Policy Updates: Hill Happenings and Administration Activities

By Julio Contreras March 8, 2021

Hill Happenings 

COVID-19 Relief Actions 

Congressional Democrats are working to quickly pass the President’s proposed $1.9 trillion pandemic relief legislative package. After early negotiations failed to offer a clear, bipartisan path forward, Democrats are leveraging the budget reconciliation process to avoid the Senate filibuster and pass the legislative package with a simple majority, which Democrats command using Vice President Harris’ tie-breaking vote. The House passed the package (H.R. 1319) on February 26, setting up a contentious party-line vote in the Senate.  

On March 4, Senate Democrats voted 51-50 to begin debating the pandemic relief package under the fast-tracked budget reconciliation process, with Vice President Harris casting the tie-breaking vote. The Senate version of the bill was modified in an effort to secure support from moderate Democrats that were wary of the relief package’s size. The Senate began a lengthy vote-a-rama on Thursday and debated the package through the weekend, where the Senate voted to pass the relief package on 50-49 party-line margin. The Senate-amended version of the relief package must now be approved by the House before it can head to President Biden’s desk for ratification.  

NASTAD continues to call on Congress to pass a COVID-19 package that provides meaningful relief and makes progress on delivering greater health coverage and affordability during the pandemic. NASTAD joined a broad coalition of youth advocates and sent a letter to Congress urging lawmakers to prioritize the economic and health security of youth in the COVID-19 relief package. Additionally, NASTAD joined over two dozen consumer advocacy organizations and signed onto a letter urging the Senate to remove the Medicaid rebate cap, a provision that allows states to penalize drug companies for big price hikes on their products, but only up to a certain threshold.  

FY2022 Appropriations 

NASTAD and the CDC Coalition called on Congressional Appropriators to increase funding for the Centers for Disease Control and Prevention (CDC) in the fiscal year 2022 appropriations package. The CDC Coalition, a nonpartisan coalition of over 190 organizations committed to strengthening the nation’s public health infrastructure and prevention programs, urges lawmakers to provide at least $10 billion for CDC programming in the FY2022 Labor, Health and Human Services, Education and Related Agencies appropriations bill. The CDC Coalition highlights the wide-ranging public health prevention activities that operate under the agency and underscore the urgency for increased funding due to the COVID-19 pandemic. 

NASTAD will continue to monitor the appropriations process in the 117th Congress and under the Biden Administration to advocate for the highest funding levels on behalf of HIV and hepatitis programs.  

Xavier Becerra’s Nomination Heads to Senate Floor  

The nomination for Xavier Becerra, President Biden’s Secretary-Designate for the Department of Health and Human Services (HHS), is headed to the Senate floor after clearing two committee votes. The former California Attorney General appeared before the Senate Finance and Health, Education, Labor, and Pensions (HELP) committees for hearings to vet his confirmation in late February. On March 3, the Senate Finance committee held a vote on the nomination, which ended in a tie split along party lines (14-14), allowing Senate Leader Chuck Schumer to introduce the nomination for a full vote on the Senate floor.  

Despite some GOP opposition to the nomination, Becerra is expected to clear the nomination vote. There is new pressure to secure the necessary votes to confirm Becerra after President Biden’s nominee to head the Office of Management and Budget (OMB) was not able to secure enough votes to pass Senate confirmation and requested the White House to withdraw her nomination.  

NASTAD Joins Coalition in Support of Dr. Rachel Levine’s Nomination to HHS Assistant Secretary for Health (ASH) 

NASTAD joined a broad coalition of over 350 LGBTQI+ and allied organizations and urged the Senate to confirm the appointment of Dr. Rachel Levine to serve as the HHS Assistant Secretary for Health (ASH). The coalition highlights Dr. Levine’s extensive background in public health, particularly her experience as the current Secretary of Health for the Commonwealth of Pennsylvania. Additionally, the advocates underscore Dr. Levine’s expertise in building close alliances between federal and state health leaders to implement pandemic policies—an invaluable asset for the Biden Administration’s COVID-19 response. 

Democrats Release Plan for Resuming Earmarks 

On February 26, House Appropriations Committee Chair Rosa DeLauro (D-CT-03) announced Democrats’ plan to restore earmarks, or the practice of appropriating funding for specific projects. Congress agreed to an earmark moratorium after reports of wasteful and inappropriate spending prompted lawmakers to reconsider the fiscal practice. Democrats are moving forwarded with a new model for earmarking funds in fiscal year 2022, branded as “Community Project Funding,” which includes more transparency and accountability measures to ensure that federal dollars are not abused. 

NASTAD Supports the Public Health Funding Prevents Pandemics Act 

NASTAD joined a coalition of 152 organizations and voiced our support for the Public Health Funding Prevents Pandemics Act, which was introduced on March 3 by Senator Richard Blumenthal (D-CT) and Representative Doris Matsui (D-CA-06). The bill would restore funding for the Prevention and Public Health Fund (Prevention Fund), which is a dedicated funding stream intended to strengthen the country’s public health system, including prevention programs, critical health challenges like the COVID-19 pandemic, and other core public health activities like infectious disease response. The Public Health Funding Prevents Pandemics Act would restore funding to the Prevention Fund to $2 billion for FY2021 and all subsequent years. 

Administrative Activity 

HRSA Awards $99 Million to End the HIV Epidemic in the United States 

On March 4, the Health Resources and Services Administration (HRSA) announced the award of nearly $99 million through the Ryan White HIV/AIDS Program to expand access to HIV care, treatment, medication and essential support services. This investment is a critical component of the U.S. Department of Health and Human Services' Ending the HIV Epidemic (EHE) initiative. EHE aims to reduce the number of new HIV infections in the United States by at least 90 percent by 2030 with the goal of decreasing the number of new HIV infections to fewer than 3,000 per year. Awards made to HRSA's Ryan White HIV/AIDS Program recipients will be used to continue to link people who are either newly diagnosed with HIV, or diagnosed but currently not in care, to essential HIV care, treatment, and support services, helping them reach viral suppression and reduce HIV transmission. 

CDC, HRSA Release Updated Integrated Planning Guidance 

On February 26, the Health Resources and Services Administration HIV/AIDS Bureau (HRSA HAB) and Centers for Disease Control and Prevention Division of HIV/AIDS Prevention (CDC DHAP) released a Dear Colleague Letter (DCL) announcing plans to issue the updated Integrated HIV Prevention and Care Plan guidance in June 2021 with submission of the plans tentatively due in December 2022. HRSA and CDC expect health departments to continue to utilize existing Integrated HIV Prevention and Care Plans and other jurisdictional plans (e.g., Ending the HIV Epidemic Plans, Fast Track Cities), as applicable, as their jurisdictional HIV strategy or roadmap. Health departments funded as Phase 1 Ending the HIV Epidemic (EHE) jurisdictions are also encouraged to incorporate community engagement efforts into integrated planning activities where appropriate. HRSA and CDC reminded health departments that the Integrated HIV Prevention and Care Plan is the umbrella plan for all health department HIV-related resources and activities and the EHE plan should work in conjunction as a subset of focused resources and activities. All questions should be directed to your designated HRSA or CDC project officer.   

NASTAD Joins Coalition Calling on HHS to Maintain Medicare’s Protected Class Benefit 

NASTAD joined the Partnership for Part D Access coalition and called on HHS Secretary-Designate Becerra to rescind a Trump-era policy proposal that would undermine key patient protections in Medicare’s prescription drug program. On January 19, the Center for Medicare and Medicaid Innovation (CMMI) announced a proposal that would allow health plans participating in the Medicare Part D Payment Modernization (PDM) Model to limit the drugs covered in the formulary, including denying patient access to medications used to manage HIV/AIDS. The coalition highlights the important role that the protected drug class policy played in ensuring that Part D formularies best serve the needs of all Medicare beneficiaries, especially the most vulnerable patients with the greatest need for drug coverage.  

Additionally, Congressional Democrats sent a letter to the Acting HHS Secretary and Acting CMS Administrator expressing strong opposition to the harmful changes implemented in the Medicare PDM Model. The lawmakers argue that stripping the protected drug class policy will not result in significant cost savings and fails to provide adequate drug coverage for patients that rely on the Medicare program for affordable drug coverage.  

NIH Office of AIDS Research Updates COVID-19 and HIV Interim Guidance 

The National Institutes of Health (NIH) Office of AIDS Research released an updated version of the Interim Guidance for COVID-19 and Persons with HIV. The updated guidance reflects new insights of severe COVID-19 infections in persons with HIV. In particular, the updated guidance recommends that people with HIV should receive SARS-CoV-2 vaccines regardless of CD4 count or viral load, and provides additional guidance on medication use for pregnant women and children living with HIV. 

Resources 

NASTAD Webinar: Serving Criminalized Survivors 

Date & Time: Wednesday, March 17 from 2:00 – 3:15 pm EST  

NASTAD will host a webinar on the topic of serving survivors of violence and criminalized populations with a harm reduction approach. The webinar will cover the principles of harm reduction through an anti-violence lens and the importance of understanding criminalization and anti-violence work for SSPs and other harm reduction/drug user health programs. The webinar is hosted by NASTAD through the CDC-funded National Harm Reduction TA Center and will be facilitated by Kate D’Adamo of Reframe Health and Justice. This webinar is for anyone currently running or supporting a harm reduction program, as well as those interested in doing so. We also encourage attendance by those affiliated with anti-violence or victim services organizations looking to expand their knowledge on clients who use substances or engage in sex work. To join the webinar, please register here. After registering, you will receive a confirmation email containing information about joining the webinar.    

AAP Pediatric HIV/AIDS Virtual Training Course – May 25-26, 2021 

The American Academy of Pediatrics (AAP) Committee on Pediatric AIDS is hosting the Pediatric HIV/AIDS Virtual Training Course on May 25-26, 2021. The comprehensive course will address all aspects of HIV management in infants, children, adolescents and young persons; and to present evidence-based data to optimize clinical practice. The course is intended for individuals that are interested in expanding their knowledge in HIV/AIDS care. Visit https://shop.aap.org/2021-pediatric-hiv-aids-training-course/ to view the agenda, access the course brochure, and to register for the course. If you have any questions, please contact Heather Stob at hstob@aap.org

Report: PrEP Rates Lowest Among Persons at Highest Risk of HIV With Medicaid Coverage 

“Individuals at high risk of contracting HIV and with commercial health insurance adhered to their pre-exposure prophylaxis (PrEP) regimens more than twice as long as persons covered by Medicaid.” 

Report: The Catastrophic Cost of Uninsurance: COVID-19 Cases and Deaths Closely Tied to America’s Health Coverage Gaps.  

“According to recent groundbreaking research, each 10% increase in the proportion of a county’s residents who lacked health insurance was associated with a 70% increase in COVID-19 cases and a 48% increase in COVID-19 deaths. This report uses that research to address one fundamental question: If everyone in America had health insurance, how many people who contracted COVID-19 could have been spared, and how many who died might still be with us today?” 

Job Postings 

U=U Global Knowledge & Advocacy Assistant – Brooklyn, NY 

This is a challenging and meaningful entrepreneurial position with PAC’s Global U=U Knowledge and Advocacy Collaborative (KAC).  The KAC is in the early stage of growth, so this is a chance to be part of the conversation as global organizations, leaders, and activists join with in-country partners to support community-driven and sustainable U=U movements that change the narrative about HIV. This position will provide support on a variety of PAC's work with partners including conducting needs assessments; providing coalition-building support; curating, developing, and offering "best practices" training and communications materials to engage key audiences including clinicians, community, and policymakers; advising on public health communications; and integrating U=U into advocacy for policies and programs that will increase access to treatment and services. 

Communicable Disease Epidemiologist – Cheyenne, Wyoming 

This position will serve as the Communicable Disease AIDS Drug Assistance Program (ADAP) Coordinator, Wyoming TB Controller, and Disease Intervention Specialist (DIS) for the Communicable Disease (CD) Treatment Program.  Assist in outbreak response to ensure the safety of Wyoming residents; by interviewing cases for exposure information, updating news outlets on the progress of outbreak control, analyzing exposure data utilizing epidemiological and statistical methods. 

Department of State Health Services, Program Informatics and Evaluation Group – Austin, TX 

  • Program Specialist V - performs advanced (senior-level) consultative services for the Program Informatics and Evaluation Group within the integrated HIV/STD/TB Surveillance and Prevention unit of DSHS 

  • Research Specialist V - conducts highly advanced (senior-level) research and analysis of program evaluation and epidemiologic data associated with HIV, particularly routine testing for HIV in clinical settings 

  • Program Specialist IV - performs highly complex and advanced technical activities related to HIV, STD, and Tuberculosis data management and processing of HIV, STD, and TB laboratory reports 

  • Epidemiologist III - designs and implements statistical analyses appropriate for epidemiologic and programmatic data with a focus on HIV prevention programming. 

Director of Operations, Bureau of Infectious Disease and Laboratory Sciences – Boston, MA 

The Bureau of Infectious Disease and Laboratory Sciences (BIDLS) at the Department of Public Health (DPH) is seeking an experienced leader who is eager to join a mission-driven and fast-paced team in effectively and efficiently supporting the day-to-day operational needs of BIDLS.  The selected candidate will provide direct and indirect supervision to a total of 55 staff, including 4 Managers, and will oversee an annual budget in excess of $500M. To be successful, the incumbent of this position must be detail-oriented and also must understand the complexities of systems change and implementation in government systems, with the ability to ensure alignment with the Bureau’s and Department’s mission, goals, and objectives. 

Open Positions – New York State 

The New York State Department of Health, in partnership with Health Research, Inc, has various job openings, including some within the AIDS Institute. Please visit this link to learn about their current opportunities.  

News Bulletin 

$200K in Grants From Syringe Access Fund to Boost Harm Reduction Programs 

“The Syringe Access Fund is excited to announce the awarding of two advocacy grants, totaling $100,000 each, to the Indiana Recovery Alliance and the Oklahoma Harm Reduction Alliance. These organizations are committed to expanding comprehensive harm reduction services to people who use drugs, including syringe exchange services, primary care, testing and treatment for HIV and viral hepatitis, and linkage to medication for opioid use disorder and substance use disorder treatment. These grants will bolster support for harm reduction in Indiana and Oklahoma by introducing community education campaigns and legislation to legalize evidence-based health services for people who use drugs.” 

NIH director apologizes for ‘structural racism,’ pledges actions 

“Responding to concerns about discrimination against Black people, National Institutes of Health (NIH) Director Francis Collins issued an unusual public apology for what he called “structural racism in biomedical research” and pledged to address it with a sweeping set of actions. NIH’s long-running efforts to improve diversity “have not been sufficient,” Collins wrote in the statement. “To those individuals in the biomedical research enterprise who have endured disadvantages due to structural racism, I am truly sorry.” The agency plans “new ways to support diversity, equity, and inclusion,” and will also correct policies within the agency “that may harm our workforce and our science,” he added.” 

CDC director urges people to keep masking and distancing 'regardless of what states decide' 

The director of the US Disease Control and Prevention on Wednesday said she hopes people will decide to individually "do the right thing" about distancing and wearing masks, even in states moving to eliminate restrictions against the CDC's recommendations. "I think we at the CDC have been very clear that now is not the time to release all restrictions," Dr. Rochelle Walensky said during a White House COVID-19 Response Team briefing. Walensky's comments come after governors of Texas and Mississippi said they were lifting mask mandates and allowing businesses to open at full capacity, starting now or within days. 

Losing Our Way: Caring for Patients Who May, Too Soon, Become Organ Donors 

“In the United States (U.S.), the rising number and proportion of HCV-infected organs from young people who overdosed are being utilized for transplantation. Both overdose deaths and HCV incidence have skyrocketed with our opioid crisis, making HCV increasingly common among organ donors. With the advent of curative anti-HCV direct-acting antivirals (DAAs) coinciding with these public health tragedies, harvesting grafts from HCV-infected overdose victims has become a novel opportunity to expand the donor pool.”