Policy Updates: Hill Happenings and Administration Activities

By Mike Weir June 4, 2018

Hill Happenings

FY2018 Rescissions

On May 24th, Senator Mike Lee (R-UT) introduced the Senate version of the rescissions package released by the White House earlier in the month. The House of Representatives released their own $15.2 billion rescissions bill, which was referred to the House Committee on Appropriations and still may be tweaked in order to protect monies allocated for the Children’s Health Insurance Program and Ebola, shortly after the release of the White House’s proposal.

The Senate bill has been referred to the Budget and Appropriations Committees, where it is expected to be challenged by Sens. Richard Shelby (R-AL), Lisa Murkowski (R-AK), and Susan Collins (R-ME) over some of the proposed cuts. The deadline for Congressional action on the White House’s rescissions package is June 22, at which point the Senate will lose its filibuster-proof powers in the Senate. Under the Budget Act of 1974, the House and Senate Appropriations Committees have 25 days to either approve, disapprove or amend the rescissions request. If the committees do not act within 25 days, the measure is subject to discharge from the committee and can go to the full House and Senate chambers for action.

“Minibus” Appropriations Bill

This week, the House of Representatives is expected to consider a three-bill "minibus" appropriations package which will include a $44.7 billion Energy-Water bill funding the Department of Energy, the Army Corps of Engineers and the Interior Department's Bureau of Reclamation; a bill funding House operations and agencies such as the Capitol Police, the Architect of the Capitol and the Library of Congress; and a $96.9 billion-dollar bill to fund the constructions of a $69 million detention facility at Guantanamo Bay, Cuba contingent on separate authorizing legislation. This will be the first appropriations package considered in the House or the Senate, though both chambers have the goal of completing the appropriations process by the August recess.

Affordable Care Act Repeal

Republican leaders are expected to propose another push to repeal the Affordable Care Act (ACA) sometime this month that would give states more say over health policy. The Trump Administration is said to be supportive of the latest ACA repeal efforts, but some in the Republican caucus are hesitant to make another attempt due to the potential of motivating political action from the Democrats and their supporters. GOP policymakers are also weary of reminding conservative voters of their continued inability to repeal the law.

Republican lawmakers and conservative thinks tanks like the Heritage Foundation, the Galen Institute, and the Ethics and Public Policy Center have been meeting regularly over the past eight months crafting recommendations for Congress to repeal the ACA's coverage requirement and taxes and give more spending power to the states through block grants. It is anticipated that the proposal will be an update on the failed Graham-Cassidy legislation.

Health Equity and Accountability Act

On May 23rd, Representative Barbara Lee (D-CA) introduced the Health Equity and Accountability Act (HEAA) of 2018. HEAA has been introduced in every Congress since 2007. This legislation reforms policies and expands federal health care resources for racial and ethnic minorities, as well as other underserved populations who face discrimination and barriers to care due to their immigration status, sex, age, ability, sexual orientation, gender identity, and English proficiency. The 300 groups that comprise the HEAA Community Working Group, including NASTAD, sent an organizational letter of support to health leaders of the Congressional Tri-Caucus expressing support for the bill leading up to its passage.

Right to Try Legislation

Last week, President Donald Trump signed into law S. 204, the Trickett Wendler, Frank Mongiello, Jordan McLinn, and Matthew Bellina Right to Try Act of 2017. The legislation allows patients with life-threatening conditions to ask drug makers for medicines the Food and Drug Administration (FDA) have not formally approved, though the treatments must be in active clinical trials, and must have cleared initial preliminary testing. Patients who want to use the pathway must have exhausted all their other options and must be unable to participate in an existing clinical trial. The legislation also doesn’t require drug makers to provide the treatments, nor does it prevent them from charging patients for their associated costs if they do. 

HIV Health Care Access Working Group Letter to Attorneys General and Insurance Commissioners

On May 17, the HIV Health Care Access Working Group, co-chaired by Amy Killeleasent a letter to all state-level Attorneys General and Insurance Commissioners warning them of the harmful practice health insurers are implementing that prevent manufacturer copay assistance from counting towards a beneficiary’s deductible and maximum out-of-pocket spending. The letter emphasizes the importance that copay cards have for many people to afford PrEP, HIV and Hepatitis C medications, and the impact these policies have on access to treatment. 

Insurers have argued that the drug manufacturers are responsible for setting what the insurers say are excessively high drug prices to begin with and that the co-payment assistance plans offered by the drug companies have been used to “steer” patients toward choosing name brand drugs rather than less expensive generic drugs. But the working group points out that for nearly all currently prescribed AIDS drugs, including Truvada used for PrEP, there is no generic alternative available.

The group also drew attention to the fact that many plans are making these policy changes without notifying consumers, leaving patients to find out these restrictive policies are in place when surprised with thousands of dollars in cost-sharing, months into the plan year. An official with Whitman-Walker Health, the D.C.-based community health provider, said that terminating the co-pay assistance from going toward some Whitman-Walker clients’ insurance deductible has resulted in their being hit with a $1,600 per month out-of-pocket cost for PrEP. 

340B Coalition Congressional Correspondence

The 340B Coalition sent a letter from healthcare providers to Congressional leadership on May 17thexpressing support for the 340B program and its discounted drug pricing for safety-net health care providers and the access it ensures to affordable, quality health care services, prescription drugs, and improved health outcomes for underserved patients across the country. The coalition warned that efforts to alter the Congressional intent of the law or otherwise dramatically narrow the 340B Program would ultimately decrease access to affordable quality health care for vulnerable populations.

In addition to the letter to Congressional leadership, over 60 patient and consumer groups also sent a letter to the Hill in support of 340B. That letter also made clear its signatories’ support of 340B and warned Congressional offices of the limits to access to affordable, clinically appropriate, pharmaceuticals for low-income, uninsured, underinsured, and other vulnerable patients as well as the reduction to access to care that would result from changes to the program.

The 340B Coalition, of which NASTAD is a member, submitted a comment letter in response to the Notice of Proposed Rulemaking published in the Federal Register on May 7, 2018. The notice proposed an extension of the delay of the effective date of a Final Rule that established regulations for the 340B ceiling price and manufacturer civil monetary penalties (CMPs) and set an effective date of March 6, 2017. In its letter, the coalition strongly opposed any additional delay of the Final Rule due to the resulting harm to 340B covered entities and their patients and asked that the rule be implemented immediately. The coalition believes that the final rule is crucial to codify important 340B policies and to ensure that manufacturers comply with 340B program requirements.

The Chronic Illness and Disability Partnership Letters to Congress

On May 15th, the Chronic Illness and Disability Partnership (CIDP), which NASTAD co-chairs, submitted a letter to Congress in support of recent legislation to combat the ongoing opioid crisis. The letter urged Congress to continue its commitment to the opioid epidemic in ways that ensure that pople living with chronic illnesses and/or disabilities have unfretted access to the programs and assistance they depend upon. A blog post from the Center on Budget and Policy Priorities summarizing the recent opioid bills and their development through the legislative process is available here.

CIDP also drafted a letter outlining concerns with expanding SNAP work requirements and increased funding and support for the formation of Association Health Plans in the Agriculture and Nutrition Act of 2018. CIDP expressed concern that the draft bill includes provisions that will harm people living with chronic illnesses and disabilities by cutting off SNAP benefits for many as a result of not satisfying work requirements with highly punitive rules. The organization also argues that supporting Association Health Plans will further segment the insurance market and make it harder for those living with chronic illnesses and disabilities to purchase affordable, comprehensive coverage. CIDP consists of national organizations representing people living with a wide range of chronic illnesses and disabilities, including cancer, cystic fibrosis, diabetes, HIV, Hepatitis B and C, multiple sclerosis, and mental health and substance use disorders representing 117 million Americans estimated to be living with a chronic illness and/or disability.

Administration Activities

Global Gag Rule

The administration issued a draft notice of proposed rulemaking (NPRM) that proposes to revise its Title X regulations to ensure compliance with, and enhance implementation of, the statutory requirement that none of the funds appropriated for Title X may be used in programs where abortion is a method of family planning and related statutory requirements, effectively eliminating eligibility for Planned Parenthood providers and many other Title X clinics. This mirrors the Mexico City policy or the global gag rule.  The proposed rule would also propose amendments to the Title X regulations that would:

  • Clarify grantee responsibilities to provide a broad range of family planning methods
  • Require documented compliance with State and local laws requiring notification or the Reporting of child abuse, child molestation, sexual abuse, rape, incest, intimate partner violence, and human trafficking
  • Provide free or low-cost access to family planning services for those women who are unable to obtain employer-sponsored insurance coverage for certain contraceptive services due to their employers’ religious beliefs or moral convictions;
  • Provide for the appropriate expenditure of federal Title X funds on family planning services, rather than on lobbying or related activities
  • Encourage family participation in family planning decisions

Planned Parenthood released a statement saying that the proposed rule would impose new rules that are designed to make it impossible for millions of patients to get birth control or preventive care from reproductive health care providers like Planned Parenthood. Under this rule doctors, nurses, hospitals, and community health centers across the country could no longer receive federal funding if they refer their patients for safe, legal abortion and it would remove the guarantee that people get full and accurate information about health care from their doctors. 

NASTAD plans to submit comments on this draft regulation and the potential impact on HIV testing and care.

2017 National HIV/AIDS Strategy (NHAS) Progress Report

On May 24th, HHS released the 2017 National HIV/AIDS Strategy (NHAS) Progress Report, the sixth since 2010. The report was developed by members of the NHAS Federal Interagency Workgroup, which coordinates implementation and monitoring of the Strategy across the federal government.

The NHAS uses a series of 17 indicators to measure progress in meeting the plan's goals of reducing new HIV infections; increasing access to care and improve outcomes for people living with HIV; reducing HIV-related health disparities and health inequities; and achieving a more coordinated national response to the HIV epidemic. The 2017 report gathered information on 16 of the indicators which showed that HHS met or exceeded the annual targets in nine categories and made valuable progress toward meeting another two of those targets. Those include:

  • The number of new HIV diagnoses decreased by nearly 5% from 41,985 in 2011 to 39,876 in 2015.
  • The percentage of persons living with diagnosed HIV who were virally suppressed increased from 46.0% in 2010 to 57.9% in 2014.
  • The number of adults prescribed PrEP increased by more than 300% from 7,972 in 2014 to 33,273 in 2015.

The report also shows that there continues to be disparities in HIV risk and diagnoses for gay and bisexual men, stable housing among people living with HIV, and HIV diagnoses in the Southern United States. HHS stated that the report is a demonstration of the administration's ongoing commitment to protecting and improving the health and well-being of all Americans, including those who are living with HIV. Although the agency is encouraged by the many areas of progress presented in the report, there is still a large amount of work that needs to be done to reach the nation’s goals for 2020.

Job Opportunities

HIV Surveillance and Epidemiology Program Director
The Tennessee Department of Health has an opening for a new HIV surveillance and epidemiology program director. The position is in the Division of Communicable and Environmental Diseases and Emergency Preparedness (CEDEP), HIV/STD/Viral Hepatitis Program and is responsible for developing and managing statewide HIV epidemiology and surveillance efforts to quantify and reduce the public health burden and consequences of HIV infection. 

Coordinator of Research and Evaluation for Viral Hepatitis

The city of Chicago’s Department of Health is hiring a Coordinator of Research and Evaluation for Viral Hepatitis. The position will be primarily responsible for researching, monitoring, coordinating, and evaluating Chicago viral hepatitis services, including testing, linkage to care, and access to treatment, as well as developing and sustaining relationships and communication with and among external stakeholders, including facilitating the Chicago area hepatitis C elimination task force.

With our members …

Director of New York State Department of Health, AIDS Institute Johanne Morne to be honored at Cielo Gala 2018

The Latino Commission on AIDS honored Johanne Morne, Director of the New York State Department of Health (NYSDOH) AIDS Institute, at its annual Cielo gala on June 1st. This year, the Cielo Gala highlighted the work of the Commission's Latinos in the Deep Southprogram. The program launched in 2006 as a regional assessment to learn about the realities and needs of growing Hispanic/Latino communities in the southern United States, where new HIV infection rates have been the highest in the nation. It builds local leadership, develops networks of collaborations, enhances knowledge and cultural competency, and spurs actions to advocate for emerging Latino LGBTQ communities around HIV prevention, access to health care and support, and community initiatives that address stigma in Alabama, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, and Tennessee.
 

News Bulletin

Walgreens Offers Free Hepatitis C Testing at Virginia Pharmacies

“The Virginia Department of Health is partnering with Walgreens to offer no-cost Hepatitis C testing at 10 pharmacies across the state.The health department announced the development Thursday.

The testing offer comes as Virginia's opioid epidemic has contributed to an increasing number of Hepatitis C cases in the state. The health department says people who share needles when they inject drugs are most at risk for acquiring the virus.”

Health Department Launches “¡Listos!”, First-Ever Campaign Promoting HIV Prevention Medication to Latinos

“The Health Department, in partnership with the Latino Commission on AIDS (LCOA), launched “¡Listos!”, a sex-positive marketing campaign that encourages Latinos to consider using pre-exposure prophylaxis (PrEP) as part of their sexual health plan. PrEP is a safe, daily pill that greatly reduces the risk of HIV infection. In 2016, only 16 percent of sexually active Latinos in New York City were aware of PrEP, and fewer Latinos are taking PrEP compared to Whites “¡Listos!”, which translates to “Ready!” in Spanish, is the agency’s first awareness campaign to be conceived of and largely released in Spanish. The campaign also seeks to dispel common myths about PrEP’s safety, effectiveness and availability so that all New Yorkers, regardless of ability to pay or immigration status, are aware of the HIV prevention options available to them. In March, the Health Department launched “Living Sure”, a campaign to inform women, including cisgender and transgender women, about using PrEP as an HIV prevention tool.”

High Prevalence of High-risk Opioid Prescribing Among HIV-positive Adults in the US

“There is a high prevalence of prescription opioid use among HIV-positive people, with many individuals having prescribing patterns associated with a high risk of dependence, investigators from the United States report in the Journal of Acquired Immune Deficiency Syndromes. Approximately 40% of people living with HIV received an opioid prescription, with high-risk use occurring in a third of these individuals. A history of injecting drug use and chronic pain were both among the risk factors for high-risk prescribing.”

Resources

Vital Signs on Rectal Gonorrhea and Chlamydia

Registration Now Open for the HIV, STD & Hepatitis Conference 2018: Advances and Opportunities to be held June 27-28, 2018 in Des Moines, IA