President Barack Obama The White House 1600 Pennsylvania Avenue Washington, D.C. 20006 Dear President Obama: The undersigned HIV/AIDS advocates and organizations thank you for your tireless efforts to reform America’s broken health care system. Your nationally televised speech on health care ignited broad based support for this reform initiative. We wish to convey our strongest support for your three overriding goals: to bring stability and security to Americans who have insurance today; to ensure affordable coverage for those who don’t; and to reduce the unsustainable growth in the cost of health care. We also support many of the specific proposals in your health care reform plan, including a public health insurance option, ending discrimination against people with pre-existing conditions, preventing insurance companies from dropping coverage when people are sick, capping out-of-pocket expenses, eliminating extra charges for preventive care, and eliminating the Medicare Part D “donut hole.” We are also grateful for your commitment to address the domestic HIV/AIDS epidemic and to secure the well-being of people living with HIV. However, we know this can not be done without specific provisions that must be included in any health care reform proposal. We also know that provisions that protect people with HIV/AIDS will also protect those living with other chronic and life-threatening conditions who are among the most vulnerable in the health care systems. Therefore, we respectfully ask for your support and leadership in ensuring that the following be included in any final health care reform bill: 1. Expansion of Medicaid coverage to all low-income individuals, including childless adults. Medicaid serves as a lifeline for those with HIV/AIDS who can qualify for coverage. However current eligibility rules exclude most people with HIV from accessing Medicaid until they become disabled. Expansion of Medicaid coverage to all low-income individuals up to 150% of federal poverty will allow many people with HIV to access lifesaving treatment and care that will keep them healthy and productive. 2. A strong national public insurance option. This would ensure the establishment of comprehensive standards for benefits and affordability across state lines. It would also lower costs of care and treatment through competition. We must have a competitive health care system based on providing quality care instead of profit margins. 3. Affordability of private insurance. Efforts to ensure affordability in the private insurance market are vital to people with HIV/AIDS and others with chronic conditions. Even nominal cost sharing can be a barrier to care for lower income people with chronic conditions such as HIV whose health depends on regular access to medical care and treatment. We strongly support an annual meaningful out of pocket cap on cost sharing and premium assistance based on a sliding scale. We must also have substantial premium subsidies to protect low income individuals and families up to 400% of the federal poverty level. 4. Prevention and Public Health Investment Fund. This Fund would help ensure that health reform strengthens our public health infrastructure and reorients our health system towards prevention and preparedness. Stabilizing our public health system and expanding the delivery of HIV prevention programs are essential to reducing the number of new infections and related health care expenses. This Fund must be established with dedicated funding. Again, we thank you for your determination to ensure that all Americans have access to affordable quality health care. We stand with you to achieve this goal and look forward to continuing to work with your Administration and Congress to secure meaningful reform of our health care system. Sincerely, List in Formation