More Questions Emerge
“For the past two years we have been looking at the enrollment numbers in ADAP and saying, ‘We do not want to start a waiting list; we want to stretch out the problem for as long as we can,’” says Tom Liberti, chief of the Florida Department of Health’s HIV/AIDS Bureau.
Liberti spoke to a crowded hall of concerned citizens, healthcare workers and journalists in Fort Lauderdale on Thursday, June 17. He gave a similar speech in Miami Gardens the night before at the behest of State Senator Frederica Wilson.
Senator Wilson put her healthcare town-hall meeting in the works long ago in order to explain to her constituents what the new federal reforms would mean for them. “Then I picked up the paper and read that there was going to be this waiting list for ADAP,” Wilson said. “I called up Tom Liberti and asked for his participation as well.”
“Mr. Liberti and I go way back,” she explained, “We were advocating for people with AIDS on Capitol Hill.” The audience at Senator Wilson’s Miami Gardens town hall was more receptive than the one in Broward County.
The discussion, facilitated by the Broward Health Department in Fort Lauderdale, was crowded, difficult to navigate and—despite their system of requiring attendees to hand in their questions to be chosen in advance—was not free of a few terse interruptions and accusatory language.
“We did not want to do this,” Liberti said in response to a pointed question from a local participant. “We didn’t have a waiting list for 14 years… We ran out of money.”
The D.O.H.’s official explanation for the necessity of a waiting list for HIV medication has, so far, been rooted in the economy. Liberti said repeatedly that the “unemployment rate and the recession” are the reasons that the need for HIV medication have exceeded the funding. To back this idea up, he referenced the Brookings Institution—a conservative think-tank that came into prominence by opposing the New Deal.
However, even as Senator Wilson was introducing Mr. Liberti to her audience the previous evening, she highlighted an improved economy in South Florida. “Florida Workforce has more jobs than they have applicants, especially if you are an able-bodied man with kids to feed, so get on over there,” she said.
Another explanation for what Liberti now calls “the ADAP crisis” is that federal contributions to the ADAP program have “hovered at around $92 million” while Florida’s need for assistance has grown beyond that.
But each state customarily makes its own funding contributions to ADAP as well, and Florida has cut its contribution to ADAP by over $3 million, despite the fact that we rank third in the number of reported HIV diagnoses in the USA.
SFGN asked Liberti if Florida state legislators were asked to increase their contributions to ADAP, and he responded by deflecting back to his department’s cost-cutting measures and their attempts at asking the federal government for more money.
Liberti defends Florida’s legislature as “generous,” noting that Florida has only cut ADAP funding by a fraction of what California did in 2009. What he omitted from that claim is that California’s governor, Arnold Schwarzenegger, provided an additional $97 million for California's ADAP in his 2010 budget and that California had previously been offering far more services under its ADAP than Florida ever has. Florida also has more people living with HIV per-capita than California does.
The change in tone on the morning of the Fort Lauderdale event was exacerbated when Liberti described last year’s $1 million cut to ADAP as a “pharmacy line-item” veto, and Dr. Jeffrey Beal, the medical director of the Bureau, told the audience that “all of [the Bureau’s] administrative costs come out of the Ryan White Care Act.”
These ideas were not expressed at the previous night’s discussion and the audience reacted with murmurs and gestures of disapproval.
Beal’s misunderstanding of the challenges that HIV-positive persons face became obvious when he claimed that there was “no difference between waiting one day for medications and waiting 30 days for them.”
Dr. Beal finally ran out of feet to place in his mouth when he admitted: “We did not invite the [ADAP] consumers in on the decisions involved because it had to be done quickly. We tried to put ourselves in their shoes and think about what we would do.”