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.

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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!

House and the Administration Begin to Show Their Hands

February 23, 2017

House Republicans Unveil a Health Care “Policy Menu”; Trump Department of Health and Human Services Proposes First Major Health Care Regulation

 

Although there is still no specific ACA repeal and replace proposal from the hill, both Congressional Republicans and the Trump Administration released documents last week articulating their approach to replacing the ACA and addressing concerns with the Marketplaces in the meantime. Congressional Republicans released a Health Care Policy Brief that is intended to serve as a menu of potential elements for a forthcoming ACA replacement bill. This Brief includes elements that have been found in previous ACA replacement proposals and that present concerns for access to care. Further, the Department of Health and Human Services (HHS) released a proposed rule entitled “Patient Protection and Affordable Care Act; Market Stabilization” (proposed rule), which is intended to help stabilize the Marketplaces until an ACA replacement is completed. Unfortunately, some of its changes may limit access to care for vulnerable individuals and make the Marketplaces less friendly to those living with chronic illnesses and disabilities. Advocates should be sure to understand both documents as well as send comments on the proposed rule to HHS by March 7, 2017.

Advocates Should:

1. Review the Health Care Policy Brief released by House Republicans last week to better understand which ideas are popular among Congressional Republicans and likely to make it into any ACA repeal and replace proposal.

2. Understand the proposed Market Stabilization regulation released by the Department of Health and Human Services and how it will impact access to care in the 2018 qualified health plans.

3. Submit comments on the proposed rule to HHS urging them to consider the impact the proposed regulations will have on access to care for vulnerable individuals.

House Republicans Unveil Health Care Policy Brief

On February 16, 2017, after a closed-door meeting, House Republicans unveiled a policy brief and resource document to explain major elements of their plan to repeal and replace key programs and protections of the ACA. House Leadership is terming this strategy “repeal plus.” The policy brief should not be considered an actual legislative proposal but rather a “menu” of replacement ideas such as tax credits for purchasing health care, health savings accounts, and high risk pools. Part of the intention of this document is to encourage Congressional Republicans, who have found it difficult to coalesce around a health care policy strategy, to find consensus on these issues. Unfortunately, many of the components of this “repeal plus” strategy would curb access to care for vulnerable individuals, including those living with chronic illnesses and disabilities.

 

New Administration, Old Approach: Trump advocates Medicaid Block Grants & ACA Repeal

 

As the shifting legislative landscape of President Trump’s first 100 days continues, two major developments emerged in the health care reform world: that the Trump administration plans to block grant the Medicaid program and that President Trump signed an initial executive order weakening the ACA.

 

From its inception in 1965 under President Lyndon Johnson until the present day, Medicaid has served as a public insurance program for low-income individuals, families, and people with certain disabilities. Unlike Medicare, which was created at the same time and is both federally funded and administered, Medicaid is a federal-state partnership program in which each individual state administers their own Medicaid program using a mixture of state and federal funds, provided that certain services and populations are covered. For the entirety of its existence, Medicaid has been an entitlement program, which means that the government is required to provide coverage for anyone who meets the eligibility rules for enrollment. This means that the amount of money being spent on a state’s Medicaid program fluctuates from year-to-year based on how many people qualify for coverage.

 

Every Republican President since Ronald Reagan has tried, and so far failed, to turn Medicaid from an entitlement program into a discretionary block grant program. Block granting Medicaid would mean the federal government would present states with a predetermined amount of money to serve their low-income and disabled residents at the beginning of each year. Most plans to block grant Medicaid would determine the amount of funding based on previous state and federal Medicaid spending in a given state, with slight changes each year to account for inflation. The states would then be allowed to determine exactly how to spend that money with many fewer requirements than in the current system. This means that if there were a recession, an unexpected disaster, disease outbreak or if general health care costs continued to rise faster than inflation, state governments would not be given extra federal funds.

 

In such a situation, states would address the health care needs of their low income and disabled residents through a variety of means, but most would reduce or eliminate covered services, restrict access to the program, or introduce higher cost-sharing mechanisms. Taken together, this would adversely affect the health and wellbeing of those in need of care. In a best case scenario, states would take on the excess costs themselves. However, this might prove difficult since many states are required to balance their budgets which might require tax increases or additional sources of revenue to meet these increased Medicaid costs. As a result, many states would choose to avoid added costs by changing the Medicaid eligibility criteria, reducing Medicaid benefits, and simply not providing care to people who are eligible. According to an analysis of a previous Republican proposal from 2012, the block granting of Medicaid could wind up dropping anywhere between 14.3 million and 20.5 million people from care.

 

It is nearly impossible to overstate how devastating Medicaid block granting would be for people living with or at risk of contracting HIV. Right now, Medicaid is the largest source of insurance coverage for people living with HIV, covering more than 40% of people with HIV who are in care. At the same time, Medicaid accounts for 30% of all federal HIV spending and when combined with state Medicaid spending, represents the 2nd biggest source of public HIV financing, trailing only Medicare. Under block grant funding, people living with HIV could bear some of the largest burdens of all impacted populations, because state governments may choose benefit designs that disproportionately affect pricey HIV medications. Given the amount of stigma regarding people living with HIV, LGBT people, and lower income populations, it is possible that some states would choose to do so. Although it may sound unlikely that a state government would discriminate against the provision of medical treatment for certain populations, it has been suggested in the past. For example homophobic legislators in Tennessee openly questioned providing funds to treat people living with AIDS due to their “bizarre lifestyle.” AIDS United strongly opposes block granting Medicaid and we urge readers to call their legislators with that message.

 

President Trump’s executive order intended to weaken the ACA may be more important for what it suggests than for what it actually accomplishes. The executive order directs federal agencies to use their current regulatory authority to “minimize the economic burden” and minimize or remove “any provision…that would impose a fiscal burden on any State, or a cost, fee, tax, penalty, or regulatory burden on an individual.” The order would also grant waivers to states that undercut the cost of consumer protections, encourage the sale of health insurance across state lines, and encourages agencies to use discretion to avoid expanding the ACA.

 

By himself, Mr. Trump doesn’t have the power to repeal or directly impede the implementation of the ACA. However, he can instruct the employees of federal agencies to begin chipping away at the law’s effectiveness. For example, the Trump administration can’t formally strike down the ACA’s individual mandate that all Americans be insured, but he can instruct the IRS to simply not fine anyone who doesn’t abide by the mandate, rendering it useless. Similarly, the executive order instructs the Department of Health and Human Services (HHS) to provide states with considerable leeway when it comes to the implementation of their health care programs and encourages HHS to accept waivers from states that would help them get around ACA regulations that they find overly restrictive.

 

On Thursday, the administration reportedly took another step to undermine the ACA. White House officials ordered the Department of Health and Human Services to halt all advertising and outreach efforts encouraging enrollment in ACA health plans purchased on the Healthcare.govmarketplace during the last days of the 2017 open enrollment period. This is significant because in previous ACA open enrollment periods, the final days were among the heaviest for signing up for health coverage. The White House action does not affect people’s ability to sign-up for coverage on the website; open enrollment ends Tuesday, Jan. 31.

 

AIDS United believes that the ACA must remain in place and that no effort to make changes, including this executive order, should attempt to repeal the law without an immediate and effective replacement in place. AIDS United will continue to provide concise analysis of the what’s happening in Washington regarding health care reform and why it should matter to people living with HIV.

 

Posted By: AIDS United, Policy Department – Friday, January 27, 2017
Search Tags: Affordable Care Act , HIV Policy

In Congress, Obamacare Replacement Plans Start To Emerge

 

Just twenty-five days into the 115th Congress, the Republican congressional majority has made significant steps to make good on campaign promises to repeal the ACA and setup President Trump for swift action on his other top priorities. Republicans kicked off a policy retreat in Philadelphia Wednesday that extends through Friday evening where they hope to hash out how to repeal and replace Obamacare.
While Republicans have had the last six years, and five-dozen attempts to overturn the ACA and plot a replacement, no clear consensus has risen on what to do following repeal. Adding to the uncertainty of how they might repeal and replace Obama’s signature law, is the assertion by President Trump that he will send his own plan to Congress, once his Health and Human Services (HHS) Secretary nominee, Tom Price is confirmed. The notion of the White House sending legislation to Congress is unnerving for many lawmakers and calls into question the separation of powers. Senator Rand Paul M.D. (R-KY), who introduced The Obamacare Replacement Act (S.222) this week, said in a statement that, “Sometimes you get ideas from the White House,” which underscores the atypical nature of President Trumps desired path toward repeal.

The Paul Replacement 

Sen. Paul’s bill has several provisions including an immediate repeal of the individual and employer mandates, the essential health benefits requirement, and other insurance mandates. Further the bill would allow unlimited deposits into Health Savings Accounts and broaden options for using those funds; allow the purchasing of insurance across state lines; and create voluntary associations for insurance pooling.

Cassidy-Collins replacement 

Sens. Bill Cassidy (R-LA) and Susan Collins (R-ME) held a press conference Monday to propose three options states could consider moving forward with health care coverage. States could either keep the Affordable Care Act (ACA) but with reduced federal funding for subsidies, switch to a different system to purchase insurance coverage, again with reduced subsidies , or go forward with an alternate plan that does not include federal assistance. The Cassidy-Collins proposal is in direct contrast to plans discussed by House and Senate leadership, which would not let the ACA continue in any form. Cassidy notes that this proposal serves as a middle-way approach that could potentially bridge Democrats’ and Republicans’ concerns. However, the Cassidy-Collins one-page compromise still needs legislative language.

Cassidy noted:
“At some point in this process, we will need a bill that can get to 60 votes. Now you can say to a blue-state senator who is invested in supporting Obamacare, ‘You can keep it, but why force it on us?’” Collins, affirms saying, “I believe most states would embrace this option, which allows states to cover the uninsured by providing a standard plan that has a high-deductible, basic pharmaceutical coverage, some preventive care and free immunizations.”

The question is, what does the rest of Congress think?

Senate Minority Leader Chuck Schumer (D-NY) described the proposal as “an empty facade that would create chaos.” Schumer wasn’t the only Democrat that predicted insurmountable challenges in the Cassidy-Collins proposal. Democratic leadership call into question the idea of giving some states the option to dismantle the current health care law and replace it with something else or nothing at all, for that matter. Conversely, Republican leadership hasn’t publicly commented much on the generality of the bill. Furthermore, Republicans have persistently supported the dismantling of the current health care law’s taxes and fees.

Presidential Executive Order 

As one of his first actions last Friday, Trump signed an executive order intended to minimize the economic burden of the ACA, pending its repeal. The order allows the U.S. Department of Health and Human Services (HHS) and other federal agencies to use their existing powers “to the maximum extent permitted by law” to weaken the ACA. HHS and agencies such as the IRS “were given vast discretion over key parts of the law including the individual and employer mandates,” per Pro Health Care’s Brianna Ehley. What this could mean is that it is possible to stop the individual mandate from being enforced.

In addition to President Trump’s actions, there was a congressional hearing, at which Republican members sought to expose what they perceive to be a decrease in marketplace competition and affordability. The hearing examined the “Failures of Obamacare.” There was also a hearing on theACA Individual Mandate. The hearing on the Price Nomination for HHS Secretary was also a forum for Republican senators to air their ACA-related grievances.

As HIV advocates we remain vigilant in the changing landscape and continue to seek intelligence and influence the proposed changes to our health care systems. It is imperative that the ACA not be repealed without a replacement that protects the expanded access the law has brought. We must insure vulnerable population, including people living with or at risk for HIV, are provided the access to care they deserve.

Posted By: AIDS United, Policy Department – Friday, January 27, 2017

Repeal Without Replace: Senate Starts Undoing Obamacare With No Replacement

In the wee hours of the morning on Thursday, the Senate took the important first step toward repealing the Affordable Care Act, narrowly approving a budget resolution that lays the groundwork for the undoing of much of President Obama’s signature health care law. The 51-48 vote fell almost entirely along party lines, with Senator Rand Paul (R-KY) being the only Republican to vote against the resolution and no Democrats voting for it. Having passed in the Senate, the budget resolution has been transferred over to the House where it could be voted on as early as this Friday or later, depending on how successful Speaker Ryan is at bringing together an often-fractured House GOP.

If the House passes the Senate resolution, reconciliation instructions will be sent out to the Senate Finance Committee; the Senate Health, Education, Labor and Pensions Committee; and to the House Ways and Means and Energy and Commerce committees. These instructions are designed to get the committees to report legislation that would reduce the federal deficit by at least $1 billion over the next decade. In practice the legislation will be used to repeal certain aspects of the ACA with only a 51-vote majority in the Senate and without having to face the risk of being filibustered by Democrats. This means that the GOP will be able to repeal major provisions of the ACA that affect the federal budget and will have to introduce other legislation to repeal the other provisions, including those that reform health insurance practices.
For people living with or at risk of contracting HIV, the changes that could be made through this reconciliation process will be immense and potentially deadly. Through reconciliation, Congress will be able to repeal the individual mandate to buy coverage, take away the ACA’s insurance premium subsidies and, perhaps worst of all, roll back Medicaid expansion. Medicaid is the single largest source of insurance coverage for people living with HIV, covering more than 40% of all people with HIV who are in care. Add to that the fact that Medicaid expansion by itself was responsible for putting an addition 14 million Americans on health insurance, and it is not hard to understand just how much of an impact this reconciliation process could have on the HIV community.

The Senate vote on the budget resolution was the climax of nearly 7 hours of rapid-fire voting known as “vote-a-rama”, a tradition whereby Senators—in this case, mostly Democrats—are allowed to propose roll call votes on amendments to a budget resolution in quick succession with the aim of getting their colleagues on the record with votes concerning politically volatile issues. On Wednesday night, Democrats put forth a number of amendments regarding some of the popular aspects of Obamacare as both an act of defiance and a way to put pro-repeal Senators on-the-record for the elimination of well received ACA provisions.

For their part, Republicans in the Senate chose in most instances to vote as a unified block even when such a vote went against the wishes of their constituencies. Over the course of the evening, the Senate rejected 19 different amendments along party lines, many of which would have served to protect access to quality, affordable health care for all Americans. Of particular interest to people living with or at risk for contracting HIV were amendments put forth by Senate Democrats aimed at preventing health insurers from discriminating against people based on pre-existing conditions, allowing children to stay on their parents’ health insurance until the age of 26, prohibiting insurers from denying health insurance or raising rates on women because of their gender, and not making any cuts to Medicaid funding. None of these amendments were accepted, but they did provide good indication of what aspects of the ACA would be vulnerable under a full ACA repeal.

Perhaps the most important vote of the night—aside from the final approval of the budget resolution—was one that didn’t happen at all. An amendment put forth by Senator Bob Corker (R-TN) and four other GOP Senators that would have extended the January 27th deadline to come up with repeal legislation by an additional 5 weeks was withdrawn late on Wednesday night. The amendment was initially brought up by Senator Corker and some of his Republican colleagues in light of legitimate fears that their party would not have a replacement plan in place when they repealed the ACA. And, while nothing happened over the course of the evening that would have given Senator Corker and his amendment’s supporters reason to believe a replacement plan was any nearer than before, they would all go on to vote in favor of the budget resolution at the end of the night, continuing down a path of repeal without replacement.

Most of America had long since gone to sleep and likely won’t remember when or exactly how it happened, but history with certainly note that, if the Affordable Care Act is indeed dismantled, that Congress began to do so when no one was watching.

Replacing Obamacare: A Look At Competing Conservative Health Care Proposals

 

The chances that the Affordable Care Act (ACA) is still the law of land at this point next year are somewhere between slim and none. With that being said, there is very little consensus around what will take its place. Despite the charged rhetoric from President-elect Trump, a full repeal of the ACA, as promised in his Contract With The American Voter, is unlikely for a number of pragmatic reasons. For starters, a complete repeal of the ACA would require at least 60 votes in the Senate, which isn’t likely given that the GOP will only hold 52 Senate seats. And, should the 60 vote hurdle be cleared, Congressional Republicans and the Trump administration would be forced to confront the fact that replacement plans created by GOP leaders and conservative think tanks are more conceptual than practical, proving thin on implementation instructions.

For his part, President-elect Trump doesn’t have a fully-formed health care plan of his own. Throughout the campaign and well into his presidential transition, both Mr. Trump’s personal and professional views on health care reform have been somewhat murky. At various times, President-elect Trump has promised to both fully repeal and keep major portions of the ACA, praised Planned Parenthood while also pledging to defund it, and said that he will “take care of everyone” while releasing a health care plan that would leave an estimated 21 million people without insurance. However, if his current platform and conservative cabinet picks are any indication, it does not appear that his administration’s health care policy will deviate too much from the GOP norm. It is very likely that any health care plan pushed by Trump will include the repeal of much of the ACA. What Trump and Congressional Republicans end up replacing it with is less certain, but the shape of reforms to come can be seen in previous proposals from Republican leadership and how closely they align to the health care page of Trump’s transition website.

Of all the existing Republican proposals, two are currently positioned to serve as blueprints for whatever Congressional Republicans and the Trump administration agree on as a replacement for the ACA. The first proposal and frontrunning proposal was put forth by House Speaker Paul Ryan (R-WI) this past summer as part of his “A Better Way” platform, is the closest thing the Republican Party currently has to a comprehensive vision of what conservative health care policy should look like. The second proposal, the Empowering Patients First Act of 2015, is the latest in a series of legislation proposed by Representative Tom Price (R-GA), who was recently nominated by President-elect Trump to be Secretary of the Department of Health & Human Services. A Tea Party conservative and former orthopedic surgeon, Price currently serves as chairman of the House Budget Committee and has been one of the most vocal opponents of the ACA in Congress. Ryan’s A Better Way plan incorporates many of the health care reform mechanisms that are included in the Empowering Patients First Act of 2015 and, given their leadership roles within the House and HHS, there’s good reason to believe that any ACA replacement plan formulated by the Trump Administration and Congress will borrow heavily from them.

There is plenty of nuance and detail to be sifted through in their health care proposals, but the defining characteristics of both are that they benefit those who are young, healthy, and well-to-do at the expense of those who are old, sick, and poor. Like the policy listed on President-elect Trump’s transition site, both the Ryan and Price plans shift the burden of providing Americans with health insurance from the Federal government and society at large to the States and individual citizens. The Republican plans replace the much maligned individual mandate to purchase health insurance and the comprehensive, need-based subsidies provided through the ACA with free-market approaches that emphasize health savings accounts and the ability to purchase insurance across state lines while doling out tax credits based on age rather than income.

On the surface, the Ryan and Price plans continue to bar insurance companies from raising rates and denying coverage due to pre-existing conditions, but a closer look shows that their proposals would only prohibit insurers from raising rates on sick people if they maintain “continuous coverage.” In layman’s terms, this means is that if someone loses their coverage for any reason after the ACA had been repealed and replaced, the insurance companies would then be allowed to hike up their rates based on any pre-existing conditions.

As for the 14 million people who were able to receive insurance though the ACA’s Medicaid expansion, most or all of them would no longer be covered by the leading Republican contenders to replace Obamacare. One of the few concrete proposals that Trump mentioned on the campaign trail was transitioning Medicaid into a block grant program. Currently, Medicaid is funded as an entitlement program where the federal government is obligated to assist states with coverage costs no matter how many people have qualified for the program. Through a block grant, states would be given a set amount of money by the federal government at the beginning of the year and would be forced to make do with what they had regardless of how many people were eligible for coverage. While theoretically not a bad thing, the purpose of transitioning the Medicaid funding to a block grant in the Ryan and Price plans is to reduce the federal contributions to the program and create more flexibility for state to adjust benefit design. There is no detailed breakdown of what effect the Medicaid block grant system would have in Price’s plan, but an analysis of a Medicaid block grant proposal in Ryan’s 2012 budget by the Kaiser Family Foundation estimates that that between 14 and 20 million people would lose coverage.

There are certainly a number of different directions for health care policy to go in the next 4 years, but—whether the end product looks more like Ryan’s plan, Price’s plan, or something else entirely—the HIV advocacy community and those who fight for quality, affordable health care for all Americans will have their work cut out for them.

Posted By: AIDS United, Policy Department – Friday, December 02, 2016