The U.S. Centers for Disease Control and Prevention (CDC) recently recommended making HIV testing a routine part of medical care for adolescents and adults. The new guidelines call for HIV screening of all patients aged 13 to 64 and all pregnant women—not just those at high risk—in all health-care settings. CDC previously recommended screening only for people at high risk and in settings with an HIV prevalence above 1 percent. “The [new] recommendation, if fully implemented, could mean testing for 100 to 200 million Americans, said Ron Spair, chief financial officer of Pennsylvania-based OraSure Technologies, one of three companies that sell rapid-result HIV tests in the United States,” the Associated Press reported.
CDC’s revised recommendations stress that HIV screening should be voluntary. However, unless the ethic of written, informed consent is upheld in all health-care settings, there are no assurances that patients will be fully aware of their right to reject the screening. Citizens and state and federal policymakers should carefully monitor HIV and other medical-diagnostic laws and policies to ensure that written, informed consent is obtained from individuals before any medical testing is performed.
The recommendation that patients can be informed orally increases the likelihood that overworked health-care providers could neglect to fully inform all patients that they are being tested for HIV. That is why written, informed consent should be obtained from all patients, including pregnant women, explaining clearly that 1) HIV testing is recommended as a routine medical test and 2) individuals are free to decline without penalty. This is especially important for patients who lack a full understanding of their legal rights regarding health-care matters.
“Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings,” CDC’s Morbidity and Mortality Weekly Report (Vol. 55/RR-14), September 22, 2006.
“HIV Testing for All, U.S. Agency Says,” by Mike Stobbe, Associated Press, September 21, 2006.
At its 2006 annual meeting, the American Medical Association (AMA) voted to support a “requirement” for Americans to obtain health insurance, using tax laws to enforce the mandate. David McKalip, M.D., who attended the meeting in June, notes that support for the insurance mandate was overwhelming. His comments on the meeting were published in the fall issue of the Journal of American Physicians and Surgeons.
The AMA reported it “voted to support a requirement that individuals and families earning greater than 500 percent of the federal poverty level obtain, at a minimum, coverage for catastrophic health care and evidence-based preventive health care, using the tax structure to achieve compliance. [Emphasis added.] Upon implementation of a system of refundable tax credits or other subsidies to obtain health care coverage, this requirement would apply to individuals and families earning less than 500 percent of the federal poverty level."
Dr. McKalip said he hoped the AMA would wait and see how “the great social experiment” (mandatory medical-insurance law) in Massachusetts plays out before embracing mandatory insurance. Other physician organizations and patient groups still have the opportunity to encourage a wait-and-see policy before endorsing the requirement in other states.
“Reference Committee Highlights,” 2006 Annual Meeting Highlights for the AMA House of Delegates.
The first state to enact universal access to health care was Maine, which passed the Dirigo Health Reform Act in 2003, an attempt through various reforms to provide state residents health care by 2009. Next Illinois passed the All Kids Health Insurance Program in 2005, expanding coverage to all children under 18.
In 2006 Massachusetts and Vermont passed legislation to expand coverage to all state residents. The Massachusetts plan combines a number of strategies, including an individual mandate for health insurance. The Vermont plan provides comprehensive coverage for uninsured state residents.
Even though a majority of legislatures failed to pass universal health insurance laws in 2006, supporters continue to press on. Universal health care will continue to be a critical issue to monitor in 2007.
“2006 Bills on Universal Health Care Coverage: Legislatures Fill in the Gaps,” National Conference of State Legislatures (website accessed October 20, 2006): (http://www.ncsl.org/programs/health/universalhealth2006.htm).