Policy Updates: Hill Happenings and Administration Activities

By Mike Weir March 12, 2018

Hill Happenings

Budget and Appropriations

Congresswoman Barbara Lee (D-CA-13) is leading an additional push to ensure HIV programs are adequately funded in the final FY2018 omnibus package. The current continuing resolution (CR) is set to expire on March 23. Debate over Planned Parenthood funding, as well as a few other contested issues, have stalled negotiations over the FY2018 omnibus package and cast doubt about lawmakers’ ability to pass the spending package by the end of March 23.

The HIV and hepatitis communities have reinforced appropriations ask for FY2018 via communications with Congress. The AIDS Budget and Appropriations Coalition (ABAC) also sent a letter urging Congress to reject cuts and continue support for HIV and hepatitis programs.    

Congressional Budget Office (CBO) Scoring

A bipartisan contingent of House lawmakers wants more clarity on long-term savings from preventive health efforts. House Budget Committee leaders from both sides of the aisle have agreed that it would be helpful for the CBO to look beyond the 10-year budget window to calculate those savings. Ranking member John Yarmuth (D-KY-3) suggested the newly formed Joint Select Committee on Budget and Appropriations Process Reform should take up the issue.

Congressman Michael Burgess (R-TX-26) has previously introduced a bill that would require CBO to predict savings 20 to 30 years into the future for preventive health initiatives, rather than just ten years out.

Opioids

The Senate Health, Education, Labor, and Pensions (HELP) Committee held a hearing examining state innovation relating to the opioid crisis. Two governors, Larry Hogan (R-MD) and Kate Brown (D-OR), emphasized the need for additional federal funding and flexibility in the fight against the opioid crisis during the sixth hearing held by the HELP committee on the crisis.

NASTAD led a community sign-on which garnered nearly 100 signers asking that Congress include at least an $100 million increase for the Centers for Disease Control and Prevention’s (CDC) viral hepatitis program from the $3 billion in the Budget Act allocated for addressing the opioid epidemic. 

Administration Activities  

Opioids

In just one year, overdoses from opioids jumped by about 30%, according to a new report released by the CDC. The Midwestern region witnessed opioid overdoses increase 70% from July 2016 through September 2017. Opioid overdoses in large cities increased by 54% in 16 states.

RWHAP Part B Update on FY2018 Awards

The Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB) will begin making FY2018 awards for the Ryan White HIV/AIDS Program (RWHAP) Part B (X07) and the AIDS Drug Assistance Program (ADAP) Emergency Relief Funds (ERF) (X09) for all recipients on or before April 1, 2018, for the budget start date of April 1, 2018. However, partial awards are required because the Federal government is currently operating under a CR.

Title X FOA

Valerie Huber, Acting Deputy Assistant Secretary for Population Affairs at the Department of Health and Human Services Department (HHS) and a longtime pro-abstinence advocate, will have the final say on which groups receive Title X federal family planning funds. Until now, final decisions on Title X funds were made by a regional health official along with the HHS deputy assistant secretary for population affairs and the assistant secretary for health, according to language in applications distributed in prior years.

Last month, the HHS Office of Population Affairs released a Funding Opportunity Announcement (FOA) for the Title X program — the nation’s program for affordable birth control and reproductive health care that more than four million people rely on each year.

UnitedHealthcare Drug Discount

UnitedHealth Group, the country's largest insurer, announced it will begin passing on rebates it gets from pharmaceutical companies to some customers when they buy prescription drugs. HHS Secretary Alex Azar praised the announcement. The announcement from UnitedHealth Group is "the type of movement toward transparency and lower drug prices for millions of patients that the Trump Administration is championing," Azar said.

2018 Federal Poverty Level Standards

The Centers for Medicare & Medicaid Services (CMS) released an informational bulletin related to the 2018 Federal Poverty Level Standards.  The 2018 guidelines reflect the 2.1% price increase between calendar years 2016 and 2017. After this inflation adjustment, the guidelines are rounded and adjusted to standardize the differences between family and household sizes. For a family or household of four persons living in one of the 48 contiguous states or the District of Columbia, the poverty guideline for 2018 is $25,100. Separate poverty guideline figures are developed for Alaska and Hawaii, and different guidelines may apply to the Territories.

CROI Updates

The annual Conference on Retroviruses and Opportunistic Infections (CROI) brings together top basic, translational, and clinical researchers from around the world to share the latest studies, important developments, and best research methods in the ongoing battle against HIV/AIDS and related infectious diseases. Below are highlights from this year’s conference which was held on March 4-7.

Reported Drug Injection Behaviors Before and After an HIV Outbreak – Indiana, 2016

“Among 124 survey respondents who reported they injected drugs both before and after the SSP was established, researchers found that after the SSP was established: The proportion of respondents who shared syringes fell from 74% to 22%.”

Utilization of HIV Testing and Prevention Services Among Persons Who Inject Drugs – Indiana, 2016

“Interviews with 200 people who inject drugs also showed that HIV testing increased substantially as a result of the outbreak response. Additionally, knowledge of pre-exposure prophylaxis (PrEP), a daily oral medication to help reduce the risk of HIV transmission, was found to be higher for people using the SSP.”

HIV prevention pill not reaching most Americans who could benefit – especially people of color

“A new CDC analysis suggests that only a small percentage of Americans who could benefit from pre-exposure prophylaxis (PrEP), a daily pill for HIV prevention, have been prescribed it. In the first detailed analysis by race and by risk group, CDC researchers also found that while two-thirds of people who could potentially benefit from PrEP are African-American or Latino, they account for the smallest percentage of prescriptions to date.”

HIV Diagnoses Among People Who Inject Drugs — United States, 2010–2016

“The national increase in HIV diagnoses among PWID during 2014-2015 followed a slowing decline during 2010-2014. Although the Scott County outbreak was largely responsible for the increase in 2015 cases, without Scott County cases, during 2014-2015 declines stalled nationally, and diagnoses increased in some demographic groups with slower declines during 2010-2014. The extent to which trends in the number and shifting characteristics of HIV diagnoses among PWID reflect a growing number of PWID in the United States, increased testing, increased reporting, or other causes cannot be determined from these data alone. Vigilance is needed so that longstanding gains in preventing HIV among PWID are not reversed.”

News Bulletin

Nebraska LB 285

On Wednesday, February 28, Nebraska Governor Pete Ricketts signed into law Legislative Bill 285.  The bill was introduced by State Senator Lou Ann Linehan of Omaha and ended the special consent requirement for HIV “Opt in” testing, while adding a requirement that pregnant women be tested for HIV.

Nebraska existing state law, passed in 1994, required patients to be given specific written consent before being tested for the human immunodeficiency virus, which included the patient also receiving an explanation of HIV infection and the meaning of both positive and negative test results.

In 2014, only two states in the United States, New York and Nebraska still mandated specific written informed consent for HIV testing and 2014, New York ended this requirement, leaving only Nebraska which as of February 2018, is no longer the case.

A lack in affordable care may lead to HIV resurgence

“National Women and Girls HIV/AIDS Awareness Day on March 10 provides an important opportunity to mark the progress that has been made in the fight against HIV/AIDS among women in America.”

Cigna to Acquire Express Scripts for $67 Billion

“The health insurance giant Cigna said on Thursday that it had agreed to buy the pharmacy benefit manager Express Scripts for $67 billion in cash and stock, including the assumption of $15 billion in debt.”

White House pitch to bolster Obamacare includes tough trade-offs for Democrats

“The White House is seeking a package of conservative policy concessions — some of which are certain to antagonize Democrats — in return for backing a legislative package bolstering Obamacare markets, according to a document obtained by POLITICO.”

Resources

Syphilis: A Provider’s Guide to Treatment and Prevention

Internalized HIV-Related Stigma

Other News

Evaluation & Planning Specialist

“This position will be responsible for the planning and implementation of the evaluation activities related to the HIV Prevention and Surveillance grant. This position will also assist in planning, project management, evaluation, and quality improvement activities for the STD/HIV/TB Section. The position will assist with the continued development and writing of the Minnesota HIV Strategy.”