The Road to 2014

1. The Road to 2014 Why your Vote Matters Tyler Andrew TerMeer, MS Sarah Sobel Ohio AIDS Coalition

2. Road Map • History of OAC • Mergers and Alliances • OAC Mission and Vision • OAC Core Objectives • OAC Public Policy and Advocacy Priorities • The Road to 2014 • Election Outcome Scenarios • Voter Empowerment and Engagement • Q & A

3. OAC History In 1989, the Ohio AIDS Coalition officially became incorporated as a non-profit organization expanding and increasing its capacity to provide education, leadership and advocacy for persons affected by HIV/AIDS throughout Ohio Communities. OAC has grown tremendously over the years; the impact that OAC has had on lives has reached thousands throughout Ohio communities. As OAC evolves advocacy, empowerment, leadership and networking people to care will continue to remain the forefront as we make strides to serve the needs of people living with and affected by HIV in Ohio. The last several years have brought a changing landscape for the organization, as OAC began to shift its focus from client outreach toward community education, engagement and leadership.

4. Mergers and Alliances … In 2011, after a year-long assessment process, three leading, Ohio organizations—AIDS Resource Center Ohio, Columbus AIDS Task Force, and the Ohio AIDS Coalition—merged. This alliance creates Ohio's largest ASO, enabling us to lead the fight against HIV/AIDS in Ohio through awareness, advocacy and care. With offices in Columbus, Cleveland, Dayton, Lima, Mansfield, Toledo, Athens, Chillicothe, and Newark, we will provide linkage to care and supportive services to more than 2,800 Ohioans living with HIV/AIDS. Thousands more will be reached with evidence-based prevention and HIV testing.

5. Who WeServe … • OAC’s supporters are People Living With HIV/AIDS, their loved ones, medical providers, local and state health department officials, social workers, mental health professionals, and other persons affected by the epidemic. • OAC continues to provide education and leadership programs for people living with HIV/AIDS, Case Managers, Medical Providers, and other Health Professionals across all 88 counties.

6. OAC’s Mission and Vision Ohio AIDS Coalition (OAC) is a division of the AIDS Resource Center Ohio (ARC Ohio) providing education, leadership training, advocacy, and support for Ohio’s HIV/AIDS community. Mission The Coalition functions as a statewide network, carrying on activities that local groups are unable to perform and are best served on a statewide level, including but not limited to Healing Events, Publications, Leadership Training, and Advocacy. The Coalition shall consult with policy makers to prevent discrimination against persons with HIV/AIDS disease and to obtain support for HIV/AIDS disease education, research and quality services. Vision To provide hope, healing, and empowerment to all persons affected by HIV/AIDS disease within the state of Ohio.

7. OAC’s Core Objectives • Objectives • To advance consumer understanding of the standard of HIV care; • To increase consumer ability to self-assess their current level of care; • To develop consumer capacity to self-advocate for improved healthcare; • To promote wellness through empowerment, education and advocacy; & • To strengthen Ohio’s community response to HIV/AIDS.

8. OAC’s Public Policy and Advocacy Priorities • Budget Levels and Funding • Emerging Needs • Monitoring Changes to OHDAP • Monitoring Standards of Care • Monitoring Program Enrollment and Retention • Monitoring Co-infection Rates • HIV-related Stigma and Criminalization Issues • The Road to 2014 • Implementation of the National HIV/AIDS Strategy • Ryan White Reauthorization • Implementation of the Affordable Care Act • Voter Empowerment and Engagement

9. The Road Ahead … “The question is not whether we know what to do, but whether we will do it” • President Barack Obama – • July 13, 2010

10. The National HIV/AIDS Strategy • Reducing HIV incidence; • Increasing access to care and optimizing health outcomes; • Reducing HIV-related health disparities; and • Achieving a more coordinated national response.

11. The National HIV/AIDS Strategy “The United States will become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity or socio-economic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination.”

12. NHAS: 23 months later • • NHAS and Implementation Plan; • • Operational Plans from Health and Human Services (HHS); • • Reinvigorated Response to the Domestic Epidemic; • • Continued Fight for Funding and Strategic New Investments; & • • True Government-wide Effort and Collaboration.

13. The Supreme Court will issue its opinion on the fate of the • Affordable Care Act this week on Thursday …

14. The New Health Reform Law • • Represents the most far reaching health legislation since the creation of the Medicare and Medicaid programs in the 1960s. • • Establishes a mandate that will require most U.S. citizens and legal residents to have health insurance or purchase it. The program is estimated to cost $940 billion over ten years. • • New costs are offset by proposed savings in Medicare and Medicaid, higher Medicare payroll taxes on high earners, a new tax on high-cost insurance and cuts to Federal charity/uninsured care payments for Medicare and Medicaid.

15. Enrollment Targets • • Newly Insured: 34 million Americans are expected to gain coverage by 2019, 20 million thru an expansion of Medicaid. • • Remaining uninsured: 23 million residents, including 5 million illegal immigrants, will remain uninsured in 2019. • • ADAP and Ryan White Insurance Continuation programs will have more options to purchase comprehensive coverage for eligible individuals. • • Various elements of health care reform will be phased in over the next ten years.

16. What will the New Law do for PLWHA? • • Reduces discrimination by health plans due to pre existing conditions. • • No national plan, State variations will remain. • • Eliminates the disability requirement for Medicaid and sets new national income standard of 133% FPL. • • Offers federal subsidies to lower income individuals to make coverage and services more affordable, including for Medicare Part D. • • Retains two year waiting period for Medicare for persons with disabilities. This population will move toward interim enrollment in high risk pools/ health exchanges.

17. Ryan White Programs • • Potential for many Ryan White clients to be covered by Medicaid, high risk pools or insurance exchanges for health care services. • • Many support services covered by Ryan White will not be covered. • • Savings for ADAPs due to incremental closing of the Medicare donut hole and allowing ADAP expenditures to count toward TrOOP. • • Increase in minimum pharmaceutical rebate percentages may translate to increased revenue for ADAP. • • RW reauthorization in 2013; major reforms effective 2014.

18. Medicaid Expansions • Increases eligibility for all States to a minimum level of 133% FPL ($14,400) in 2014. • Federal funding for Medicaid expansion population. • Gradually increases reimbursement rates to primary care providers to Medicare levels for 2013 and 2014. • States have the option beginning in 2011 to expand to adults w/o children. • Improved coordination for dual Medicare-Medicaid population through demonstrations and a dedicated office at CMS. • Community based and private Long Term Care incentives.

19. Insurance Exchanges • • Centralized, state-based marketplaces to purchase insurance which commence in 2014. • • Bars discrimination based on health status. • - no longer permitted to deny coverage based on health history • - not permitted to increase costs based on health history or gender • - increases based upon age are limited • • Exchanges must include 340B providers in their networks. • • Places cap on out-of-pocket costs for individuals and families. • • Even with subsidies plans are still expensive with high co-pays.

20. Insurance Exchanges: Essential Benefits Package • • Ambulatory patient services • • Emergency services • • Hospitalization • • Maternity and newborn care • • Mental health and substance use disorder services, including behavioral • health treatment • • Prescription drugs • • Rehabilitative and habilitative services and devices • • Laboratory services • • Preventive and wellness services and chronic disease management • • Pediatric services, including oral and vision care

21. Community Safety Net Providers •  • The law includes a goal of doubling the number of community clinics •  over the next five years. • • Existing clinics will have the opportunity to open new sites and expand their current service capacity. • • Significant changes will take place in the distribution of resources amongst safety net providers through the introduction of Insurance • Exchanges and the reduction in charity care payments.

22. The Road Continues … • • Discussions with HRSA over the next several years on Ryan White interface with Health Care Reform. • • It will be important for 2013 Ryan White reauthorization to examine the Ryan White Care Act in its entirety as it relates to Health Care Reform. • • Develop systems and capacity to leverage Ryan White funding to expand access to comprehensive health services for all PLWHAs.

24. Your Vote Matters • Your right to vote can then become a journey to the truth. • It is in telling our stories, sharing a piece of ourselves, that we break the code of silence and secrecy surrounding HIV/AIDS in our communities. • Such humility and optimism about the rewards of using stories to enhance the statistical data we are able to provide is a strategy advocates will continue to embrace. • Because, no matter how powerful our data, sometimes there is nothing more compelling than a story. • Value Your Voice – Vote!

25. Contact Information Tyler Andrew TerMeer, MS Director of Ohio AIDS Coalition A Division of ARC Ohio 614-444-1683 termeer@ohioaidscoalition.org Sarah Sobel Senior Community Engagement Coordinator Ohio AIDS Coalition, a Division of ARC Ohio 216-325-7720 sobel@ohioaidscoalition.org