
     departments working with people living with or affected by 
     HIV, I would like to thank you for introducing the Early 
     Treatment for HIV Act (ETHA) with Senator Clinton and offer 
     my strong support for this important piece of legislation.
       As you know, ETHA is a means to eliminate barriers to early 
     drug therapy and comprehensive care for people living with 
     HIV. This important legislation would give states the option 
     of allowing HIV positive people with low incomes to qualify 
     for Medicaid coverage earlier in the course of their 
     infection, permitting them to receive greater benefits from 
     anti-retroviral therapy.
       Access to pharmaceuticals and quality health services is 
     vital for people living with HIV. Advancements in treatment 
     and the development of anti-retroviral (ARV) therapy have 
     enabled HIV positive individuals to lead longer and healthier 
     lives. However, ARV therapy is often prohibitively expensive, 
     costing approximately $10,000 to $12,000 annually, making it 
     virtually impossible for low-income people, who are often 
     uninsured or underinsured, to access these life-prolonging 
     medications.
       Current federal treatment guidelines recommend the 
     initiation of ARV therapy early in the course of HIV 
     infection. With early initiation, the efficacy of ARV therapy 
     increases, boosting the effectiveness of other available HIV 
     drugs and staving off disability. Initiated early on, ARV 
     therapy ultimately saves costs associated with delayed 
     medical treatment. Unfortunately, many uninsured and 
     underinsured people living with HIV cannot afford ARV therapy 
     on their own. Further, Americans living with HIV do not 
     qualify for Medicaid until they have received an AIDS 
     diagnosis and are sick enough to meet Medicaid's categorical 
     requirements for disability--a point at which it is too late 
     for ARV treatment to be optimally effective. These barriers 
     to early treatment must be eliminated so that low income 
     people living with HIV can access the health care they need.
       During this time of shrinking federal budgets and economic 
     downsizing, savings in federal HIV programs, whether in 
     mandatory or discretionary spending, are beneficial to all 
     parties involved. By allowing HIV positive individuals to 
     qualify for Medicaid earlier in the course of HIV infection, 
     ETHA will create significant savings for the federal 
     government in overall health care funding.
       AIDS Action looks forward to working with you on passage of 
     this bill. Together we can ensure that people living with HIV 
     have access to the treatments and health services they need 
     to stay healthy.
           Sincerely,
                                            Marsha A. Martin, DSW,
     Executive Director.
                                  ____

  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 311

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Early Treatment for HIV Act 
     of 2005''.

     SEC. 2. OPTIONAL MEDICAID COVERAGE OF LOW-INCOME HIV-INFECTED 
                   INDIVIDUALS.

       (a) In General.--Section 1902 of the Social Security Act 
     (42 U.S.C. 1396a) is amended--
       (1) in subsection (a)(10)(A)(ii)--
       (A) by striking ``or'' at the end of subclause (XVII);
       (B) by adding ``or'' at the end of subclause (XVIII); and
       (C) by adding at the end the following:

       ``(XIX) who are described in subsection (cc) (relating to 
     HIV-infected individuals);''; and

       (2) by adding at the end the following:
       ``(cc) HIV-infected individuals described in this 
     subsection are individuals not described in subsection 
     (a)(10)(A)(i)--
       ``(1) who have HIV infection;
       ``(2) whose income (as determined under the State plan 
     under this title with respect to disabled individuals) does 
     not exceed the maximum amount of income a disabled individual 
     described in subsection (a)(10)(A)(i) may have and obtain 
     medical assistance under the plan; and
       ``(3) whose resources (as determined under the State plan 
     under this title with respect to disabled individuals) do not 
     exceed the maximum amount of resources a disabled individual 
     described in subsection (a)(10)(A)(i) may have and obtain 
     medical assistance under the plan.''.
       (b) Enhanced Match.--The first sentence of section 1905(b) 
     of the Social Security Act (42 U.S.C. 1396d(b)) is amended by 
     striking ``section 1902(a)(10)(A)(ii)(XVIII)'' and inserting 
     ``subclause (XVIII) or (XIX) of section 1902(a)(10)(A)(ii)''.
       (c) Conforming Amendments.--Section 1905(a) of the Social 
     Security Act (42 U.S.C. 1396d(a)) is amended in the matter 
     preceding paragraph (1)--
       (1) by striking ``or'' at the end of clause (xii);
       (2) by adding ``or'' at the end of clause (xiii); and
       (3) by inserting after clause (xiii) the following:
       ``(xiv) individuals described in section 1902(cc);''.
       (d) Exemption From Funding Limitation for Territories.--
     Section 1108(g) of the Social Security Act (42 U.S.C. 
     1308(g)) is amended by adding at the end the following:
       ``(3) Disregarding medical assistance for optional low-
     income hiv-infected individuals.--The limitations under 
     subsection (f) and the previous provisions of this subsection 
     shall not apply to amounts expended for medical assistance 
     for individuals described in section 1902(cc) who are only 
     eligible for such assistance on the basis of section 
     1902(a)(10)(A)(ii)(XIX).''.
       (e) Effective Date.--The amendments made by this section 
     shall apply to calendar quarters beginning on or after the 
     date of

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     the enactment of this Act, without regard to whether or not 
     final regulations to carry out such amendments have been 
     promulgated by such date.
                                 ______