Policy Updates: Hill Happenings and Administration Activities

By Mike Weir December 3, 2018

Hill Happenings

Congressional Leadership

Senators Mitch McConnell (R-KY) and Chuck Schumer (D-NY) were reelected to serve as their respective party leaders in the Senate for the 116th Congress. Steny Hoyer (D-MD-1) was elected to serve as House minority leader in the next Congress. House Democrats voted 203-32 to nominate Nancy Pelosi (D-CA-12) as the next speaker. The full House will vote January 3 to elect a new speaker.

The Senate Leadership for the 116th Congress by party:

Democrats

Democratic Whip: Senator Dick Durbin (IL); Assistant Democratic Leader: Senator Patty Murray (WA); Chair of the Democratic Policy and Communications Committee: Senator Debbie Stabenow (MI); Vice Chair of the Conference: Senator Elizabeth Warren (MA); Vice Chair of the Conference: Senator Mark Warner (VA); Chair of Steering Committee: Senator Amy Klobuchar (MN); Chair of Outreach: Senator Bernie Sanders (VT): Vice Chair of the Democratic Policy and Communications Committee: Senator Joe Manchin (WV); and Senate Democratic Conference Secretary: Senator Tammy Baldwin (WI)

Republicans:

Republican Whip: Senator John Thune (SD); Conference Chair: Senator John Barrasso (WY); Vice Chair: Senator Joni Ernst (IA); Campaign Committee Chair: Senator Todd Young (IN); Policy Committee Chair: Senator Roy Blunt (MO)

The House Leadership for the 116th Congress by party:

Democrats:

Majority Leader: Steny Hoyer (MD-1); Democratic Whip: Jim Clyburn (SC-6); Assistant Democratic Leader: Ben Ray Lujan (NM-3); Caucus Chairman: Hakeem Jefferies (NY-8)

Republicans:

Minority Leader: Kevin McCarthy (CA-23); Republican Whip: Steve Scalise (LA-1); Conference Chair: Liz Cheney (WY-At Large); Policy Committee Chair Gary Palmer (AL-6); Conference Vice Chair Mark Walker (NC-6); Conference Secretary Jason Smith (MO-8)

Committee Assignments

Congressional leaders will spend the coming weeks giving committee assignments to members. With Democrats losing Senate seats in the midterms, Minority Leader Chuck Schumer (D-NY) has to renegotiate committee assignments with Republicans before the 116th Congress begins in January. Since Democrats now control the House, they will have to assign and select leadership for various committees of interest. Many of the committees impacting HIV and hepatitis funding and public health programs will see changes due to retirements and losses.

House Appropriations Committee:

Ranking Member – Kay Granger (R-TX-12)

Congressional Black Caucus

Members of the Congressional Black Caucus (CBC) elected Congresswoman Karen Bass (D-CA-37) to lead them in the 116th Congress. Bass, who currently serves as the caucus’s second vice chair, replaces Congressman Cedric L. Richmond (D-LA-2).

Election Results

As a result of the 2018 elections, Democrats now control the House and Republicans have expanded their Senate majority. Currently in the House, Democrats have 234 seats to Republicans 199; there are still two undecided races. In the Senate, Republicans gained two seats, bringing their majority to have 53 seats to Democrats 47. 

PEPFAR

The Senate passed the PEPFAR Stewardship and Oversight Act, H.R. 6651— PEPFAR reauthorization legislation. The legislation reauthorizes the program for five years. The House has previously passed the bill on November 13.  It is expected that President Trump will sign the legislation soon. 

Health Equity and Accountability Act

On November 27, Senator Mazie Hirano (D-HI) 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. In May, Congresswoman Barbara Lee (D-CA-13) introduced the House companion bill (HR-5942). 

Administration Activities

World AIDS Day

December 1 was the 30th World AIDS Day (WAD). The Centers for Disease Control and Prevention (CDC) provided free tools in the WAD Resource Center to help in supporting awareness activities and testing events. 

Vice President Pence provided remarks at a White House event honoring WAD. President Trump issued a Presidential Proclamation on World AIDS Day, 2018. The HHS Secretary Azar released also statement observing WAD.  

The Act Now End AIDS coalition, in concert with AIDS United, released a policy paper – "Ending the HIV Epidemic in the United States: A Roadmap for Federal Action."  The coalition also released an Executive Summary which be used as the basis of Hill advocacy for the Roadmap. NASTAD is an original signer of the document and has been involved in its development.

340B Rule

The Department of Health and Human Services (HHS) released a long-delayed rule that will penalize drug makers for overcharging providers in the 340B drug discount program. The new rule goes into effect on January 1, 2019. NASTAD has begun reviewing the finalized rule and will provide additional details in the coming weeks. 

USPSTF Recommendation

The U.S. Preventive Services Task Force (USPSTF) issued a Draft Recommendation Statement for pre-exposure prophylaxis (PrEP), with a proposed ‘A’ grade for “persons at high risk of HIV acquisition. ”The opportunity for public comment on USPSTF’s Draft Recommendation Statement expires on December 26, 2018 at 8:00 PM EST. 

USPSTF also released a Draft Research Plan for Screening for Hepatitis B in Nonpregnant Adolescents and Adults. The comment period is open from today, November 29, 2018 through January 2, 2019.

NASTAD is preparing comments for both drafts and encourages members and partners to submit comments of their own.

National HIV/AIDS Strategy and National Viral Hepatitis Action Plan Update

The HHS Office of HIV/AIDS and Infectious Disease Policy (OHAIDP) announced it will begin engaging with community partners to update the National HIV/AIDS Strategy (NHAS) and National Viral Hepatitis Action Plan. As part of their community engagement, OHAIDP anticipates to host listening sessions in the Spring of 2019. OHAIDP expects the updates to be released in Spring/Summer 2020. 

Medicaid Waiver Decision 

The Trump administration has reapproved a Kentucky Medicaid waiver which imposes work requirements on some enrollees. The HIV Health Care Access Working Group sent a letter to the Centers for Medicare and Medicaid Services (CMS) urging CMS to oppose the Kentucky request.

Medicare Part D

CMS issued a proposed rule that would give Medicare Part D and Medicare Advantage plans additional options to exclude the six protected classes from their formularies.

recent study conducted by Avalere Health found that Part D plans already have plenty of tools to encourage use of lower-cost drugs in the protected classes.The study found “that Part D benefit designs are steering patients to cheaper drugs. More than 90% of prescriptions in the protected classes are for lower cost generics, even when accounting for the fact that nearly all HIV drugs are branded medicines.”

2019 Open Enrollment

Open enrollment is now open throughout the country. Enrollment on the HealthCare.gov platform during the first three weeks of plan selections have lagged 9.2% behind the rate during the same period last year. The Centers for Medicare and Medicaid Services (CMS) announced Healthcare.gov now has 2019 plan data available for window shopping which allows consumers to look at plans without logging in, creating an account, or filling out the official application. 

Job Opportunities

Disease Intervention Specialist– Alaska

The Alaska Department of Health and Social Services is hiring for a Disease Investigation Specialist I within their Division of Public Health, Section of Epidemiology, HIV/STD Program.

DExIS Project Coordinator – Philadelphia

The Philadelphia Department of Public Health is hiring for a DExIS Project Coordinator within their AIDS Activities Coordinating Office.

Upcoming Conferences

2019 National HIV Prevention Conference

The 2019 National HIV Prevention Conference will be held March 18-21, 2019 in Atlanta, Georgia. Check out the updated website for more information about tracks and to view the tentative conference schedule. 

2019 HIV Diagnostics Conference

The 2019 HIV Diagnostics Conference will be held in Atlanta on March 25-28, 2019. The conference will address advances in diagnostic testing, and strategies for using test technologies in public health programs and clinical practice. The conference program this year expands beyond HIV testing, and incorporates STI and HCV testing technologies and strategies, with an emphasis on integrating testing programmatically. As with past conferences, there will be a mix of oral presentations, panel discussions, and poster sessions. We strongly encourage health department HIV, HCV, and STI testing program managers and other staff consider submitting an abstract, attending the conference.  

Resources

NASTAD released a map detailing jurisdictions who have developed Ending the Epidemic plans. These plans are dynamic and will be updated as progress continues.

NASTAD released a Private Insurance State Policy Tracker. The tool tracks state action in the following areas: 1332 waivers, individual mandates, short-term limited duration insurance protections, bans on transitional policies, extended Open Enrollment period, and Essential Health Benefits modifications.In addition to this new Private Insurance State Policy Tracker, NASTAD continues to update our Medicaid Waiver Map and two Medicaid fact sheets: Medicaid 1115 Waivers: Considerations for HIV and Hepatitis Programs and Medicaid 1115 Waivers: Exemptions for People Living with HIV and Hepatitis.

NASTAD recently released PrEPcost.org. PrEPcost.org is an online tool that will help PrEP navigators and their clients evaluate the cost and coverage for PrEP across on- and off-Marketplace health plans.

AIDS United and Project Inform released a report examining current efforts to bring safer consumption spaces to the United States.

The O’Neill Institute for National and Global Health Law at Georgetown Law released two policy briefs: Big Ideas: Leveraging the Ryan White HIV/AIDS Program to Make Rapid Start of HIV Antiretroviral Therapy Standard Practice and Big Ideas: State and Local ‘End the Epidemic’ Plans Can Drive HIV Progress.

Funders Concerned About AIDS (FCAA) released its 16thannual Philanthropic Support to Address HIV/AIDS report.FCAA reports that HIV/AIDS philanthropic disbursements decreased by 5%, or $37 million, in 2017.

News Bulletin

Overshadowed By Opioids, Meth Is Back And Hospitalizations Surge

“The number of people hospitalized because of amphetamine use is skyrocketing in the United States, but the resurgence of the drug largely has been overshadowed by the nation’s intense focus on opioids. Amphetamine-related hospitalizations jumped by about 245 percent from 2008 to 2015, according to a recent study in the Journal of the American Medical Association. That dwarfs the rise in hospitalizations from other drugs, such as opioids, which were up by about 46 percent. The most significant increases were in Western states.”

Task Force Calls for Offering PrEP to All at High Risk for H.I.V.

“An influential government task force has drafted a recommendation that would for the first time urge doctors to offer a daily prophylactic pill to patients who are at risk for contracting H.I.V. The recommendation would include all men and women whose sexual behavior, sex partners or drug use place them at high risk of contracting the virus that causes AIDS.”

Everyone at high risk of HIV should be offered preventive medication, panel says

“An influential panel of medical experts recommended for the first time Tuesday that physicians offer preventive medication to anyone at high risk of acquiring HIV.

The U.S. Preventive Services Task Force estimated that 1.2 million people are eligible for the daily drug regimen, which is very effective at preventing HIV infection, but that only 78,360 took the medication in 2016. About 40,000 people were newly diagnosed with HIV that year.”

5,000 inmates with hepatitis C sued Pa. prisons. Now, they’re on their way to getting treatment

“Now, through a legal settlement filed for approval Monday in federal court for the Eastern District of Pennsylvania, approximately 5,000 incarcerated Pennsylvanians who have hepatitis C would also have access to direct-acting antiviral drugs, which are effective in about 95 percent of cases.”

Meet the 'radical gay doctor' behind NYC's falling HIV rate

“Daskalakis still sees patients, as he has since the late 1990s, but today he’s just moonlighting as a clinician. The infectious disease specialist squeezes his patients in around the busy schedule of his main job: deputy commissioner for the Division of Disease Control at the New York City Department of Health and Mental Hygiene, one of the world’s largest public health agencies.”