VIENNA, Austria – Overall support for global AIDS efforts from donor nations flattened in the midst of last year’s global economic crisis, according to a new analysis of 2009 funding levels from the Kaiser Family Foundation (KFF) and the Joint United Nations Programme on HIV/AIDS (UNAIDS).

In 2009, the Group of Eight nations, European Commission (EC) and other donor governments provided US$7.6 billion for AIDS relief in developing nations, compared with US$7.7 billion disbursed in 2008.

The 2009 totals ended a run of annual double-digit percentage point increases in donor support for international AIDS assistance since at least 2002, when donor governments provided a total of US$1.2 billion. The results are consistent with preliminary data about overall trends in official developmental assistance during last year’s global recession and economic instability.

“Donor nations essentially were treading water last year on AIDS relief, but did not cut back overall as they dealt with the economic tsunami that sparked a global recession,” KFF President and CEO Drew Altman said. “Time will tell whether support will resume its rapid growth once the global recovery takes hold.”

“Reductions in investment on AIDS programs are hurting the AIDS response. At a time when we are seeing results in HIV prevention and treatment, we must scale up, not scale down,” said Michel Sidibé, UNAIDS Executive Director.

This year’s totals reflect a substantial increase in funding provided by the United States (rising from US$3.95 billion in 2008 to US$4.4 billion in 2009), which helped to offset reductions in support from Canada, France, Germany, Ireland, Italy, and the Netherlands

The United States remains the largest donor nation in the world, accounting for more than half (58%) of 2009 disbursements, followed by United Kingdom (10.2%), Germany (5.2%), the Netherlands (5%), and France (4.4%). Denmark accounted for 2.5%.

The new report provides the latest data available on donor funding based on data provided by governments and collected and analyzed by researchers as part of a collaborative effort between Kaiser and UNAIDS, with research assistance provided by the Stimson Center. It does not examine donor nation support for other health and development efforts.

Other key findings include:

•  UNAIDS estimates that US$23.6 billion was needed to address the epidemic in low- and middle-income countries in 2009. That suggests a growing gap of US$7.7 billion between available resources and need, according to UNAIDS estimates.

•  In 2009, donor governments disbursed US$5.9 billion bilaterally and earmarked funds for HIV through multilateral organizations, as well as an additional US$1.6 billion to combat HIV through the Global Fund to Fight AIDS, Tuberculosis and Malaria and US$123 million to UNITAID.

The full report is available online at the Kaiser Family Foundation’s website or on the UNAIDS’ Website.

The Kaiser Family Foundation is a non-profit private operating foundation, based in Menlo Park, California, dedicated to producing and communicating the best possible analysis and information on health issues.

UNAIDS, the Joint United Nations Programme on HIV/AIDS, is an innovative United Nations partnership that leads and inspires the world in achieving universal access to HIV prevention, treatment, care and support. Learn more at unaids.org.

Conservatives are out of sorts these days about the direction in which health care is headed. They think the new health reform law expands the role of government too much and spends too much at a time when they believe deficit reduction should be a higher priority. The claims about death panels and a government takeover of the health system aside, these are principled positions for conservatives to take – they are supposed to be for smaller government and less public spending. But for all of the frustration and even anger within the conservative movement about where health care is headed, the fact of the matter is that they are winning more than even they may realize in the current health care equation. That’s because the nature of health insurance itself is being redefined and moving gradually but seemingly inexorably in the direction conservatives have long advocated: more consumer “skin in the game” through higher patient deductibles.

Item: In our recent survey of people in the non-group insurance market, we found that the average deductible for an individual policy is now $2,498, and for families it’s $5,149. These are very high thresholds by any standard. Consider, for example, that a family with median income facing such a deductible would be spending almost 10% of their annual income just for their deductible before their insurance kicked in.

Item: The percentage of workers facing high deductibles — $1,000 or more for single coverage —  has been growing rapidly. It doubled from 10 percent to 22 percent between 2006 and 2009, and increased from 16 percent to 40 percent in small firms.

Item: Indications are that the share of workers with high deductibles is continuing to grow, a trend I expect our 2010 employer survey to confirm when we release it in September as we have every year for more than a decade now. And a substantial number of these high deductible plans are paired with tax-advantaged savings accounts, which conservatives have long advocated. Facing cost pressures without alternative answers, employers are moving to plans with less comprehensive coverage to reduce their expenses for employee benefits.

Item: Health reform is unlikely to reverse these trends. Large employers will continue to look for ways to address the rising cost of health care. And, for the basic “bronze” insurance plan that people will be required to buy, deductibles could run several thousand dollars for individuals and double that for families. To be sure, other aspects of health reform cut the other way. For example, there will be no cost sharing for preventive services in newly-purchased plans, and insurers will be required to cap consumer out-of-pocket costs at defined levels. And, of course, there are substantial subsidies to reduce premium and out-of-pocket costs for lower-income people. But, for the first time, the government will be defining the threshold that decent insurance must meet, and that minimum coverage will have the kind of high deductibles that conservatives favor.

Given the drift towards less comprehensive coverage in the marketplace, it is perhaps no surprise that two seemingly contradictory things are happening at the same time. For several years we have seen moderate increases in premiums for employment-based health insurance. I suspect that rising deductibles and other out-of-pocket costs are one explanation for this. It’s simple arithmetic that employers can buy down premium increases by switching to less comprehensive coverage and shifting more costs to workers. Plus, these higher out-of-pocket costs exert downward pressure on utilization – in some cases for the better, in some cases for the worse — and thus on premiums as well. At the same time, people have never been more upset about their own rising health care costs, as the coverage they get offers less and less financial protection. This seeming contradiction underscores the fundamental difference between how people and experts look at health care costs: To experts, who focus on the rate of increase in aggregate numbers such as the annual increase in health insurance premiums, costs look like they have been moderating. But to people, who focus only on what they themselves are paying, expenses out of their own pockets are rising far faster than they can afford, especially in a bad economy.

If you look at what is happening in health insurance from a policy perspective, the big challenge will be to find the right balance between appropriate cost sharing and cost sharing that is so high that it poses barriers to care and a threat to people’s economic security, especially for people who are chronically ill or have lower or moderate incomes. Deductibles are just one part of this picture. Looked at through a political lens, liberals have gained through passage of major health reform legislation, including expanded coverage and increased government oversight of the health insurance system. But increasingly, the insurance itself is looking more and more like the vision advanced by conservatives – less comprehensive with more skin in the game. That’s where conservatives may be winning more than they realize in the ongoing battle over the future of health care.

With Medicaid set to expand under health reform, the program will begin to reach individuals who have previously had little interaction with the health care system. The data in this brief profile uninsured adults with incomes at or below 133 percent of the poverty level who, because of health reform, will be eligible for Medicaid in 2014 based on income. It focuses on those who received no medical care over a two-year period to help assess unmet need.

Of all the uninsured adults in this income group, 38 percent did not receive any medical care over two years. Identifying how uninsured adults with minimal ties to the health care system differ from other adults will allow outreach efforts to be tailored to those who are unlikely to hear about Medicaid through a health provider. Additionally, the data may be relevant when designing enrollment procedures and setting premiums and cost sharing.

Issue Brief (.pdf)

International AIDS Society and Kaiser Family Foundation Partner to Offer Daily, Comprehensive Coverage of Conference for Free

MENLO PARK, Calif. and GENEVA, Switzerland — The International AIDS Society (IAS) and the Kaiser Family Foundation will provide worldwide online access to the XVIII International AIDS Conference (AIDS 2010) taking place in Vienna, Austria, July 18-23, 2010. Kaiser — an independent operating foundation and non-partisan source of facts, information, and analysis, based in Menlo Park, Calif., USA — is the official webcaster for AIDS 2010, providing daily coverage of conference developments on its website, http://www.kff.org/aids2010.

In addition to more than 50 online webcasts of conference sessions, podcasts will be available for downloading in both English and Russian.  Some sessions, including the Opening and Closing Sessions, will be presented via live webcast, while other coverage will be tape-delayed by a few hours and available on-demand.  The webcasts will include sessions featuring former U.S. President Bill Clinton, South African Deputy President Kgalema Motlanthe, South African Health Minister Aaron Motsoaledi, philanthropist Bill Gates and Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases at the U.S. National Institutes of Health.

A daily video recap of conference developments with Science magazine’s Jon Cohen will also be available.  An outline of scheduled coverage is available at http://www.kff.org/aids2010.

Kaiser’s Daily Global Health Policy Report, a free, daily news summary service will be enhanced during the week of the conference to include summaries of what the global media are reporting from the conference and original recaps of information that may not be covered elsewhere.

Kaiser is also providing session coverage for the official and independent conference hubs, which will feature a viewing of select sessions followed by discussions and workshops on how the sessions’ content can be applied locally.  The three official conference hubs will be held in Moscow, Russia, Kiev, Ukraine, and Almaty, Kazakhstan, while more than 30 independent hubs in over 20 countries are already planned.

A widget for sharing Kaiser’s content is available for organizations and individuals who want to further spread the information by carrying the coverage on their own websites, blogs or social networking pages.

“The partnership with Kaiser Family Foundation is central to our ability to extend the reach of the International AIDS Conference well beyond the conference venue and dates,” said IAS Acting Executive Director, Mats Ahnlund. “In conjunction with our other online resources, the webcasts ensure that those unable to attend the conference have access to its key resources, while providing a lasting record of conference proceedings. Kaiser’s substantive and technical expertise, along with their well-earned reputation for high-quality coverage, makes them the ideal webcasting partner.”

“This eight-year running partnership allows us to play a vital role in ensuring people around the world can learn about the important developments in HIV/AIDS that come out of this conference,” said Drew Altman, Ph.D., Kaiser President and CEO.  “By providing free, online access, we are helping to connect the information and advances generated at the conference to communities in the developed and developing world, ultimately raising awareness of the HIV/AIDS epidemic and the efforts to address it.”

AIDS 2010 will provide presentations of important new scientific research and opportunities for dialogue on the major challenges facing the global response to AIDS. The 2010 conference theme, Rights Here, Right Now, emphasizes human rights as a prerequisite to a successful response to HIV, including equal access to health care and life-saving prevention and treatment programs. There are more than 33 million people living with HIV worldwide.

More information about the XVIII International AIDS Conference, including the latest program details, is available at http://www.aids2010.org.

Kaiser’s AIDS 2010 conference coverage will be available through the Foundation’s Global Health Gateway, http://globalhealth.kff.org, which also features original policy analysis and polling on the U.S. role in global health; country-specific data through the Global Health Facts database; regularly updated resources tracking major policy and budget developments; news summaries from the Kaiser Daily Global Health Policy Report; and a reporter’s guide to covering global health.

About the Kaiser Family FoundationThe Henry J. Kaiser Family Foundation is a U.S.-based, non-profit, private operating foundation focusing on the major health care issues facing the U.S. and on global health policy. The Foundation has a longstanding interest in HIV in the U.S. and around the world.

About the IASThe International AIDS Society (IAS) is the world’s leading independent association of HIV professionals, with 14,000 members from 190 countries working at all levels of the global response to AIDS. Our members include researchers from all disciplines, clinicians, public health and community practitioners on the frontlines of the epidemic, as well as policy and program planners. The IAS is the custodian of the biennial International AIDS Conference.

The health reform law creates a temporary national high-risk pool to provide health coverage to people with pre-existing medical conditions who have been uninsured for six months. It is a temporary measure designed to bridge the gap until the implementation of other coverage provisions in the law that will take effect in January 2014. This summary provides answers to basic questions about the high-risk pool program.

Brief (.pdf)

The health reform law contains provisions that aim to improve the delivery and coordination of services for persons enrolled in both Medicaid and Medicare, known as the dual eligibles. This population includes individuals with some of the most severely disabling chronic conditions. While the higher costs associated with services to dual eligibles is well-known, information on how spending is distributed across these programs is less understood.

This study uses linked Medicare and Medicaid data to examine the chronic physical and mental conditions and multiple co-morbidities that create substantial needs for medical and long-term services among dual eligibles, and provides information about the financial contributions of Medicare and Medicaid in meeting these needs.

Report (.pdf)

The health reform law will expand Medicaid to millions of low-income adults, including many childless adults who have historically been ineligible for the program, necessitating one of the largest enrollment efforts in the program’s history. This report, based on interviews with officials in seven states and the District of Columbia and national experts, examines lessons learned from past state experience covering childless adults through waiver and state-funded programs and profiles the programs included in the study.

The report finds that many best practices for enrolling parents and children in Medicaid will apply to childless adults, but successful efforts will also require new strategies and messages given their historic ineligibility for Medicaid, limited connection to public programs, fluctuating incomes and language and cultural barriers. Further, more needs to be learned about the health needs of this group and how best to deliver and manage their care. Given the significance and size of the expansion, it will be imperative for states to be ready and prepared with the necessary systems, technology, and administrative capacity in place to process enrollments and coordinate coverage and care with the new Health Insurance Exchanges.

Report (.pdf)

The Global HIV Prevention Working Group is a panel of nearly 50 leading public health experts, clinicians, biomedical, and behavioral researchers, and people affected by HIV/AIDS, convened by the Bill & Melinda Gates Foundation and the Kaiser Family Foundation.

Executive Summary (.pdf)

Report (.pdf)

Press Release (.pdf)

Foundation Establishes Fellowship in Recognition of Former New York Times Health Journalist

WASHINGTON, D.C.– National Journal health care and welfare reporter Marilyn Werber Serafini has been selected as the inaugural Robin Toner Distinguished Fellow of the Kaiser Family Foundation.

Serafini is a veteran, award-winning journalist who has covered the U.S. Congress since 1985 writing about health care, tax, trade, welfare, pension and banking legislation. She covered the health reform debate during the Clinton Administration and the recent debate that led to the Patient Protection and Affordable Care Act. Serafini will begin her fellowship later this summer and work closely with the editors of Kaiser Health News (KHN) and KHN news organization partners on a series of articles on health policy and politics, as well as stories that explore the intricacies of health reform implementation. KHN is an editorially independent news service of the Foundation.

The fellowship honors the late Robin Toner, The New York Times‘ long-time health and politics reporter whose work so often framed the public debate on health issues and the intersection of these debates with the politics of Washington and the nation.

Noted for her relentless approach, meticulous work and elegant delivery, Toner was the first woman to be the national political correspondent for The New York Times. She led the newspaper’s coverage of the 1992 presidential election, and was central to its subsequent reporting on President Clinton’s health reform effort. In a Times career of nearly a quarter century, she reported on almost every domestic issue and had a significant role in the coverage of five presidential election cycles.

Toner started her journalism career at the Charleston, West Virginia Daily Mail, then worked for The Atlanta Journal Constitution before joining The New York Times.  She died of cancer in 2008 at the age of 54.

“Robin Toner set the standard for reporting on health policy and politics. This Fellowship will honor Robin and allow Toner fellows for years to come to bring a greater understanding of health policy issues to the American people,” said Kaiser Family Foundation President and CEO Drew Altman.

The Robin Toner Distinguished Fellowship continues the Kaiser Family Foundation’s longstanding commitment to health care journalism, recognizing the critical role the media plays in explaining complex health issues to the nation. This commitment has included media fellowship and internship programs on health, survey partnerships with media organizations, and most recently, the establishment of KHN.

Public opinion played a prominent role during the recent health care reform debate. In a published Health Affairs article, Kaiser researchers examine past and present polling and show that opinion tracked with historic patterns and was relatively stable, even if the contentious public debate suggested a volatile public mood in 2009 and 2010.

Going forward, the public will begin reacting to reform implementation, primarily by judging it in terms of their perceptions of and experiences with what the new law does and does not do for people. These opinions could in turn influence implementation or future legislation.

Abstract

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