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APRIL 26, 2013
Presidential Advisory Council on HIV/AIDS Convenes for 51st Meeting to Discuss HIV and Affordable Care Act

HIV and the Patient Protection and Affordable Care Act (ACA) was the focus of the 51st meeting of the Presidential Advisory Council on HIV/AIDS (PACHA). The unique town hall-style format of the meeting allowed for interactive and informative discussions with guest speakers, panelists and PACHA members.

Some of the most pressing concerns that have emerged during the transition into full implementation of the ACA include the role of the Ryan White Program, Medicaid expansion and the functionality of state health insurance marketplaces (which will allow individuals to purchase insurance from qualified health plans, all of which must provide a core set of benefits, known as Essential Health Benefits). The first panel featured department of health officials from Massachusetts and Michigan who highlighted efforts in their own states to ensure continuity of care for people living with HIV/AIDS as they adapt to certain aspects of health care reform. Massachusetts, for example, has been living in a post-health care reform environment for years now, having already expanded Medicaid and enacted health care reform. However, it took many years to transition low-income HIV-positive individuals into the Medicaid system. H. Dawn Fukuda, Director of the Office of HIV/AIDS, Bureau of Infectious Disease at the Massachusetts Department of Public Health, warned that full implementation of ACA will be a long process requiring extensive outreach and communication with providers and HIV-positive individuals. She also stressed the need for the Ryan White Program to be as flexible as possible, which will allow it to adapt and provide the necessary supplemental support to coverage provided by the ACA and Medicaid expansion. The second panel provided detailed information regarding state health insurance marketplaces and Medicaid expansion, including those Essential Health Benefits that must be provided by qualified health plans.

The final panel featured community and stakeholder input including Center for Budget and Policy Priorities Vice President for Health Policy, Judy Solomon. Solomon emphasized it was not likely that the new electronic Medicaid system for determining Medicaid eligibility vs. health insurance marketplaces would be up and running. As a result, many decisions about where and how to enroll would continue to be made by hand. Solomon suggested that HIV organizations and advocates should become involved with eligibility decisions at the ground level. She urged the community to be engaged, review multiple sources of information and establish expertise in practical ways, including education about the new healthcare system, monitoring the system and advocating for change. Andrew Baskin, National Medical Director for Aetna Insurance, noted Aetna had many tools that might be particularly helpful in getting people to adhere to medical care. Dr. Michael Saag of the University of Alabama at Birmingham provided new data about the financing of a Ryan White Part C funded clinic and showed how funding shortfalls were at least in part a result of funding disparities even within the same city. Finally, Jeff Crowley from Georgetown Law School spoke about the need to make changes in the next few years as coverage needs and gaps emerged with the implementation of the ACA.

This interactive town hall-style meeting allowed the community to engage with officials working directly on ACA implementation and helped provide valuable information regarding HIV-positive individuals and possible issues that may arise as the major ACA transition begins. AIDS United will continue to update you on issues associated with ACA implementation as more information becomes available.

Secretary Sebelius Testifies Before Senate and House Subcommittees

On two successive days this week, Kathleen Sebelius, Secretary of the Department of Health and Human Services, testified in front of the Senate and House Labor, Health and Human Services and Education subcommittees about the Administration’s Fiscal Year (FY) 2014 budget. In both cases she submitted written testimony that specifically mentioned the Ryan White Program, stating, “The Budget includes $2.4 billion for the Ryan White HIV/AIDS program to continue its critical role in support of patients across the HIV/AIDS continuum, by linking patients to care, prescribing and improving adherence to antiretroviral medicine, and achieving viral suppression. Included in this total is $943 million for the AIDS Drug Assistance Program (ADAP), an increase of $10 million over FY 2012 to provide life-saving and life-extending medications to 218,900 individuals. This investment will allow ADAP to serve an additional 1,600 people living with HIV/AIDS relative to the estimated number of clients served in FY 2012.” The testimony additionally noted the Administration’s request for $471 million in new funds for research through the National Institutes of Health.

In the Senate hearing, Senator Tom Harkin (D-IA), the Chair of the Subcommittee, delivered a fiery speech to the Secretary about the Administration’s trade of funds from the Prevention and Public Health Fund (a program that Senator Harkin has long championed) to pay for outreach and other activities implementing health insurance marketplaces under the Affordable Care Act. The Senator backed up his words by placing a hold on the nomination of Marilyn Tavenner as the administrator of the Center for Medicare and Medicaid Services (CMS).

Both hearings included a particular focus on the upcoming implementation of the Affordable Care Act. Senators and Representatives in both hearings asked about recent Arkansas legislation that would allow expansion of Medicaid to go forward in the state by providing coverage through private insurance providers on the state’s health insurance marketplace. The premiums would be paid for using federal Medicaid expansion funds. The Secretary said that the department was awaiting a specific plan but that she had been in contact with Governor Mike Beebe (R) and looked forward to being able to review specific details.

The Senate Testimony can be found here; for the Senate video, click here.

The House Testimony can be found here; for the House video, click here.

CDC Releases Surveillance Report on Social Determinants of Health

This week the Centers for Disease Control and Prevention (CDC) released an HIV Surveillance Supplemental Report that focuses on census tract-level social determinants of health (SDH) among adults diagnosed with HIV infection. The term “social determinants of health” refers to the overlapping social structures and economic systems (e.g., social environment, physical environment, health services, and structural and societal factors) that are responsible for most health inequities. Addressing the SDH that adversely affect health outcomes may help advance efforts to reduce disparities in HIV diagnosis rates between populations. The report, the first of its kind, covers the time period 2005-2009 in 18 jurisdictions. The areas are 13 states, Washington, D.C.; Puerto Rico; Los Angeles County; New York City; and San Francisco. Among the states are New York, Illinois (but not Chicago), Minnesota, Virginia, Washington, and Wisconsin.

The report’s data do not represent all of the diagnosed adult HIV cases during the time period in the 18 areas. The data are only from cases where an individual’s residence in a census tract was known and census-tract level data on social determinants was available for the full time period. The SDH indicators included in the report are federal poverty status, education level, median household income, and employment status.

The full report can be found here.

Readers of the report are urged to read the “Commentary” and “Technical Notes” sections to understand better the limitations of the data.

State Healthcare Access Research Project Massachusetts Hepatitis C Report Released

This week, the Center for Health Law and Policy Innovation of Harvard Law School, the Treatment Access Expansion Project (TAEP), and the Massachusetts Viral Hepatitis Coalition (MVHC) released the State Healthcare Access Research Project (SHARP) Massachusetts Hepatitis C (HCV) Report. The report identifies: (1) challenges to access to care and treatment faced by people living with or at risk for hepatitis C virus in Massachusetts, (2) successful policies that facilitate access to care, and (3) opportunities for improving access to prevention, testing, care and treatment for persons living with or at risk for HCV.

SHARP examines access to care for people living with either HCV or HIV and develops state-level research reports through focus groups and one-on-one interviews with people living with HCV or HIV/AIDS, community-based services providers, healthcare providers, faith leaders, state and federal government officials, and other researchers and advocates. The report is an important tool in understanding how to transition more effectively into full implementation of the Affordable Care Act.

The Executive Summary of the report is availablehere. To read the Full Report, click here.

White House Releases National Drug Control Strategy, Supports Lifting of Ban on Use of Federal Funds for Syringe Exchange

This week the Obama Administration released its National Drug Control Strategy for reducing drug use and its consequences in the United States. “My Administration remains committed to a balanced public health and public safety approach to drug policy,” the President says in the opening letter to the Strategy. “This approach is based on science, not ideology—and scientific research suggests that we have made real progress.”

One of the Strategy’s key objectives is to “Inform Public Health Systems on Implementation of Needle Exchange Programs.” The Strategy supports of the lifting of the ban on the use of federal funds for syringe services programs, which research shows to be effective at reducing drug abuse and reducing transmission of HIV and other bloodborne diseases. To read the National Drug Control Strategy, click here.

Human Rights Campaign and GLMA: Health Professionals Advancing Equality Warn of Bacterial Meningitis Outbreak

The recent death of a gay man in Los Angeles due to bacterial meningitis has the Human Rights Campaign (HRC) and GLMA: Health Professionals Advancing Equality teaming up to provide information about the disease.

Bacterial meningitis occurs most often among infants less than a year old; since 2010, however, a “cluster” of cases has been reported among gay and bisexual men in New York City, resulting in seven deaths. As a result, in March of this year, New York City health officials recommended vaccination to prevent this type of meningitis for HIV-positive men and/or those men “who regularly have close or intimate contact with other men.”

Four cases of bacterial meningitis have been reported among gay men in Los Angeles in recent months; while Los Angeles health officials have not deemed the cases an outbreak, they have warned the public about the most recent case.

The New York City health department has issued this factsheet for those men seeking more detailed information about bacterial meningitis, including symptoms and frequently asked questions.

For more news on this subject, click here to read a recent NBC news article.

Click here to read the information provided by HRC and GLMA: Health Professionals Advancing Equality.


AIDS United Needs Your Help!

AIDS United wants to hear YOUR story about the impacts of sequestration and the $1.5 trillion in cuts already enacted by Congress! We are currently compiling stories about the real effects that drastic budget cuts and the sequester have had on people living with and affected by HIV/AIDS. Members of Congress need to know that the decisions they make have real, drastic impacts! Please use the following questions to frame your story:

  • What has life been like for you/your organization/your community before these budget cuts?
  • What are the indicators that sequestration may already be having an effect on you/your organization/your community?
  • What will the results be for you/your organization/your community if sequestration is fully realized?
  • What will you/your organization/your community do if the drastic budget cuts enacted in the sequester are not replaced with a more responsible and balanced solution?

You can send your stories to policy@aidsunited.org. Please keep stories to 500 words, and include a headshot if possible!

Town Hall for People Living with HIV/AIDS

The Federal AIDS Policy Partnership (FAPP) and the U.S. People Living with HIV Caucus (U.S. PLHIV Caucus) is hosting a forum to review mechanisms for PLHIV to offer input into federal policy decision-making and discuss ongoing engagement of individuals living with HIV or AIDS following the closure of the National Association of People with AIDS (NAPWA) at the end of last year. Leadership from FAPP and the U.S. PLHIV Caucus will be present to hear both your concerns and your recommendations. A FAPP social event will immediately follow the town hall and provide further opportunity to network.

The town hall will take place Tuesday, May 14, 2013, from 5:00pm – 7:00pm at the Metropolitan Community Church of Washington, D.C., located at 472 Ridge Street NW, Washington, D.C., 20001 (2 blocks from the Mt. Vernon Square Metro on the Green and Yellow Lines). Please contact Kali Lindsey ( klindsey@nmac.org) for more details.

2013 Johnson & Johnson /UCLA Healthcare Executive Program Now Accepting Applications

The UCLA/Johnson & Johnson Health Care Executive Program (HCEP) is a management and leadership development program for executive directors and leaders of Community Health Centers (CHCs) and AIDS Service Organizations (ASOs). The HCEP is especially designed and valuable for ASOs and CHCs that need to prepare for and adapt to the changes in service delivery and healthcare financing related to the Affordable Care Act (ACA) as well as how the ACA will impact the future of traditional AIDS service funding mechanism like the Ryan White Care Act. The program will take place July 7-17, 2013, and the deadline to submit an application is 5:00pm PT on May 15, 2013.

You can learn more about the program, upcoming informational calls, and application directions by clicking here.

2013 National Transgender Health Summit

Cosponsored by the UCSF Center of Excellence for Transgender Health and the World Professional Association for Transgender Health, the National Transgender Health Summit aims to provide a multidisciplinary program presenting cutting edge research in transgender health and evidence-based clinical training curricula for healthcare providers of all backgrounds.

The National Transgender Health Summit will take place May 17-18, 2013, at the Oakland Marriott City Center in Oakland, California, and will feature programming by world-renowned experts in the field of transgender health on a variety of tracks. For more information, email transhealthsummit@ucsf.edu.

To register, click here.

Centers for Disease Control and Prevention (CDC) Launches New National Hepatitis Testing Day Website

May 19, 2013, is the second national Hepatitis Testing Day, and in order to support and promote the events and activities surrounding the day, the CDC has launched a new national Hepatitis Testing Day website. The new site allows people to search for Hepatitis Testing Day events near them during the month of May, which is also Hepatitis Awareness Month.

Hepatitis Testing Day is a day for people at risk to be tested, and for health care providers to educate patients about chronic viral hepatitis and testing. Millions of Americans have chronic hepatitis; most of them do not know they are infected.

You can read more about the initiative here.

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