The emotional and physical costs of AIDS are greatest for those who have the fatal disease, but the financial cost of its treatment is nearly as overwhelming - for those with it, as well as for society.
An estimated $500,000 in Medicaid funds, a figure that may double, will be spent this fiscal year on people with AIDS in the state, Utah Department of Health officials said.AZT, the single treatment for the disease, now costs $10,000 or more yearly in Utah. The total cost per person can reach more than $150,000.
AIDS can dry up a life savings in a few months. Because they are too weak to work, victims often lose jobs and accompanying insurance benefits.
Although insurance companies in Utah and across the country must pay bills for clients who have contracted the disease after taking out a policy, insurers equate covering those with the disease with "insuring a burning house."
Some say the final safety net, Medicaid, is tattered and can't provide adequate treatment and humane care in the lives of AIDS patients who are all but assigned a deathbed.
The resulting predicament brings people with AIDS, already weak and sickly from the physical symptoms, to their knees, said Kristen Ries, a Salt Lake doctor who treats more than half the AIDS patient in Utah.
The greatest financial difficulty people with AIDS face is paying for the $900-a-month-plus cost of AZT, which, despite its severe side-effects, is the only anti-AIDS drug approved for prescription use, Ries said.
Medicaid may pay for the cost of AZT, or azidothymidine, but an AIDS patient must be severely sick to qualify, Ries said.
In the last year, 61 AIDS patients received Medicaid assistance, said RaeDell Ashley, a Medicaid program specialist at the state health department. Of that number, 34 are now living.
Despite complaints over the inadequacy of Medicaid, Ashley said the people with the disease she serves are grateful for whatever assistance they can obtain.
"Medicaid does do one thing for them. It provides for the medical needs so they can quit worrying about where they're going to get care," she said.
But many people who don't meet Medicaid criteria for AZT funding should be given the support anyway, Ries said.
"It's like saying a cancer patient can't have chemotherapy because `you can't afford it.' "
Even for those who aren't as sick as those qualifying for AZT, the drug - despite its sometimes severe side-effects - might keep patients at work longer, enabling them to pay for other medical costs, she said.
But even for those who qualify for Medicaid assistance, the federal support is barely adequate and provides little comfort for people with AIDS, Ries said.
Some patients are actually too sick to fill out the necessary paperwork to apply for Medicaid, Ries said, noting that obtaining the federal assistance took one person 10 months.
Being insured helps, Ries said. Insurance companies are bound to cover someone with AIDS if the disease is contracted following a policy agreement.
Blue Cross and Blue Shield of Utah, which estimates six of its policy holders have the disease, says none has resulted in expensive "shock cases," or claims resulting in more than $25,000 paid out to policy holders.
"It's not breaking the bank for us and we see no reason to make an exception of it and treat it differently than any other disease at this point," said Knox Fitzpatrick, medical director for Blue Cross.
In fact, AIDS treatment is less expensive than that for other fatal diseases. Nevertheless, several lawsuits pending against insurance companies have been filed nationwide by people with AIDS who claim their insurers have illegally cut off their benefits following diagnosis.
Only California and the District of Columbia restrict insurance companies from screening applicants in order to put clients in risk categories. In most states, including Utah, insurers can screen applicants.
But the practice is hardly revealing, Fitzpatrick said, because many questions about an applicant's sexual tendencies verge on invasion of privacy.
Some applicants who have had contact with the AIDS virus have an "unfair advantage" over insurance companies because of this, he said.
"AIDS is a national problem," Fitzpatrick said.
And the cost of treating the disease is affecting a wider array of people than just those who are dying from the disease. Whether insurance companies are forced to spread the cost among premium payers or the taxpayers are called on to foot the bill, the impact will be felt nationwide.