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.



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

5 Things To Know About Rep. Tom Price’s Health 

Rep. Tom Price has introduced his own alternative to the Affordable Care Act four times. The legislation provides an idea of how he might lead the Department of Health And Human Services.

Andrew Harrer/Bloomberg via Getty Images

Georgia Rep. Tom Price has been a fierce critic of the Affordable Care Act and a leading advocate of repealing and replacing the 2010 health care law.

Price, an orthopedic surgeon from the suburbs of Atlanta, introduced his own legislation to repeal and replace Obamacare in the current Congress and the three previous sessions. Price’s plan, known as the Empowering Patients First Act, was the basis for a subsequent health care proposal unveiled by House Speaker Paul Ryan, with Price’s endorsement, in June.

Price’s major complaint about the ACA is that it puts the government in the middle of the doctor-patient relationship.

“They believe the government ought to be in control of health care,” Price said in June at the American Enterprise Institute event where Ryan unveiled theRepublican proposal to replace Obamacare. “We believe that patients and doctors should be in control of health care,” Price continued. “People have coverage, but they don’t have care.”

Now that President-elect Donald Trump has tapped Price to lead the Department of Health and Human Services, here are five key planks in his own health care proposal.

  1. Price’s plan offers fixed tax credits so people can buy their own insurance on the private market. The credit starts at $1,200 a year and rises with age, but isn’t adjusted for income. Everyone receives the same credit whether they are rich or poor. People on Medicaid, Medicare, the military health plan known as Tricare, or the Veterans Affairs’ health plan could opt instead for the tax credit to buy private insurance.
  2. Price advocates for expansion of health savings accounts, which allow people to save money before taxes to pay for health care. This includes allowing people who are covered by government health programs including Medicare and the VA to contribute to health savings accounts to pay for premiums and copayments. These proposals are included in Ryan’s plan.
  3. People with existing medical conditions couldn’t be denied coverage under Price’s plan as long as they had continuous insurance for 18 months prior to selecting a new policy. If they didn’t, then they could be denied coverage for that condition for up to 18 months after buying a new plan.
  4. The Price proposal limits the amount of money companies can deduct from their taxes for employee health insurance expenses. Companies can deduct up to $20,000 for a family health insurance plan and $8,000 for an individual. The goal is to discourage companies from offering overly generous insurance benefits to their workers. Ryan’s plan proposes a cap on the employer tax deduction but doesn’t specify the level of the cap.
  5. States would get federal money to create so-called high-risk pools under Price’s plan. These are government-run health plans for people with existing medical conditions who can’t get affordable health insurance on the private market. Critics say high-risk pools have been tried in as many as 34 states and largely failed because they were routinely underfunded.

Price has said he’s not wedded to his own ideas and is open to compromise, so the final proposal to replace Obamacare is likely to be a hybrid of his ideas and those hammered out with other Republican House members and presented as Ryan’s plan.

Still, with Price on track to be at the helm of HHS, he would be the one writing the rules to implement whatever legislation is eventually passed.

Upcoming Support Group Meeting at Site #2

Cordially invites you to an
Evening Dinner
Amongst Friends

Wednesday, January 18th, 2017


Topic:  Work it out!


Presented by – Alison Ruby


Sponsor by – Merrick Pharmaceutical


5:00pm – 5:30pm Dinner

5:30pm – 6:30pm Presentation

6:30pm – 7:00pm – Rap Up!     



WAD 2016

Please see attachment concering our collaboration with IRCHD and IRCHAAN for the upcoming WAD 2016.






Serious Infections Tied to Suicide Risk

Study suggests biological basis for suicide among those with serious infections.

People hospitalized for serious infections may face an increased risk of dying by suicide, and researchers suspect there’s a biological reason for it.

In a study of over 7 million people, Danish researchers found that those who’d been hospitalized for infections were 42 percent more likely to die of suicide compared to people with no history of serious infection.

People hospitalized for HIV/AIDS or the liver infection hepatitis showed the highest risk — more than twice that of people without those diseases, the study found.

Although the study couldn’t prove a cause-and-effect link, the study authors and at least one other brain health expert think the increased risk of suicide after infection might not simply reflect the psychological impact of serious illness. Instead, infections might directly contribute to suicide risk by causing inflammation in the brain.

“We know that inflammation can cause depression symptoms,” said Dr. Lena Brundin. She’s an associate professor at the Van Andel Research Institute’s Center for Neurodegenerative Science in Grand Rapids, Mich.

That, she said, is based on evidence from both animals and humans. For example, the drug interferon revs up the immune system’s inflammatory response, and up to 45 percent of patients develop depression during treatment, according to Brundin. Interferon is used to treat certain infections and some cancers, according to the U.S. Food and Drug Administration.

The new study is important, in part, because it’s huge, according to Brundin. She said it strengthens the case that smaller studies have made: Depression, and suicidal behavior, may be inflammatory disorders to some degree.

Brundin wrote an editorial published with the findings Aug. 10 in JAMA Psychiatry.
For the study, researchers used Denmark’s system of national registries to comb through data on over 7 million people who lived in the country between 1980 and 2011. During that time, over 800,000 — or 11 percent — were hospitalized for an infection, including HIV, hepatitis or infections of the lungs, digestive system, skin or blood.

Based on death certificates, nearly 32,700 people died of suicide during the 32-year study period. Almost one-quarter of them had ever been hospitalized for an infection, the study showed.

When the researchers dug further, they found that people hospitalized for most kinds of infection had an elevated rate of suicide — pregnancy-related infections being the only exception.

And the more infections people had contracted, or the longer their treatment course, the higher their suicide risk.

“There are many potential mechanisms that might link infections to death by suicide,” said lead researcher Helene Lund-Sorensen. She’s from the Mental Health Center Copenhagen in Denmark.

Lund-Sorensen said her team tried to account for as many as possible — including whether people with infections had additional health conditions, were lower-income or had ever been diagnosed with depression or substance abuse.

Even then, there was a statistical link between infections and increased suicide risk. That, according to Lund-Sorensen, implies that psychiatric disorders “may only explain parts of the association.”
She agreed that there could be a biological connection between serious infections and suicide, including the effects of inflammation.

Inflammation is part of the immune system’s response to injury and infection. But when those inflammatory chemicals build up, there can be negative effects, too. If they infiltrate the central nervous system, there can be “profound effects on brain chemistry,” Brundin said.

Studies have found that people who are clinically depressed or have attempted suicide tend to have heightened levels of inflammatory immune-system chemicals in their blood, spinal fluid and brain, according to Brundin.

Still, none of that proves that infections, or inflammation, directly contribute to suicide. Brundin said more definitive evidence could come from treatment trials testing the effects of anti-inflammatory medications.

There are already such studies underway, she noted.

One trial is looking at whether adding an anti-inflammatory drug called sirukumab to antidepressant treatment helps ease symptoms of major depression.

Lund-Sorensen said her team is also planning to study whether less-serious infections are related to suicide risk, too.

“Our research, [along with] others’, will hopefully in time clarify the role of infections and inflammatory diseases in suicide,” Lund-Sorensen said.

If infections do raise suicide risk, she said, “we believe that early identification and treatment of infections could be explored as a public health measure for suicide prevention.”

In this study, Lund-Sorensen’s team said, about 10 percent of suicides could be attributed to severe infections.

For people living with chronic infections such as HIV or hepatitis C, Brundin said she thinks there is some positive news in the findings.

If they do suffer from depression, she said, there is mounting evidence that there could be a “biological basis” for it.

“And it’s possible that in the near future, we’ll have better treatments for it,” Brundin said.

SOURCES: Helene Lund-Sorensen, B.M., Mental Health Center Copenhagen, Denmark; Lena Brundin, M.D., Ph.D., associate professor, Center for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, Mich.; Aug. 10, 2016, JAMA Psychiatry, online


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