The Florida Roundup - Florida’s AIDS drug assistance program in jeopardy, James Patterson on early literacy and more

Episode Date: March 20, 2026

This week on The Florida Roundup, we spoke with Florida Senate President Pro Tempore Jason Brodeur about the Senate’s stop-gap funding measure for the state’s AIDS Drug Assistance Program or ADAP (00:00). Then, KFF’s Lindsey Dawson joined us to talk about the troubles facing the federal ADAP program and how states are responding (17:16). Plus, best-selling author James Patterson joins us to talk about an effort to boast early literacy (21:12). And later, news from across the state including a letter from a group of Florida sheriffs urging a change in federal immigration policy (37:32), an update on a new state-produced intro to biology college textbook (39:52), and the story of a pair of traveling burrowing owls (46:20).

Support for Florida Roundup comes from the Everglades Foundation, working to restore and protect Florida's $1 trillion asset that helps to bring clean water to Floridians. Learn more at Everglades Foundation.org. This is the Florida Roundup. I'm Carlton Gillespie. Tom is out this week. The state's AIDS drug assistance program, or ADAP, is the nation's largest. More than 30,000 Floridians receive either drugs directly through the program or payment assistance for health care plans that cover their medication. But in January, the state's Department of Health said the program, which is federally funded through the Ryan White Act, was facing a $120 million deficit.

So they announced a series of sweeping changes. First, the income eligibility requirements to qualify for ADAP coverage went from 400% of the federal poverty lever, or just over $60,000 a year, to $130% of the federal poverty level, just over $20,000 a year. The state also announced it would no longer cover Bictarvi, a one-a-day pill for HIV treatment that often results in few, if any, side effects. It's the most popular drug for those starting HIV therapy. The result of these changes would kick around 16,000 Floridians from ADAP coverage and force them to scramble to afford increasingly expensive out-of-pocket costs. Let's not pull punches. For a person with HIV, if left untreated, it will develop into AIDS and they will die. the state attempted to adopt a formal rule codifying these changes,

but a flurry of lawsuits from advocacy groups like the AIDS Health Care Foundation stalled that effort. To navigate around that, the state issued an emergency rule that went into effect on March 1st. Since then, those 16,000 Floridians have been without coverage, but legislative helps looks like it could be on the way. Just this week, the Florida Senate approved more than $30 million in bridge funding for ADAP until June 30th. If Governor Rondesantis signs that bill and the legislature funds ADAP when they reconvened to finalize the budget for next fiscal year, the program will survive. For now, there is a national reckoning coming for ADAP programs around the country. What could that mean for the fight against a disease that has devastated communities?

Do you or someone you know receive aid through ADAP? Has your life been impacted by HIV or AIDS? 305-995-1800 or radio at the Florida Round. up.org. We spoke with Florida Senate President pro tempore Jason Broder, a Republican representing Seminole County and a portion of Orange County. He sponsored a stopgap funding bill. Senator, thank you for joining the Florida Roundup. Thank you for having me. You sponsored this stopgap measure. What spurred this effort on and what are your constituents saying? Well, by way of background, the Department of Health announced in January that they were going to be

making some changes to Florida's ADAP program that stands for age drug assistance program because we were going to have a gap in funding that was caused by the expiration of the premium tax credits for the Affordable Care Act. And we were notified in the early January and we thought, well, what's happening here? And it turns out we're not alone. Twenty-three other states have implemented or are considering these cost-cutting measures brought on by the expiration of the federal tax credits. And so out of those 23 states, 18 of them have already made or are making changes and implementing cost containment measures to see if we can't provide a stopgap to some of those folks that are losing coverage. You mentioned that there are other states that are taking

this measure up, but Florida is definitely the most severe with its proposed changes. And the state has claimed that it's because ADAP is at risk of a $120 million funding shortfall. Have they provided the legislature with any evidence of that shortfall? Yeah, and it's a in some levels it's up to $202 million or $204 million. The reason is is because we're the third most populous state and we have a very high AIDS population here. And so for both of those things combined, it creates a much larger coverage gap than you would see in Rhode Island or Georgia even. And so for us, we had seen anywhere, like I said, up to a $204 million gap. And we just don't have that. That was coming in the form of federal subsidies. And so we were able to find money in a trust fund at the Department of Health

that was able to close that gap for folks over the remaining four months of this fiscal year. ADAP has provided medications to people who need them in one of two ways, either directly paying for the medications or paying for insurance plans that cover medications. Is that still the case with the new funding allocation for anyone who is eligible? Yes, that's right. And so you're either on one of these two different formularies. One is for self-insured folks, as folks that have been able to secure health insurance on their own.

And the other one is what we call direct dispense clients. And that's just covering directly just for the drugs. And so, yes, those two still remain. But one thing that this bill does not do is restore coverage for Big Tarvey, which is the most widely prescribed drug for people beginning HIV treatment. and why leave it off? And are there any plans to reinstate the drug for the state's formulary?

So the reason why it was left off, we still covered Discovy for those folks that have renal insufficiency or kidney-related concerns, but it's that there are drugs that have the equal clinical outcome as Bictarvey, although you do have to take more pills. And by doing that, you're talking about thousands of dollars less per month per person,

which means we can cover more individuals. And so there's a public health concern where you have to make the choice. Do you leave one very expensive drug on there and cover fewer individuals? Or do you cover drugs that have the same clinical outcomes? You may need to take more pills, but you can cover many, many more people. And so that's what we chose to do. How does this bill factor into upcoming budget negotiations? You're saying that the funding shortfall could be larger than the state had reported.

What's the long-term future of funding for this program? So in our proposed Senate budget that we have, we have proposed covering at the same level we're covering now for this gap for the next fiscal year. And so that means that whatever changes we've made today will be carried out through the next fiscal year. But those budget negotiations aren't done. And the House doesn't have the same thing in their budget. And so we would need to make sure during the negotiations that that's something we continue to cover for the next year. So as of now, the measure is sitting on the governor's desk. Do you expect that he will sign it?

If so, when? I mean, every day that it remains unsigned, people will have to make up funding to find these drugs for themselves. I do. We changed the language in the bill. The bill that it was originally going in wasn't going to go into effect until July 1st, which really didn't help us out very much. And so we changed the wording in the bill to make sure that it went into effect upon becoming law, which means as soon as the governor signs that that funding will turn on. Right.

Senator, thank you so much for joining the show. Thank you for having me. I appreciate it. Joining us now to discuss the problems facing ADAP programs in Florida and other states is Lindsay Dawson, Associate Director of KFF's HIV Policy Program and Director of KFF's LGBT Health Policy Program. KFF is a nonpartisan health policy organization. Lindsay, welcome to the Roundup. Hello, thank you so much for having me. Can you just start by giving us some background on how ADAP programs have functioned?

How are they funded and how do they operate at the state level? Sure. So ADAPs are part of the nation's Ryan White HIV AIDS program. And so Ryan White was a teenager from Indiana who was kicked out of his elementary school for having AIDS and died at age 18. Exactly. And really became the namesake of what is now the nation's safety net program for people with HIV. And it serves about half of people with HIV in the United States. states and is really focused on meeting the needs of those with low and moderate incomes.

And the biggest part of the Ryan White program are grants that go to states, and that includes funding for their ADAPs, which everyone's now heard is the AIDS Drug Assistance Program. And ADAPs can either provide medications or they can help with insurance costs for people with HIV. And it seems like there is nationally a funding crunch for these programs. You heard the senator mentioned not just Florida, but other states. How did we get into this funding crunch? So there were multiple factors that came together to make this a very difficult funding environment for Florida's ADAP as well as that of other states.

ADAPs are funded through federal appropriations, which means that Congress decides how much money goes to the program each year, through state dollars and through other sources. But funding doesn't always necessarily meet the needs if everybody who needs support or the cost of those services. So when we look at the federal appropriation, we see that the funding has been flat since 2014, so no increase. But when we adjust for inflation, funding today looks like it did in the late 90s. And this is despite the cost of drugs increasing and enrollment in the programs increasing. So programs are being asked to do more with less. And that's not the only challenge. Programs are also having trouble generating the rebates they want.

for generating and insurance premiums are increasing. Congress also didn't extend the enhanced premium tax credits. And so it's really a storm of multiple pressures that got us to where we are today. So what strategies are states looking at, including Florida, to address these funding problems with their ADAP programs? Right. So certainly, as we've said, Florida is not alone, but it does stand out. About half of states are taking actions to address. these budget challenges in their ADAPs. This isn't a red state or a blue state issue. This isn't about a southern state issue.

But states are making different decisions on how they're going to deal with these challenges. And they really have a menu of options. So some are restricting eligibility. Some are changing their formularies. Some are restricting insurance access, creating recertification periods. A recertification period is essentially an opportunity

to create churn in the program and people would maybe not recertify on time and fall off of the program, reducing access to services. And so there are a menu of options, but the ones that are being enacted in Florida are quite broad and deep compared to what we've seen elsewhere. It's more of a hatchet than a scalpel approach. And this is especially concerning for the community of people affected with HIV or AIDS, because Florida is a national hotspot for these diseases, right? Right. So Florida is a state where we see high HIV incidence and prevalence. That means that there are many new infections that occur each year in the state and that the state hosts a large number of people living with HIV. And this is in part two just to do to just Florida being a high populous state. So there's over 130,000 people in the state with HIV. There are about 3,000 new infections that occur each year in Florida. So whether this bill to Stop Gap Fund ADAP is signed by Governor DeSantis or not, the drug BICTARV will no longer be covered by Florida's ADAP program. What does that drug do and why is it under scrutiny here?

So BICTARV is a highly effective HIV medication over half of people in the U.S. on antiretrovirals or on BICTARV. And when the federal government lays out drugs that they see, these are the drugs that we think are probably the best drugs to start with. And Bich Harvey is the only one listed that's a single tablet regimen. Single tablet regimens can be helpful because it's one pill once a day that can improve adherence and just allow people to stay on treatment longer. But it's a very expensive drug. The average wholesale price for the drug is $60,000 a year. ADAPs do get a discount on that price, but unfortunately, we don't know what that drug is, that discount is.

But it's fair to say it's expensive and it's part of what presents a budgetary challenge. $60,000 a year, that's almost as much as the pre-funding cut ADAP was in the state. And what four times almost, what the income eligibility requirements are for the new rules? Right. I mean, it's an extremely expensive drug. all HIV drugs are expensive. So even if we look to less expensive options, we're still talking about tens of thousands of dollars a year in drug costs.

These drug costs, yeah, sorry, go ahead. No, you're fine. We're going to take a call here. We've got Paul in Tallahassee on line one. Paul, you're on the floor to Roundup. Are you there, Paul? Talking about before. Part of the changes that were implemented by a surprise emergency rule by the Department of Health

were to discontinue payment of premiums for health insurance for people who were in ADAP. And those premiums generated rebate revenues from pharmaceutical copayments and deductibles that paid for two-thirds of the program. So the changes that, and we're certainly grateful to the legislature, for coming through with some bridge funding to keep the program active and to allow people up to 400% of the poverty level to be covered for direct dispense. But the changes that need to be made going forward must include the restoring of the premium payments and also replacing or putting back on the formulary, Big Tarvey,

which is the most used antiretroviral medication because it's so effective and a single tablet regimen. Paul, Paul, I want to let Lindsay jump in here. Lindsay, what he's saying there about rebate funding, you mentioned rebates as part of the problem that states aren't able to get rebates as efficiently as they were before. What do you have to...

Yeah, no. Paul raises a really important point here. And when ADAPs purchase insurance instead of just providing the drug directly, they are able to generate rebates. And this is by design. And so this ends up being good for the ADAPs because it helps with financial solvency of the program. But it's good for the individual as well.

When you are enrolled in Ryan White and you're getting your HIV care needs met and direct drugs from ADAP, it's really focused on your HIV care needs. But we know that many people with HIV have other comorbid conditions. And so when you have insurance covered, you can also address things like diabetes, or high cholesterol and are protected in the case of an emergency from really high, you know, out-of-pocket costs if you're uninsured. And so it does pose a problem not to continue providing access to insurance. I want to jump back just quickly to when we were talking about Big Tarvey, the senator in our interview mentioned Discovy as a potential replacement drug. Is that an

equitable substitute what that drug does? There are other drugs that you can substitute. The other recommended start drugs are multiple drug regimens. And there's still great clinical efficacy. We're at a point where there is a sort of multiple drugs that can be selected to treat HIV really effectively. But limiting the Vick-Therby option certainly does create a challenge for folks who are used to that drug, enrolled in it, and whose clinicians see it as the best option for them. So this is a disease that we've made incredible strides in fighting in recent years.

It wasn't long ago that this diagnosis was a death sentence. How far back could this new dynamic of reducing access to these drugs set us back in the fight against HIV and AIDS in just the minute we have left? Yeah, certainly. I mean, drugs have improved dramatically. In the past, there was a high pill burden. Drugs weren't as good. There were lots of side effects.

And today, drugs are a game changer. The side effects are limited. They're highly effective. And when somebody who's engaged in treatment has a reduced viral load, they have optimal health outcomes. But it also means that when there's no viral load present, they can't transmit HIV. So engaging in HIV care and treatment is both good for the individual, but it's also a public health measure. Right. There are increasing HIV infections could have not just public health concerns, but economic

economic concerns that the states are trying to protect themselves from. Certainly. You know, if we increase HIV incidents, if there are more infections, if people's condition worsens and they have more disease progression, all of those factors are going to increase costs. Right. Well, Lindsay, thank you for joining us. Lindsay Dawson is the Associate Director of KFF's HIV Policy Program and the Director of KFF's LGBTQ Health Policy Program.

Thank you so much for joining us on the Florida Roundup. Thank you so much for having me. The arts community is stepping up to raise money for HIV-positive Floridians who are struggling to afford their medications during this time. Tampa's Hell on Heels cast will host a special pop-up event this weekend featuring select musical numbers from the Rocky Horror Picture Show. That's the now famous queer cult classic film and production. Alistair Graves, a burlesque and cabaret performer, will co-host. They don't need to worry about walking away without seeing. the classics like Time Warp and Street Transvestite, and they'll still be doing all the fun movie beats with us.

Proceeds from the performance will benefit out of the closet, the thrift store chain that helps fund HIV testing, prevention, and treatment. You can head to our partner station WUSF.org for more information. Coming up, a conversation about how we teach reading with best-selling author James Patterson. You're listening to The Florida Roundup from your public reading. radio station. Support for Florida Roundup comes from the Everglades Foundation, working to restore and protect Florida's one trillion dollar asset that helps to bring clean water to Floridians. Learn more at Everglades Foundation.org.

This is the Florida Roundup. I'm Carlton Gillespie. Next week on our program, a preview of our summer reading program. Spring break is here, and that's gotten us thinking about what to read when summer comes. We'll give you a little sample of what's on our reading list next week. Artis Henderson's dad was an airline pilot flying out of Miami in the 1970s and 80s. He also was a drug runner with a fleet of planes smuggling marijuana into Florida. Florida was key to his path, but Florida in this very specific era.

There is so much more to this real-life story of drugs, deception, and a search for answers to what happened to her dad. We will hear a different family story from former Washington Post. columnist Eugene Robinson, who traces his own history alongside the uneven march towards civil rights. I saw ancestors who were talented and industrious, intensely patriotic, and who could have done so much more had they just been allowed to. But they weren't allowed to. Robinson covered politics for decades, and we asked him about how Florida has changed teaching about slavery. And then, what's a summer reading list without a thriller? I fear that the book would not ever have come into existence if I had not moved to Florida.

Kip Lyman is a first-time author who set her novel in Fort Pierce. We will have a preview of our summer reading special next week. Let us know what's on your reading list, especially if it's a book with a Florida connection. Email us, Radio at theflordoroundup.org. This week, James Patterson has sold. more than 400 million books, mysteries, romance, nonfiction, and children's books. He's written and co-written more than 200 books, and he's donated tens of millions of dollars to help children learn to read, including millions to the University of Florida Literacy Institute.

Patterson has been a full-time Floridian for more than 25 years. The Institute aims to help teach teachers how to teach kids to read. Its work Patterson explores in a new public television documentary, The Reading Reboot. The film premieres Wednesday and will be available on YouTube and the PBS app. Tom Hudson spoke with James about the film and efforts to change how kids learn to read. James, we appreciate you sharing your time with us. Why did you get involved in how reading is taught in classrooms? I'm here to save lives.

This program will save lives. when I was growing up, everybody could read. We lost our way and we found it back. University of Florida has a program. It's not my program, but I've been supporting it, you know, financially for a long time. I believe in this. And this program works. We have the vaccine.

It's a controversial word it shouldn't be. But we can fix this thing right now, which means we can save thousands of lives. I think we're in about half of Florida now. And we want to be in the other half of the Florida. We need the governor to really. The governor stepped up somewhat. They need to step up even more. It's just a great, great program.

The National Assessment of Education Progress found that fourth grade reading scores in Florida are at a 20-year low. Well, you know, the COVID killed everything. That killed everything. It's got to be more than just the pandemic, more than just remote learning here, right? It really was about how reading has been taught, how it was taught when you were learning, when I was learning how it evolved through the years and your effort to return to an old school way of teaching reading. It's old school, new school, getting back to phonics. Somewhere along the way that was thrown out or, you know, and that was just a big mistake.

That's the old school part of it. Yeah. I want to ask you about that because many of the teachers and principals you feature in the documentary talk about phonics, talk about how reading had been taught. There's a principal school teacher at Ketterlinus Elementary School, Kathy Tucker, who said, We had some stellar teachers who really were phonic space, and they were fabulous. And then we had some other teachers that maybe weren't as strong. Even at my own education, college education, we don't teach how to teach reading.

I saw that with my teachers. There was such inconsistency. But for the student, it was kind of hit and miss. So what was lacking with the being explicit phonics instruction, you really didn't highlight what was the new concept or skill that was going to be taught. How and why do you think reading, how reading has been taught, has evolved and changed through the years? I don't know how it changed.

Things happen sometimes. Somebody's at the head and they don't entirely understand what they should be doing. And that's what happened with reading, and it was not useful, and it just hurt people for a long, long time, but they're not reading as much, they're not reading as many books. And that doesn't help. When I went out doing this film and I sat in these kindergartens in second grades and watching these kids, they are so turned on by this program. Even when I was growing up, I never remember that kind of excitement in the rooms. The teachers will say, you know, last year, I was wondering if I even wanted to be a teacher. And now they're going, I can't wait to go to work.

Because they're getting rewarded. The kids are reading. What was it like when you went into those kindergarten first grade and second grade rooms? I got to imagine it's somewhat humbling because they don't know it's James Patterson. Oh no, I told them. I told them. I told them who I was. Did that work? No. But the kids were terrific and they're just turned on. They're so excited about the class. And anything that's going to add to the class they're cool with, they're open, which is terrific. The teachers are turned on. And the parents, I have. I've had literally thousands of parents, they'll come and say thank you for helping, both with the books that I write for young kids and this program, thank you for helping getting my kids reading.

And they'll cry, not all of them, but many, they cry because it's heartbreaking if your kid is not learning how to read in school. It's heartbreaking because you know that that is not good for the welfare and the future of your child. I want to ask you about some of the politics and public policy at play of education here in Florida. But the basis of this is what's called the science of reading. And there was a parent and reading specialist in Hillsborough County, Lisa Dodge, who spoke about this. The way we were taught how to teach kids to read by certain people and certain curriculums that told us that, oh, as long as your room is nice and dark and everybody has a levy in their arms, that they're just going to love to read. They're going to love to read by osmosis, right?

Like, it's just going to happen organically. But then we would look at data and just kind of say, well, what's happening then? Like, why aren't our kids reading at a faster pace? Like, what's going on? What is the science of reading, James? How can you describe that to us? It's a combination of understanding where different kids are coming from, what their backgrounds are, understanding that's going to change from school to school, from county to county, from state to state, and being aware of it.

It's getting people enthused, it's getting the teachers enthused and hopeful. And I got to tell you, I mean, teachers want to teach and they want to be successful with their teaching. And that's one of the things that happens here. They go in here and they go, oh, my God, this thing works. And that's very exciting for people. The state of Florida did pass a law several years ago requiring the science of reading in reading curricula, kind of early days for that.

But what's been the response? I'm going to give you an example. and this may ruffle some feathers, but they have a program where they send a book every month into houses where kids with our books. Okay. Here's the problem. They don't really curate the books very well. The kids get the book. They start to read the book.

They don't like the book. They got to be books that the kids are going to go, not dumb books, just books that have good stories. And they go, I like that. Give me another book. So that when the next book comes in it, and it's a very expensive program. So in the theory you go, oh, that's great. You're going to put in all these families. Well, the problems are in a lot of these homes.

The parents are not really into reading. The kids look at that first book and the book isn't really interesting. And then they stop opening the books. And it's expensive program. The whole program is it's just too expensive. This program, it works, it works. We have the vaccine, folks. We can get the numbers in Florida up into the 70s.

If you can get 70% of the kids in Florida reading it great, level, that means that that group, they all have a chance to get through high school. That means that they'll have more choices in life. The important thing is this program. It's huge, huge, huge, huge, huge. And I hope that Florida turns on even more than they have. Let me ask you about some public policy things in education in Florida. As you know, Florida has been active on policy when it comes to public education and passing

a series of laws in recent years. No, I think Florida's heart is in the right place. I think the heart is in the right place. Now we have to get their heads in the right place. So what I want to ask you is in Florida, among the education policies and laws that have been passed in recent years, include one requiring teachers to use strategies grounded in this science of reading. The state legislature and the governor have also passed and approved the parent rights in education law, which expands parental view into curricula used in classrooms.

How do you think these laws shape reading instruction? Not only the science of reading requirement, but also. the more parental involvement in curriculum. Yeah, in theory, the science of reading. And then it's just an issue of let's make sure that the teachers actually can execute it, okay, which is what this program does. If you have teachers that have been in the system for 20, 25 years, how wonderful and stimulating it is for them to get a second life here.

Because everybody, every teacher wants it to work. They want these systems. They want these kids to read and they'll take great joy out of it. it. The second part of the question, I don't understand as much, but you can get into that a little bit. Well, fair enough. I'll try to rephrase it a little bit for you, James. The Florida Parent Bill of Rights invites parents to have more input in curriculum. This was passed after, you know, the remote learning of COVID in the pandemic years, certainly. Yeah, yeah, yeah, yeah. It's caused some tension, and I'll ask you a little bit about that when it comes to books in a second, but parental involvement

in reading is key. You referenced that earlier. How about in your own house? Take care of your own house. There's where the parental involvement should really happen in a big way. Make sure your kids are reading in your house in a reasonable way. When our son was eight, I think it was, that summer, we just said, you're going to read every day. We went out and got like nine to 11 books, and we knew they would all be good books that Jack would really like. And no screens until he read. for 45 minutes to an hour.