Policy Updates: Hill Happenings and Administration Activities

By Mike Weir April 2, 2019

Hill Happenings

Health Care Legislation

House Energy & Commerce Committee Chairman Frank Pallone (D-NJ-6) introduced the Protecting Pre-existing Conditions & Making Health Care More Affordable Act. According to analysis from the Center on Budget and Policy Priorities, the bill “would lower health insurance premiums by hundreds or thousands of dollars per year for more than 13 million people and extend coverage to millions more.”

Administration Activities

Affordable Care Act

As litigation over the constitutionality of the Affordable Care Act (ACA) continues, the Department of Justice (DOJ) took the new position that the entire law should be invalidated. This is a sudden departure from the DOJ’s previous position that only the ACA’s individual mandate and pre-existing condition protections are unconstitutional, but that the rest of the law is severable and should be upheld. The DOJ now agrees with the lower federal court decision from December 2018 that declared the entire ACA invalid and sent a two-sentence letter to the Fifth Circuit Court of Appeals stating that the federal government does not intend to argue for reversal of that decision. The ACA is still the law of the land while the litigation makes its way through appeals.

Medicaid Work Requirements

A federal judge on Wednesday rejected Medicaid work requirements in Arkansas and Kentucky, finding that the federal government failed to consider the harmful impacts of work requirements before approving the states’ programs. This is the second time the Kentucky requirement has been invalidated in court—in a ruling last June, the judge ordered the Department of Health and Human Services (HHS) to re-evaluate the impact of Kentucky’s work requirement to determine whether it would “in fact help the state furnish medical assistance to its citizens” as required by federal law. The judge ruled this week that HHS once again failed to adequately consider the coverage loss consequences of Kentucky’s work requirement, and that Arkansas’ requirement is invalid for similar reasons. Six other states currently have approval from HHS to implement work requirements in their Medicaid programs.

In a statement, Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma said, “We will continue to defend our efforts to give states greater flexibility to help low-income Americans rise out of poverty. . . . States are the laboratories of democracy and we will vigorously support their innovative, state-driven efforts to develop and test reforms that will advance the objectives of the Medicaid program.”

Resources

Shifting the Paradigm in HIV Prevention and Treatment Service Delivery Toward Differentiated Care for Youth

Institute for Sexual and Gender Minority Health and Wellbeing

Northwestern University’s Institute for Sexual and Gender Minority Health and Wellbeing is requesting proposals from community-based organizations (CBOs) and other HIV service organizations to implement Keep It Up! (KIU!), an online e-health HIV prevention intervention, as part of their existing HIV testing services. 

KIU! has been demonstrated to be highly effective throughout the past decade in multiple randomized control trials and program evaluations of the intervention delivered by CBOs. The RFPsolicits applications to identify and fund 22 CBOs/HIV service organizations in different counties to integrate KIU! into their existing HIV testing and prevention services. The RFP includes a map displaying eligible counties (list of counties can be found on page 25 of the RFP). Northwestern is trying to make sure that all CBOs in the eligible counties are aware of the RFP to ensure that they get a nationally representative sample of CBOs. Health department staff are encouraged to review and  distribute to eligible CBOs in their jurisdiction.

Upcoming Meetings

2019 National Sexual Health Conference 

The 2019 National Sexual Health Conference will take place July 10-12 in Chicago, IL. The conference aims to create opportunities to share information, efforts, and best practices around sexual health across the lifespan by bridging the varied disciplines of education, advocacy, and clinical care, among others. Registration is currently open

Job Opportunities 

Chief, Center for HIV/STI Integration and Capacity Program Manager II– Maryland

The Maryland Department of Health is hiring a Chief for their Center for HIV/STI Integration and Capacity Program Manager II within their Infectious Disease Prevention and Health Services Bureau. This posting closes on April 9, 2019. 

Director Epidemiologic Unit– New Jersey

The New Jersey Department of Health is hiring a Director for their Epidemiologic Unit within the Division of HIV, STD and TB Services. This posting closes on April 5, 2019.

News Bulletin

First living HIV-positive donor provides kidney for transplant in medical breakthrough

“Surgeons at the Johns Hopkins Hospital have transplanted a kidney from a living HIV-positive donor to an HIV-positive recipient, a medical breakthrough they hope will expand the pool of available organs and help change perceptions of HIV. The donor, 35-year-old Nina Martinez, and the recipient, who chose to remain anonymous, are recovering in the hospital after Monday’s surgery, doctors said. The recipient no longer needs kidney dialysis for the first time in a year.”

Public not aware of HIV treatments and their efficacy, poll finds

“Less than half of the American public is aware there is a prescription treatment to lower the risk of HIV or about the effectiveness of antiretrovirals, a new poll released Tuesday found. Kaiser Family Foundation's poll found only 42% of Americans were aware of PrEP, a drug that lowers the risk of getting HIV for people at high-risk of contracting the virus. However, a majority of African-Americans surveyed (54%) were aware of the drug.”

An HIV treatment cost taxpayers millions. The government patented it. But a pharma giant is making billions.

“Thomas Folks spent years in his U.S. Centers for Disease Control and Prevention lab developing a treatment to block deadly HIV in monkeys. Then San Francisco AIDS researcher Robert Grant, using $50 million in federal grants, proved the treatment worked in people who engaged in risky sex. Their work — almost fully funded by U.S. taxpayers — created a new use for an older prescription drug called Truvada: preventing HIV infection. But the U.S. government, which patented the treatment in 2015, is not receiving a penny for that use of the drug from Gilead Sciences, Truvada’s maker, which earned $3 billion in Truvada sales last year.”

LGBT groups sue Arizona over HIV/AIDS instruction law

“LGBT groups sued Arizona Thursday asking a federal judge to strike down a state law prohibiting HIV and AIDS instruction that “promotes a homosexual lifestyle.”

The lawsuit, filed on behalf of Equality Arizona, alleges the 1991 law constitutes unconstitutional discrimination and restricts educational opportunity for LGBT students. It says it enshrines in state law that LGBT students can only be discussed in a negative light and communicates to students and teachers “that there is something so undesirable, shameful, or controversial about ‘homosexuality’ that any positive portrayals of LGBTQ people or same-sex relationships must be explicitly barred.”

Trump pledged to end the HIV epidemic. San Francisco could get there first

“This city is on course to be the first in the country to eliminate new HIV infections — or at least come close. President Trump pledged in his State of the Union speech that the U.S. will “eliminate the HIV epidemic … within 10 years.” San Francisco is poised to get there first.”

CDC chief ‘totally confident’ in plan to beat HIV by 2030

“We presented that initiative to our secretary of health, who has fully embraced it as one of his major priorities,” Redfield said. “He was successful in presenting this to the president, who was also very committed and engaged, but I don’t know the actual process of how words get into his speech.” Although the administration is also seeking to roll back the Affordable Care Act and to cut Medicare and Medicaid, Redfield said he doesn’t think changes to other health programs will affect the main HIV initiative.