Policy Updates: Hill Happenings and Administration Activities

By Mike Weir March 19, 2018

Hill Happenings

Budget and Appropriations

Congress is approaching the March 23 deadline to fund the federal government, as the House is unlikely to take up a massive spending bill until early this week. The vote on the $1 trillion-plus omnibus funding bill was supposed to occur in the House last week but was delayed by disagreements over several policy and funding issues. House Republican leaders are expected to present the details of the FY2018 omnibus spending bill to their members in a closed-door meeting tonight. The full text of the bill is expected to be released afterward. NASTAD will continue to advocate on behalf of HIV and hepatitis programs to ensure the highest funding level possible. We will keep you posted as further developments occur.

House Labor-HHS Chairman Tom Cole (R-OK-4) suggested that House and Senate negotiators have agreed to a larger amount of funding for the National Institutes of Health (NIH) than the $2 billion over two years committed as part of the Bipartisan Budget Act. House Minority Leader Nancy Pelosi (D-CA-12) said she expects $3 billion for NIH in the bill.

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

The Senate Appropriations Committee is expected to vote on naming their committee's next chair on April 9, when Senators return from the two-week recess. Senator Richard Shelby (R-AL) is in line to be the next chair, replacing Senator Thad Cochran (R-MS) who will resign on April 1.

Medicare Drug Coverage

Lawmakers are discussing how to use the omnibus spending package to adjust the Medicare donut hole policy, according to a key Republican appropriator, in what could potentially be a big win for drug makers. Senator Roy Blunt (R-MO), chairman of the Labor-HHS appropriations subcommittee, said Congressional Budget Office (CBO) "has become convinced" it underestimated the savings the government would see under a policy change in last month's budget caps deal that addressed the Medicare Part D coverage gap. The multi-billion dollar change required manufacturers to pay more of patients' branded drug costs.

Drug makers and their industry trade group PhRMA have been aggressively lobbying to undo or scale back the new policy as part of the omnibus. Part of their argument is that the policy change would generate significantly more government savings than what CBO had estimated. No official legislation or language has been introduced, but NASTAD will continue to provide updates on any potential legislation and the impact on health departments.

Opioids

This week, the House Energy and Commerce health subcommittee will be reviewing several opioid-related measures intended to be part of a broad, bipartisan package that lawmakers aim to have on the House floor by Memorial Day.  Included in the review will be the Eliminating Opioid Related Infectious Diseases Act of 2018 authored by Representatives Leonard Lance (R-NJ-7) and Joe Kennedy (D-MA-4) which would bring needed attention and funding to rising hepatitis C infections related to injection drug use.  NASTAD has sent a letter of support for the bill.  The bill is expected to be introduced very soon.

The host of measures slated for consideration during a two-day legislative hearing beginning March 21 are nearly all bipartisan and focus on the public health and prevention aspects of addressing the opioid crisis, Committee aides told reporters on a call this morning.

The proposals range from allowing the NIH more flexibility to focus research efforts on non-addictive pain medications to making it easier for doctors to obtain complete medical information for patients with substance use disorder.

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 Bipartisan Budget Act allocated for addressing the opioid epidemic. 

Right-to-Try

The House failed to pass “right to try” legislation on experimental drugs Tuesday evening after Democrats expressed safety concerns over how the measure would let patients bypass the Food and Drug Administration (FDA)

In a vote of 259-140, the bill fell short of the necessary two-thirds support to send it to the Senate. The House had voted for the measure under suspension of the rules. The chamber's Republicans are setting up their "right-to-try" drug bill for another vote this week — and this time they'll only need a simple majority for passage.

340B Drug Pricing Program

Last week, the Senate HELP Committee held a hearing on the 340B program. Senate HELP Committee Chairman Lamar Alexander (R-TN) called a hearing for Thursday, saying he will focus on gathering information from stakeholders. "Congress created this program to help some of the most vulnerable people in our country afford their medications to treat HIV, hepatitis C, diabetes or cancer," Alexander said in the hearing notice. "I am looking forward to hearing from many of those involved in how the program is working, and what steps, if any, the federal government should take to strengthen the program and ensure patients are receiving benefits."

Since the House Energy & Commerce Committee released its report in January that recommended greater oversight of the 340B program, the legislative and lobbying push has continued to mount for issues ranging from patient definition to a change in statute that would define congressional intent.

Administration Activities  

Affordable Care Act

The Centers for Medicare and Medicaid Services (CMS) responded to Idaho’s proposal to allow issuers to sell non- Affordable Care Act (ACA) compliant plans in its individual market. The letter states that issuers in Idaho must abide by ACA requirements and if Idaho is unable or unwilling to enforce the ACA’s requirements, CMS will step in to directly enforce them. However, CMS directed Idaho to consider encouraging short-term, limited duration plans (which do not have to be ACA compliant) once the federal rule potentially expanding these plans is finalized.

CDC Director

Robert Redfield, a professor of medicine at the University of Maryland School of Medicine, has emerged as the leading candidate to be CDC director, according to several public health sources. Dr. Redfield is a “longtime AIDS researcher who is well-respected for his clinical work but once took controversial positions on HIV testing. He has no apparent experience running a governmental public health agency.”

Anne Schuchat, MD (RADM, USPHS), who had been CDC's principal deputy director, has been serving as acting director of CDC.

Opioids

President Trump will announce his long-awaited opioid plan on his visit to New Hampshire today. The plan includes a mix of administration actions and initiatives that would require new funds or laws from Congress. The plan involves three major components, said White House counselor Kellyanne Conway: education and prevention; law enforcement and interdiction; and treatment and recovery efforts. We will keep you updated as further developments occur.

Other News

The International AIDS Society (IAS) has announced that San Francisco, California, in partnership with nearby Oakland, will host the 23rd International AIDS Conference (AIDS 2020). This is 30 years after the event was held there at the height of the epidemic in the United States. AIDS 2020 will take place on July 6-10, 2020 and is expected to bring together more than 15,000 participants from around the world. Democratic Leader Nancy Pelosi (D-CA-12) and Congresswoman Barbara Lee (D-CA-13) released a press release applauding the decision.

11 networks expressed deep concern over naming San Francisco & Oakland host cities for AIDS2020.

News Bulletin

Governor Cuomo Announces Statewide Expansion of Enhanced Rental Assistance Program To Increase Access To Affordable Housing For New Yorkers Living With HIV/AIDS

“Governor Andrew M. Cuomo today announced he is advancing a statewide expansion of the HIV/AIDS Services Administration rental assistance program for New Yorkers living with HIV/AIDS. Additionally, the Governor announced the nation's first state-level Hepatitis C comprehensive elimination strategy to end the Hepatitis C and HIV epidemics in New York State. The new effort aims to stop the Hepatitis C virus in its tracks by increasing access to medications that can cure Hepatitis C and expanding programs to connect New Yorkers in high-risk communities with wrap-around Hepatitis C prevention, screenings and treatment services.”

Use Of HIV-Prevention Drug Grows, But Lags Among Non-Whites

“Nationally, the number of PrEP users rose from 8,768 in 2012 to 77,120 in 2016 — an average annual increase of 73 percent in each of those four years, according to new data released by AIDSVu.org, an HIV website run jointly by Emory University’s Rollins School of Public Health and Gilead Sciences Inc., which manufactures the pill. Gilead told financial analysts in July 2017 that 136,000 people in the U.S. were taking PrEP, also known by its brand name, Truvada.”

Hepatitis C Drugs Save Lives, but Sick Prisoners Aren’t Getting Them

“Any national campaign to eliminate hepatitis C, an insidious virus that kills tens of thousands of Americans a year, would almost certainly involve prisons. One in seven state inmates are believed to be infected, and the regimented environment of a prison has its advantages when it comes to screening and treatment.”

Bill Gates: I'm going to tell Trump why foreign aid is important

"I’ll take his framework … and I’ll explain that even within that narrow framework where you don’t take into account things like saving lives in Africa and the pure humanitarian benefit, even without that, this is money well spent,” says Bill Gates.

How Isolation, Stigma and Shame Are Killing Black Women Living With HIV

“Now, in 2018, one might believe that Brown’s experiences are merely a thing of the past, but sadly, that’s not the case. Isolation, stigma and a lack of support are still haunting black women living with HIV/AIDS, especially in the South, according to a recent study, “Networks That Care: An Ethnographic Research Study of Women Living With HIV.” Most importantly, these factors play a role in whether or not HIV-positive women stay linked into lifesaving care.”

Milwaukee Leaders Ramp Up Free STD Testing After Discovery Of HIV, Syphilis Cluster

“Milwaukee Health Department officials, local health providers and nonprofits are reminding residents of free sexually transmitted disease testing available around the city. The push comes after the discovery of a cluster of 125 confirmed cases of HIV and syphilis.”

Resources

HIV Prevention with Health Departments

HIV Prevention in the South

New County Health Rankings Show Differences in Health and Opportunity by Place and Race

Webinar: Improving Adherence and Persistence among Adolescent PrEP Users

Funding Opportunities

Promoting Adolescent Health through School-Based HIV Prevention

CDC has issued the funding opportunity. "This new opportunity aims to improve the health and wellbeing of our nation's youth by working with education agencies and other organizations to reduce HIV, STD, teen pregnancy, and related risk behaviors among middle and high school students."