MS. REBECCA SHEIR
I'm Rebecca Sheir. Welcome back to "Metro Connection." This week's show is all about design. And before the break we were focusing on the kind of design we can see all around us here in Washington, monuments, architecture, you know, that kind of thing. But now we're going to turn to something a little bit different. The design of health care. What does that mean exactly?
MS. REBECCA SHEIR
Well, consider this, D.C. has one of the highest rates of HIV in the nation, with nearly 3 percent of residents infected with the virus. But as the Affordable Care Act takes full effect next year, some organizations that help these residents are struggling to redesign their operations because, as Jacob Fenston tells us, these organizations believe that while health care reform can be great for people with HIV, the law could also have some unintended side effects.
MR. JACOB FENSTON
After Ron Simmons learned he had HIV in 1989, he started going to a support group.
MR. RON SIMMONS
We had the first support group in the founder's home and I think it was like 22 of us in his living room.
Specifically, it was a group for gay black men who are HIV positive, called Us Helping Us. Simmons found camaraderie, and what was at the time a rare a sense of hope.
I feel that I owe that group to being able to live with HIV now for, oh, my God, what is it, 24 years. I'm on medication now, but I was able to sustain my immune system until the late '90s when indeed they came up with effective medications.
Over the years, new drugs and new ways of using those drugs, have transformed HIV from a death sentence to a manageable disease. And groups like Us Helping Us have evolved too.
Our budget is about 1.7 million.
For the past 20 years, Simmons has been president and CEO of Us Helping Us. He's showing me around their offices on Georgia Avenue.
We have 14 full-time employees.
It's gone from a support group to providing a range of HIV and AIDS services, from testing and prevention, to mental health. Currently those activities are mostly funded through grants from the Centers for Disease Control and the local health department. But that funding structure will likely be changing with the Affordable Care Act.
It's going to be a challenging time. I mean, I've already told my staff, I said that basically the next one to three years are going to be really challenging. I can't guarantee you that you'll all be here in three years.
DR. JULIA HIDALGO
I am very concerned that the tremendous amount of experience we have now in the HIV care system may potentially be lost.
Julia Hidalgo is a health policy professor at George Washington University. She's also a consultant and she's helping groups like Us Helping Us figure out how to adapt to the new health care landscape. She says the problem is that much of the grant funding that keeps them afloat will dry up, as many of the support services they currently offer will be shifted to a more coordinated primary care setting, not necessarily bad thing, except Hildalgo says that some groups fill very specific needs.
Many of those organizations provide an excellent service to a very specific set of HIV-infected folks in the community, men who have sex with men, transgender population, racial or ethnic minorities.
The D.C. health department is working to help HIV/AIDS groups redesign. For one thing, the department has offered grants so organizations can hire consultants like Dr. Hidalgo.
MR. SAUL LEVIN
We need those organizations.
Saul Levin is the D.C. Health Department's interim director.
They're the people who truly are out in the community, can really reach out to the populations that they've taken care of throughout this whole epidemic. But we all know in the Affordable Care Act and the changing health care delivery system that all of us are going to have to change.
Groups that haven't ever had to worry about the complicated world of medical billing, for example, may have to figure out which of their services they can charge to insurance or Medicaid.
MR. ADAM TENNER
I feel like I'm moving onto a second career in health care finance to understand the landscape.
Adam Tenner is the executive director of Metro TeenAIDS, which provides prevention and other services to young people in D.C.
We've looked for many years at becoming a Medicaid provider. And it's a not very pretty world inside Medicaid. Reimbursements tend to be low and slow.
He says his group is looking at how it can repackage the work it's currently doing. They're also considering expanding in other directions, asking…
What are the other health issues that fit within how we do our work, that are also broader than HIV? We provide high-quality of services, but if there's no money to fund it--so we're exploring every option we possibly can.
Some organizations are already shifting focus. Us Helping Us is moving more toward mental health services, because it can bill insurance or Medicaid. And for HIV/AIDS groups that provide medical care, the path forward under health reform is much clearer. Don Blanchon is the CEO of Whitman-Walker Health, a clinic that specializes in HIV and AIDS.
MR. DON BLANCHON
From our perspective, it absolutely should help us financially.
He says about 10 percent of the clinic's patients don't have insurance.
Right now for some portion of that final 10 percent of our patient base, we're having to raise a lot of money every year to cover the cost of care. So we should get some financial help or relief because some of those individuals now, obviously, we can bill for their care.
But it still means an adjustment.
It kind of is a bit of a culture shock.
As more people get health insurance, they may have more options for treatment.
So those folks who now are in that group where they're uninsured or underinsured and who come here because they see us as a safety net or they have no other place to go, they now are going to have coverage. And if they don't like the quality of the care and the customer service we provide, they'll have coverage and they'll be able to go to some other health center or some other private practice.
D.C. is already further along with health reform than most states. While many are still arguing over whether or not to expand Medicaid under the Affordable Care Act, the District already did, just months after the law was passed in 2010. Now, about 93 percent of residents have health insurance, but that doesn't mean everyone is getting the treatment they need. According to the D.C. Department of Health, just one in four residents diagnosed with HIV gets the necessary treatment and stays on it long enough to keep the virus under control. I'm Jacob Fenston.
This story came to us through WAMU's Public Insight Network or PIN. It's a way for people to share their stories with us and for us to reach out for input on topics we're covering. You can find out more about the network by visiting metroconnection.org/pin.
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