2018 United States Conference on AIDS

 

 

June 12th has been designated as Orlando United Day.  On this day, we remember the 49 angels who were killed at the Pulse nightclub in Orlando. This was a deliberate attack on the LGBT community that must never be forgotten.

To show our support for Orlando and the LGBT community, NMAC is pleased to announce that we will hold the 2018 United States Conference on AIDS in Orlando on September 6-9, 2018.  Please save the date.

The 2018 meeting will highlight the contributions made by the LGBT community to our efforts in ending the epidemic.  Our community has suffered so many losses and we must stand together.

The 49 beautiful portraits in this e-newsletter were created by 49 different artists across the country.  Each portrait portrays someone who was killed in the Pulse shootings.  They are all on exhibit at the Terrace Gallery at Orlando City Hall from May 1 – June 14, 2017.

Yours in the struggle,

Board & Staff of NMAC
Stronger Together!

Resilience



By Fernando De Hoyos · NMAC Treatment Coordinator

Every year we come together on this day to honor the lives and struggles of Long-Term Survivors of HIV and AIDS. For me, everyone who was old enough to remember the early days of the epidemic is a long-term survivor regardless of HIV status. Countless allies living without the virus have been side by side with us along this journey. It was a time like no other in US history. June 5th was chosen because on this day, in 1981, the Center for Disease Control (CDC) first announced the “mysterious cancer” that was killing gay men around the country. Therefore, this day is a national day of remembrance and sharing our stories of resilience and survival, to document them for posterity.

I have told my story many times, so I want to talk about this year’s theme: “Resilience”. As a long-term survivor, I know resilience very well. Resilience is the ability to cope with adversity and to adapt well to tragedies, traumas, threats or severe stress. Being resilient does not mean not feeling discomfort, emotional pain, or difficulty in adversity. However, people living with HIV are usually able to overcome their diagnosis and adapt well over time. Resilience involves a series of behaviors and ways of thinking that anyone can learn and develop. I believe resilient people have three main characteristics: Know how to accept reality as it is; Have a deep belief that life makes sense; And have an unwavering ability to adapt to almost anything, often making the best out of it.

Resilient people usually possess a good dosage of realistic optimism. A positive vision of the future without being carried away by unreality or fantasies. Our perceptions and thoughts influence the way we deal with stress and adversity. We don’t run away from problems but face them head on and seek creative and innovative solutions. It involves seeing problems as challenges that we can overcome and not as terrible threats. Challenges are opportunities for learning and growing. I think blessings sometimes come in ugly packages, but what is inside could be the gift of a lifetime. “We are shaped by our thoughts; we become what we think.”– Buddha.

Which takes me to Gratefulness. Gratitude is a major contributor to resilience. When we focus on what we have, we realize that what we might be missing is not as important. It allows us to focus on life from a place of abundance versus a place of deficit. Gratitude improves physical and psychological health. Studies have shown that people living with HIV who practice gratefulness are more likely to take care of their heath, exercise and have good medication adherence. Developing an attitude of gratitude is one of the simplest ways to improve quality of life and sense of wellbeing.

Life is a blessing, with all the good and the not so good. The notion that whatever our journey might be, is unique and wonderful as it is. This is what makes life worth living. We just must be present to enjoy it, and the present moment is a gift, that’s why is called The Present. Please join us in raising awareness about HIV Long-Term Survivors contributions and accomplishments, as well as needs, issues, and journeys.

Yours in the Struggle,

AIDS United’s Statement on President Trump’s Budget for FY 2018

AIDS United is shocked by President Trump’s Fiscal Year 2018 budget request released today. It threatens to roll back the progress in the fight against the domestic HIV epidemic. Now more than ever we must maintain and strengthen our progress towards our national goals and priorities of reducing new HIV infections, increasing access to care and improving health outcomes for people living with HIV, and reducing HIV-related health disparities.

The deep proposed cuts to domestic HIV and STD prevention cannot be reconciled with the goal of preventing new HIV transmissions and the rising rates of STDs. The proposed $59 million cut to the Ryan White HIV/AIDS Program, coupled with a fundamental restructuring of the Medicaid program capping federal spending for the first time to the tune of a $610 million funding reduction over the next decade, diminishes every community’s ability to deliver quality health care to people living with HIV by eliminating AIDS Education and Training Centers and Special Programs of National Significance (SPNS).

“AIDS Education and Training Centers (AETCs) are essential to the HIV care continuum and the success of the national goals and priorities to end the epidemic,” said AIDS United President & CEO Jesse Milan, Jr. “AETCs assure that providers know and apply the best standards of care for people living with and at risk for HIV.”

Further, AIDS United is particularly concerned that the President’s budget eliminates SPNS and reduces funding for Minority AIDS Initiative (MAI) programs. SPNS and MAI programs address the HIV epidemic by developing targeted, innovative approaches to reach chronically underserved people.

“Investment in targeted approaches are effective and save money, at a time when 1 in 2 and 1 in 4 Black and Latino gay and bisexual men respectively are at substantial risk for HIV infection in their lifetime. How can we reduce funding to programs that address these disparities? The President’s budget isn’t just a set of numbers, it’s a disturbing statement of values. Every voter must send their own message to Congress to express that they value the health of our people,” said Milan.

AIDS United urges Congress to reject the draconian cuts proposed in the President’s budget request and support funding for Medicaid, HIV programs, and STD prevention. Congress cannot idly allow the return of reduced, sequester discretionary spending caps for fiscal year 2018. These restrictive caps must be raised so that non-defense discretionary programs, which include HIV programs, can be adequately funded in fiscal year 2018. A bipartisan budget agreement that provides relief from the sequester spending caps while preserving parity between defense and non-defense discretionary programs must be achieved for 2018.

“The president’s budget would turn back the clock for years and years on progress to end the HIV epidemic. We call on Congress to keep the country moving forward,” said Milan.

The facts are in – TrumpCare is dangerous and destructive

The Congressional Budget Office (CBO) has finally released their report on TrumpCare, the bill that passed out of the U.S. House of Representatives on May 4. Yeah. You read that right. The U.S. House passed TrumpCare before they knew what it cost or how it would affect health insurance.

And now we know why. The facts are clear. The American Health Care Act is dangerous and destructive.

The CBO tells us that the bill will strip 23 million people of their health insurance. We already knew that the bill completely guts protections for people with pre-existing conditions and makes devastating cuts to Medicaid. All while providing massive tax cuts to the wealthy and giant corporations.

But the fight is not over. The Senate now has to pass a bill, and it will then likely have to go to back to the House for a final vote.

WE CAN STILL STOP THIS.

Here are three things you can do NOW to make your voice heard:

Call Gov. Rauner at 312-814-2121 and demand that he publicly oppose the American Health Care Act, which will cost Illinois billions of dollars in Medicaid funding and thousands of jobs.
Call your member of Congress at 1-866-877-3303 and demand that they publicly oppose the American Health Care Act.
Forward this immediately to 10 friends and family members in Illinois, especially if they live outside of Chicago. You can also share these steps on social media using #ilsaveaca
We have asked a lot of you, but it is only because you are making a difference. Your Member of Congress is crucial in this fight and they need to hear from you again!

AIDS United Responds to Fiscal Year 2017 Omnibus Appropriations Bil

 

AIDS United acknowledges that the Fiscal Year 2017 omnibus appropriations bill, released last night, provides continuity of HIV funding for most domestic programs. This is an important development for maintaining our progress towards the national goals and priorities of reducing new HIV infections, increasing access to care and improving health outcomes for people living with HIV, and reducing HIV-related health disparities.

While most HIV programs will see level funding in the budget, AIDS United is concerned that a $4 million cut to Ryan White HIV/AIDS Program Part C clinical providers and a $5 million cut affecting the budget to fight sexually transmitted infections will diminish our response to HIV and health care, particularly given the increasing cases of sexually transmitted infections, such as syphilis, among men who have sex with men.

“Knowing that Congress plans to keep funding intact for most HIV efforts is reassuring, but we urge Congress to also ensure that Part C clinical providers and our response to sexually transmitted infections are fully funded,” said AIDS United President & CEO Jesse Milan, Jr.

AIDS United is particularly appreciative that Congress listened to the voices of people living with and affected by HIV in increasing funding for the Housing Opportunities for People With AIDS (HOPWA) program by $21 million. “Housing is fundamental to ensuring that people living with HIV live longer and healthier lives and we thank Congress for recognizing the importance of this program by securing its current stability,” said Milan.


About AIDS United: AIDS United’s mission is to end the AIDS epidemic in the U.S., through strategic grant-making, capacity building, formative research and policy. AIDS United works to ensure access to life-saving HIV/AIDS care and prevention services and to advance sound HIV/AIDS-related policy for U.S. populations and communities most impacted by the epidemic. To date, our strategic grant-making initiatives have directly funded more than $104 million to local communities, and have leveraged more than $117 million in additional investments for programs that include, but are not limited to HIV prevention, access to care, capacity building, harm reduction and advocacy. aidsunited.org

Upcoming PMBSGN Support Group Meeting

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House and the Administration Begin to Show Their Hands

Among the ideas proposed in the policy brief are:

Moving Subsidies to Reflect Age and Not Income. Although the plan is short on specifics, it would replace the ACA’s current tax subsidies for purchasing insurance on the exchanges with tax credits. Limited detail is provided regarding these tax credits except that they would be refundable (similar to the current subsidies) and would be age-rated. These tax credits, however, would not scale to reflect an individual’s income. This means that lower income individuals will receive the same amount of support as middle or upper class Americans. While this support may be enough to help higher income individuals, it will likely not be enough to provide meaningful access to care for a person who is unable to supplement the tax credit with his or her own income. This is especially alarming for access to care for individuals living with chronic illnesses and disabilities because lower income Americans tend to be sicker and more likely to be disabled than higher income individuals.

Encouraging Health Savings Accounts (HSAs). Republicans have long been proponents of HSAs, especially coupled with high deductible health plans, and the policy brief is no exception. The plan allows for individuals to contribute more to health savings accounts, which are tax free, and to deposit any tax credit funds left over after purchasing a health care plan, to their HSA. HSAs often do not work for lower income individuals, who cannot adequately fund such accounts. They also do not work for individuals with high anticipated health care costs, such as those living with certain chronic illnesses and disabilities, because their medical spending quickly outstrips any savings they can contribute to their HSA. While HSAs can allow higher income individuals with low medical costs to save, they should not be considered a good solution to access to care problems for vulnerable individuals.

Sharply Curtailing Federal Support of Medicaid. The policy brief calls for the federal government to limit its financial support of Medicaid. The plan calls for repealing the ACA’s Medicaid expansion. Additionally, it calls for the federal government to fund expansion enrollees at the basic Medicaid level, rather than at the 90% level currently promised by the ACA. This would force states to bear more of the cost of their expansion populations, which may lead states to limit their eligibility for Medicaid or end expansion altogether. The policy brief also gives states the choice of moving their Medicaid program to a block grant or per capita cap funding formula. Block grants would limit federal financial support of Medicaid programs, and likely force states to tighten enrollment requirements or cut benefits. The Congressional Budget Office determined that a similar block grant proposal would cut federal Medicaid spending by 35%.

Because the policy brief is so short, advocates interested in understanding these proposals in depth should review Speaker of the House Paul Ryan’s A Better Way” plan, which covers the same elements in greater depth. Although Congressional Republicans have yet to coalesce around a particular proposal, the policy brief is a good indication of which elements will likely be included in a “repeal and replace” bill. Advocates should make sure they understand the impact these elements, could have on vulnerable individuals.

Administration Proposes First Major Health Care Regulation Intended to Stabilize the 2018 Marketplaces

On February 15, 2017 the Department of Health and Human Services (HHS) released its first major health care regulation under new Secretary Tom Price. The purpose of this proposed rule is to stabilize the individual health insurance Marketplaces until Congress is able to repeal, replace, or repair the ACA. Unfortunately, however, many of the major components of the new regulation may have the opposite effect on the Marketplaces and actually curtail access to care.

The proposed new regulation would implement the following changes in the Marketplaces:

Shortening Open Enrollment for 2018: The proposed rule moves the end of the 2018 open enrollment period from January 31, 2018 to December 15, 2017. HHS promises that they will “conduct extensive outreach to ensure that all consumers are aware of this change.” Advocates should be sure to hold HHS accountable for this promise because

otherwise many consumers, who are used to much longer open enrollment periods from the past several years, may find themselves shut out of enrollment for 2018.

Tightening Special Enrollment Periods (SEPs): The ACA provides for SEPs to recognize that major life changes, such as loss of employer based coverage or the birth of a child, necessitate changes in health insurance coverage. Under President Obama, HHS was already working to fine tune SEPs, in response to insurer complaints, such as requiring documentation for certain SEPs and initiating a pilot program requiring verification for other SEPs. The proposed rule further tightens requirements to qualify for an SEP by: 1) requiring pre-enrollment verification of eligibility for all SEP categories as of June 2017 and expanding on the pre-enrollment verification program to cover about 650,000 individuals; 2) limiting the ability of enrollees to upgrade from one metal level (i.e. gold, silver, bronze) to another during a coverage year by using an SEP; 3) limiting eligibility for certain SEPs such as requiring at least one partner to have minimum essential coverage within the last 60 days prior to marriage for both spouses to qualify for a marriage SEP; and 4) limiting the use of the exception circumstances SEP (although more guidance on this issue will be forthcoming). Advocates should make sure that enrollment assisters and consumers are aware of the tightened restrictions around SEPs. Consumers should not assume that because they qualified for an SEP in the past that they will be able to do so in the coming years and should be strongly encouraged to obtain coverage during the open enrollment period whenever possible.

Establishing Continuous Coverage Requirements: The proposed regulation asks for input on establishing continuous coverage requirements, designed to discourage adverse selection. The ACA has generally relied on the individual mandate instead of a continuous coverage requirement to encourage healthy individuals to maintain coverage. This request for input likely reflects the popularity of continuous coverage requirements as an alternative to the individual mandate among the Administration and Congressional Republicans. Unfortunately, continuous coverage requirements disproportionately burden people living with chronic illnesses and disabilities because any lock out period can prevent them from accessing the care they need to manage their often life-long conditions. The proposed rule does not contain a specific continuous coverage proposal, suggesting that HHS is unsure of whether to proceed on this issue. Advocates should be very vocal on this issue, making it clear to the Administration that a requirement that burdens vulnerable individuals rather than spreading the responsibility among all Americans is unacceptable. Now is the best time to intervene to halt the implementation of continuous coverage requirements in the Marketplaces, before a proposal is fully fleshed out.

Undermining Guaranteed Availability: Under the current regulations and the ACA, consumers who fall behind on their premium payments cannot be terminated by insurers until the end of a three month grace period. During the first month of this grace period the insurer will pay claims as normal and in the second two months the insurer will pend claims until the individual catches up on payments. Under the ACA’s guaranteed availability provision, insurers must offer coverage to any consumer during open enrollment periods or appropriate special enrollment periods regardless of whether they owe the insurer for last year’s coverage so long as they are picking a different plan. This is intended to preserve access to care for many low income individuals who may fall behind on their premium payments. Under the proposed rule, however, an insurer would be able to attribute payments from a reenrolling consumer to last year’s debts and refuse to effectuate further coverage until outstanding premiums were paid. This change may prevent individuals from obtaining coverage because their plans will not begin until they can clear their debts from last year’s coverage. For those living with conditions that require continuous care and management to control properly, like diabetes or HIV, this change could result in a disruption of care.

Relaxing Actuarial Value (AV) Requirements: The ACA requires that each metal level of qualified health plans achieve a certain AV. AV is the percentage of the total cost of health care expenses of a standard population that are covered by the insurer using premiums rather than by the enrollee using cost sharing and deductibles. A higher AV protects people with high medical spending, such as those living with chronic illnesses and disabilities, by requiring insurers to spread the costs of treatment around their entire enrollment population rather than asking vulnerable individuals to pay large sums out of pocket. The ACA allows some variation in AV among plans of the same metal

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level. The proposed rule would allow for greater variation in AV among these plans, which would allow insurers to market qualified health plans with higher cost sharing but lower premiums on the Marketplaces. These plans would be attractive to healthy higher income consumers but would potentially dissuade higher cost sicker individuals who could not afford the increased out of pocket costs. The crowding effect would in turn raise premiums on the plans that did not use the change in AV requirements to offer lower premiums because these plans would have a disproportionately sicker enrollment group. The Center on Budget and Policy Priorities estimates that the proposed change in AV requirements would require a family of four with an income of $65,000 to either pay $327 more per year in premiums for a plan that meets the current AV requirements or face an $550 increase in their deductible if they purchased a plan with the new, lowered AV. Advocates should understand how AV requirements affect their communities, especially when it comes to lower income individuals who cannot shoulder higher out of pocket costs for their medical care. Advocates should submit comments to educate HHS on how AV requirements protect the most vulnerable and how relaxing these restrictions could affect these individuals.

Relaxing Network Standards: Under the ACA, insurers must offer a sufficient choice of providers in their plans’ networks. The proposed regulation seeks to weaken this provision by relying on state regulators and accreditation organizations to ensure network adequacy rather than HHS itself. There are some state regulators who will be able to handle this task, but other regulators are ill-equipped to do so. HHS also proposed to relax the requirement for insurers to include essential community providers, such as community health centers, safety-net hospitals, Ryan White Providers and Indian Health Services Centers, by requiring insurers to include within their network only 20% of essential community providers in their area rather than the 30% currently required. Advocates should reach out to their state regulators to understand how they anticipate reviewing network adequacy and pressuring insurers to include as many essential health providers who serve low-income medically-underserved individuals as possible in their networks.

One interesting aspect of the proposed rule is that it encompasses many of the demands presented by America’s Health Insurance Plans and the Blue Cross Blue Shield Association of America. This perhaps reflects the Trump Administration’s desire to keep as many insurers in the Marketplaces for 2018, especially with Humana’s high profile pull back from the 2018 Marketplaces. Advocates should make sure that the Administration does not forget that insurers are only one key stakeholder in the Marketplaces and that it is important for any new regulations also to reflect the need of consumers, particularly those living with chronic illnesses and disabilities who depend the most on their insurance to deliver the care they need.

Comments are due to HHS on March 7, 2017 and may be submitted electronically here. Advocates should also keep their eyes open for a comment template focused on access to care concerns, to be released by the Center for Health Law and Policy Innovation in the next few days, and which can be easily modified to facilitate submission of comments.

Health Care in Motion is written by:

Caitlin McCormick-Brault, Associate Director at the Center for Health Law and Policy Innovation; Carmel Shachar, Clinical Instructor at the Center for Health Law and Policy Innovation; and Phil Waters, Clinical Fellow at the Center for Health Law and Policy Innovation.

For further questions or inquiries please contact Carmel Shachar, cshachar@law.harvard.edu.

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