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

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.

 

When The HIV Community Speaks, Congress Better Learn to Listen

 

If the Republican majority in Congress, emboldened by its control of both chambers and the White House, thought it would be easy to roll back health reform and other progressive gains, they have begun to learn a lesson taught to Obama early on, that it is easier to articulate hope than it is to affect change. Over the first few weeks of Mr. Trump’s presidency, a massive and in many ways spontaneous resistance movement has formed all across the country, with millions of people taking to the streets to express their unwillingness to tolerate a White House and a Congress that pursues policies that are anti-woman, anti-immigrant, anti-Muslim, and would turn our social safety net to tatters.

One of the policies that has received some of the most vocal and passionate opposition has been the repeal and as-yet-unspecified replacement of the Affordable Care Act Repealing the ACA is a policy goal that served as the Republican Party’s white whale under the Obama administration, but one which their rhetoric and desire to implement have lagged in recent weeks. The lack of enthusiasm to promptly repeal the ACA is due to congressional Republican’s inability to design a replacement plan that doesn’t strip 18 million Americans of their health insurance in a year’s time and, perhaps more importantly, the fear of the collective outrage of millions of Americans should their health care be taken from them.

Over the past few weeks, numerous stories have been circling around both traditional and social media, showing Representatives going to extreme measures to avoid the wrath of a public that is rightfully incensed by plans to block grant Medicaid and tear apart the ACA with no concrete plans on how to sufficiently replace it. Whether it’s sneaking out of an event via a side exit or simply refusing to engage in town halls due to the anger of their constituents, members of Congress are clearly unnerved by the breadth and the intensity of the protests that have greeted them in their home districts. In fact, House Republicans were so shaken by the backlash against the prospect of ACA repeal that they convened a closed-door meeting this past Tuesday to discuss how to “protect themselves” from protesters.

It may not feel like it at times, but the power of collective resistance and protest is proving unparalleled in affecting change. If we are to save the ACA, or at least ensure that its most vital  benefits survive in a replacement plan, people living with HIV and those who advocate alongside them are going to have to engage in sustained, vocal opposition to any politician who tries to snatch our health care from us. This means suiting up and showing up to town halls and rallies, even when we don’t feel like going. It means calling your members of Congress at their offices and refusing to take no for an answer when you’re told a line is busy or a mailbox is full. The HIV community’s opposition to the destruction of the ACA must be unrelenting because the only way our elected officials will act in our best interest is if they are provided with no alternative.

Yes, changing the will of Congress may seem daunting, but each individual action on the road from where we are to where we aim to be is one step closer. One of the first steps you can take is to commit to meeting with your members of Congress and letting them know the repeal of the ACA is unacceptable. For the week beginning February 20, both the Senate and the House will be out of session and in their home districts and states. Many of them will be hosting town halls or have open hours for visiting and we must make sure that our presence is acutely felt. It is important to remember that they are beholden to us and that the amount of power they wield is indirectly proportional to degree to which we are politically engaged.

If you click here, you will find a substantial, but by no means comprehensive spreadsheet that lists the office hours and scheduled events for many members of Congress in their home districts and states in the near future. Use this list and any other resources you can find to plan an action during Presidents’ Day weekend and the days that follow. Make sure that, whether it’s in person or over the phone, your members of Congress are incapable of ignoring the needs of people living with HIV and all Americans living with chronic diseases.

Question them.
Tell your story.

Share your concerns and ensure that your voice is heard and that the provision of quality health care is nonnegotiable if they want to keep their job for long. And, if you want to continue with your HIV advocacy after the actions around Presidents’ Day, there’s no better way to do so than to register for AIDSWatch, the largest annual HIV/AIDS advocacy event in America. This year, AIDSWatch is more important than ever and we need your help more than ever if we’re going to make Congress recognize the possibility and importance of ending the AIDS epidemic and protecting the policies that allow people living with HIV to get access to quality, affordable care.

Posted By: AIDS United, Policy Department – Thursday, February 09, 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

Experts Support Use of PrEP Despite New HIV Infection Reported in Adherent PrEP User

 

A second case of HIV transmission to a person who was adherent to Pre-Exposure Prophylaxis (PrEP) protocols was announced at the HIV Research for Prevention conference. A previous case was reported in February. In both cases, testing revealed that the strain of HIV acquired was resistant to Truvada, the FDA’s only approved drug for PrEP. Despite these two widely reported cases, this mutation is rare and Truvada continues to be highly effective at preventing HIV infection.

HIV infection while PrEP adherent is most likely to occur due to exposure of an HIV strain resistant to tenofovir or emtricitabine, the component drugs in Truvada. This drug resistance occurs most often when a person living with HIV is not consistent with their treatment protocol. HIV has the highest mutation rate of any biological substance ever recorded, meaning that it rapidly transforms its structure, defenses, and identity. Missing doses of antiretroviral therapy (ART) allows the virus to replicate in presence of ART, increasing the likelihood the it will adapt and develop resistance. With this new resistance, the virus could replicate unchecked, becoming amplified and dominant. Individuals adherent to Truvada may not be protected if they are exposed to a strain of HIV that is already resistant to tenofovir or emtricitabine. Experts have tried to be clear that PrEP is not 100% effective as shown by these two cases. For this reason, the Centers for Disease Control and Prevention (CDC) recommends that PrEP be combined with the use of condoms. At the same time, most experts acknowledge that these cases are extremely rare and continue to support the use of PrEP in populations at risk for HIV infection.

AIDS United’s position statement on PrEP supports nationwide implementation of CDC guidelines on PrEP as an effective prevention strategy for men and women at risk for HIV. We continue to follow the research regarding PrEP including new cases of HIV transmission, despite PrEP adherence. However, it is important not to overreact to these cases as well. Since 2012, more than 79,000 people have taken Truvada as a PrEP in the United States, and yet there have only been just two cases of HIV transmission among those adherent. PrEP remains a highly effective method of HIV prevention.

As PrEP continues to be implemented in the U.S., another lesson is that the field must continue to combat drug resistance. One way to address drug resistance is to support treatment adherence among people with HIV. Similarly we should provide tools to people who are taking PrEP so that they can adhere to their regimen as well.

We also should note that these cases reinforce the need for regular (quarterly) STI screenings including for HIV for people who take PrEP. Early discovery of any new HIV infection leads to faster treatment with the benefits of a longer, healthier life as well as reducing the likelihood of future transmission through viral suppression. Finally, we hope that HIV providers and educators will continue to help people to understand the benefits and value of PrEP so that individuals can make informed decisions about deciding to take PrEP.

END THE EPIDEMIC ” STOP STIGMA”

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