PORTLAND, Ore. – Faced with a tight budget, Oregon is delaying and paring benefits for low-income people who rely on the state for help purchasing AIDS drugs.
The state is also not currently accepting new applicants for participation in its program, one of the consequences of a $1.7 million shortfall in the $3.8 million set aside for the AIDS drug program.
And, for the first time in a decade, there's a waiting list of people who want to be participate in the program.
Currently, 769 people are covered by the program in Oregon. Eighteen more are on the waiting list.
Oregon's program pays directly for some drugs. But it pays mainly for insurance that covers medication and health services such as doctor visits.
Officials with the Department of Human Services are looking for ways to tackle the shortfall in its AIDS drug program. Ideas floated this week include creating new monthly charges for all clients and eliminating payments for non-drug services, such as doctor visits, for those who earn the most.
Another possibility: Turn some applicants away. The state is considering lowering the income cap to qualify for the program which, for a single man or woman, would mean a drop of $28,795 to $17,760 in annual pay. State officials say a final plan will be approved next month and take effect by October.
Dr. Mel Kohn, the state's top-ranking disease expert, would prefer to keep benefits intact. Not only do AIDS drugs keep people alive longer, Kohn said, but they also fight the spread of the disease. By reducing the amount of HIV in the blood, the drugs reduce the likelihood that the virus will be passed on through unprotected sex, needle-sharing and other high-risk activities.
"This program is important, not only for people already infected, but for prevention as well," Kohn said. "But we have to run it in a fiscally sound manner."
Steve Carroll and Fred Schaich are two Portland activists living with AIDS. They rely on Oregon's program to pay for their drugs: a dozen or more pills a day to battle the virus, stave off life-threatening infections and treat chronic pain.
Both men know the state has tough choices to make. And both are willing to pay what they can to keep their benefits. But they worry. What about people who can't afford a monthly fee? What about people who won't be eligible for the drugs anymore?
"There are going to be a lot of people falling into a hole," Carroll said. "This is a life-and-death issue."
Carroll and other advocates have blasted the state for not making the budget problem public sooner -- a problem they say pits poor, sick people against each other. Thomas Bruner, executive director of Cascade AIDS Project, said it already has hit HIV and AIDS service providers.
Because of the money crisis, the group that decides how to divvy up federal AIDS dollars in the Portland area voted this month to shift $400,000 to drug coverage beginning in March. Bruner said that means his agency and others must cut housing, transportation and other services.
"One set of desperately needed services is now competing against another set of desperately needed services," he said. "If you've got HIV or AIDS, you're not going to win."