Subtopic 2: Bioethical Problems Identification
Subtopic 3: Methods and Strategies for Decision-Making
The Case of HIV-AIDS and ADAP Funding
In 1990, the Congress of the United States enacted The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act to meet the public health problems posed by the HIV/AIDS epidemic. Since then, this legislation has been twice renewed. The act is divided into four separate titles. These are:
This subtopic deals with a problem that arose in 2003 when funding to Title II programs was cut at the Federal level. Title II funding includes monies appropriated by Congress for medications to treat HIV disease (AIDS Drug Assistance Program, ADAP). These monies are distributed on a state by state basis and are administered by state agencies charged with operating the program. In Texas, the administrative agency is the Texas Department of Health (TDH).
In simple terms, ADAP is a publically-funded
prescription drug program that is supplemental to a qualifying individual's
private health insurance prescription drug coverage. Accordingly,
payments are made only after the maximum benefit has been reached under
the terms of that private coverage. When this occurs in Texas, qualifying
individuals continue to receive the drugs necessary to treat his or her
HIV disease as if they are still receiving benefits under their insurance
plan, including the payment of copays. The problem is that with funding
cuts, states are now faced with either providing the short-fall themselves,
or cutting benefits to persons whose lives depend on them. The question
is whether it is ethical to cut these benefits, no matter what the reason.
Students are to note the reasons for any changes being considered or made in ADAP benefits including their impact on individual lives, as well as any reasons found for not making such changes. These reasons are then to be related to possible associations with values, both ethical and not ethical. Each group will then present its findings to the entire class, either online or in a traditional classroom setting.