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OCTOBER 25, 2013
Budget Bonanza!

Late on Wednesday, October 16, lawmakers on Capitol Hill reached an agreement to end the government shutdown and avoid the catastrophic consequence of the United States defaulting on its financial obligations. This deal funds the government through January 15 and suspends the debt ceiling (limit) until February 7. Also as a part of this fiscal deal, a bipartisan and bicameral committee—the Budget Conference Committee—was created with the charge of reconciling the House and Senate Fiscal Year 14 (FY14) budget resolutions (H Con Res 25, S Con Res 8) and possibly FY15 as well. The agreement requires the conference committee members to create such a proposal by December 13.

The conference committee includes seven Members of the House of Representatives and 22 Senators—the entirety of the Senate Budget Committee. Because of the imbalance between the number of House and Senate Members, any proposal put forward by the committee must have first received a majority of votes from the House conference members and Senate conference members. The House Members of the Budget Conference Committee are as follows:

- Paul Ryan (R-WS) Chairman of the House Budget Committee

- Diane Black (R-TN) Member of the House Budget Committee and House Ways and Means Committee

- Tom Cole (R-OK) Member of the House Budget Committee, Appropriations Committee, and Rules Committee.

- Tom Price (R-GA) Member of the House Budget Committee, Education and Workforce Committee and Ways and Means Committee

- Chris Van Hollen (D-MD) Ranking Member of the House Budget Committee

- James Clyburn (D-SC) Assistant Minority Leader

- Nita M. Lowey (D-NY) Ranking Member of Appropriations Committee

Rep. Ryan and Sen. Murray will serve as co-chairs of the conference committee.

It is important to note that of the seven House Members of the Committee, three voted against the fiscal deal on October 16, a telling sign of these individuals’ budgetary priorities. Those Members who voted against were Ryan, Black and Price. As stated earlier, the entire Senate Budget Committee has been appointed as conferees. Some key members are:

- Patty Murray (D-WA) Chairwoman of Senate Budget Committee, member of Appropriations, Health Education labor & Pensions, Rules & Administration, and Veterans’ Affairs Committees

- Debbie Stabenow (D-MI) Chairwoman of Senate Agricultural, Nutrition & Forestry Committee, member of Senate Budget, Energy & Natural Resources, and Finance Committees

- Tammy Baldwin (D-WS)- member of Senate Budget, Energy & Natural Resources, Health Education Labor & Pensions, Homeland Security & Governmental Affairs, and Special Aging Committees.

- Jeff Sessions (R-AL)-Ranking member Budget Committee, member of Senate Armed Services, Environment & Public Works, and Judiciary Committees

- Lindsey Graham (R-SC)- member of Senate Appropriations, Armed Services, Budget, and Judiciary Committees

- Rob Portman (R-OH)- Deputy Whip of Senate Republican party member of Senate Budget, Energy & Natural Resources, Finance, Homeland Security & Governmental Affairs Committees.

Of the 22 Senators appointed to the conference committee, only six voted against the fiscal deal on October 16. Those members were Jeff Sessions (R-AL), Chuck Grassley (R-IA), Mike Enzi (R-WY), Mike Crapo (R-ID), Ron Johnson (R-WS) and Pat Toomey (R-PA). For a full list of the Budget Conference Committee members, click here

When the conference committee was formed last week, there was speculation in the media on the committee recommending a "grand bargain" on long-term deficit reduction. Toward the end of this week, the leadership of the committee clearly sought to lower expectations as to the scope of any recommendations. On Thursday, the two co-chairs focused on finding common ground to replace sequestration in FY 2014 and perhaps in later years. Also on Thursday, Senate Majority Leader Harry Reid (D-NV) dismissed speculation about a grand bargain "happy talk." Ending sequestration is extremely important. The sequester has already significantly impacted critical HIV prevention, testing and access to care programs, many of which will not withstand a second round of cuts. It is also imperative that other critical services for low-income individuals, such as funding for ACA implementation, Medicaid, Medicare, SNAP and other entitlement programs, are protected from drastic structural changes or spending cuts.

Obama Addresses ACA's Website Woes

President Obama addressed concerns on Monday about the slow rollout of the healthcare.gov website implementing the Affordable Care Act marketplaces. In his speech he acknowledged the problems that some users have been experiencing, but stressed that the Affordable Care Act is “not just a website”, and that the benefits that have already taken effect for millions of Americans. For instance, young people already are able to stay covered by their parents’ plans until they are 26. According to President Obama, Seniors have saved billions of dollars thanks to deeper discounts on prescriptions. Preventive care like birth control has been made free through employer-provided insurance. And even for those experiencing trouble signing up in the marketplaces, the President emphasized that it is not a problem with the law, but with the “massive demand for it,” as the website has already been visited nearly 20 million times. He urged people to keep trying, assured them that they would still have months of the enrollment period to pick a plan, and reaffirmed that the problems are being fixed.

With the shutdown over, however, Republicans have jumped on the website problems to criticize the Act. Senate Minority Leader Mitch McConnell (R – KY) compared a visit to the website to a trip to the Department of Motor Vehicles , suggesting that "it's time for the President to consider delaying this rushed effort." House Speaker John Boehner (R – OH) asserted that “the President doesn’t grasp the scale of the law’s failures.” Despite continued Republican objection to the law, two polls released this week found that people who have used the exchanges like them, that 46% of Americans approve of the law, and that even many of those who disapprove of the law still want to see it implemented. According to the poll by the Washington Post and ABC News, a full two-thirds of the country wants the Affordable Care Act to be implemented.

In the meantime, AIDS United and many HIV/AIDS community organizations continue to suggest that people with HIV wait to enroll until more details about marketplace policies such as the coverage of needed anti-retroviral or other drugs or whether a person’s provider is in a policy’s network become available. For more information, see this blog post written by John Peller, Vice President of Policy at the AIDS Foundation of Chicago, a member of our Public Policy Committee.

There have been two new ACA-related developments this week. First, the Controlling Board of Ohio agreed to expand Ohio’s Medicaid program which will provide health coverage to over 275,000 low income people in the state. Ohio becomes the 25th state plus the District of Columbia to expand according to the Kaiser Family Foundation. In addition, the Obama administration announced Wednesday night that Americans would have an extra six weeks to sign up for health insurance through the new marketplaces before the mandate kicks in and they have to pay a penalty. This is unrelated, the administration says, to website problems, but is a grace period to clear up confusion.

Struggles from Sequestration 

To better illustrate the effects and significant impact that sequestration has had on the HIV/AIDS community, AIDS United will bring you stories from our community-based grantees and Public Policy Committee (PPC) member organizations that provide life-saving HIV-focused services on the front lines. These organizations and individuals are feeling the brunt of budget cuts in their communities. This is the first in a multi-part series entitled “Struggles from Sequestration.”

AIDS Resource Center Ohio (ARC Ohio) is a client-focused, community-based provider of specialized HIV prevention, testing, advocacy, pharmacy, and support services. ARC Ohio receives multiple sources of funding from the federal government; including a $330K Mpowerment grant funded by the Centers for Disease Control and Prevention (CDC) focused on MSM of color, ages 13-29, and Ryan White Program funding from Parts A, B, and C totaling more than $4.5 million. The plethora of spending cuts from Capitol Hill has affected ARC Ohio’s staff in numerous ways. While the organization has been fortunate enough to not lay off any employees, several vacant positions have not been filled due to funding restrictions and budget uncertainty. The cuts have been felt most significantly in prevention, but the uncertainty has prohibited the organization from hiring additional workers throughout its departments. The number of average clients per case manager has nearly doubled, from 60 to 110, for Ryan White Part B in Ohio. The standard case manager workload in the state is 50.

These cuts have had adverse effects on ARC Ohio’s ability to provide timely essential services to their clients. Since the cuts have been enacted, waiting lists for housing have grown around the state, and ARC’s capacity to administer HIV tests, which are critical to identifying those who are HIV positive and linking them to care and treatment, has been significantly curbed.

According to Tyler TerMeer, Director of the Ohio AIDS Coalition, ARC Ohio’s policy and advocacy division, if these cuts were to continue, “ARC Ohio would have to make some very strategic decisions in 2014 about the scope of prevention services we are able to offer across the state.”

To learn more about AIDS Resource Center Ohio, click here.

The Right to Comprehensive Sex Ed

Comprehensive sex education should be considered a right, not a privilege, according to speakers at a briefing hosted by the Secular Coalition for America for House and Senate Congressional staffers. This past Monday, Marty Klein, PhD, a sex therapist, and Phil Harvey, an entrepreneur and philanthropist, presented a briefing titled “Giving Kids What We Didn’t Have” on the importance of comprehensive sex education and the harm caused by abstinence-only education hosted by the Secular Coalition for America.

As puberty hits children earlier and the age of first marriage rises, there is an increasing gap between the two, which Dr. Klein calls the “abstinence expectation zone.” This zone makes achieving the ideal of abstinence encouraged by health programs based on religious ideals less likely. Teenagers and young adults who receive abstinence-only education are likely to go without crucial knowledge about how to prevent STIs, and pregnancy, according to the speakers. They also are more likely to associate healthy sexual activity with feelings of shame or guilt.

In contrast, Dr. Klein said statistical analysis of sex education programs nation-wide shows that comprehensive sex education is more likely to lead to better public health outcomes in teens and young adults, including delayed sex, reduced partners, and increased contraceptive use. Abstinence-only programs which include less information (or even misinformation), lead to worse outcomes in each of these categories. Both speakers agreed that religious institutions and parents should welcome comprehensive sex education rather than advocating for abstinence-only programs. These programs give their children the information they need to implement the morals they learn at home, says Dr. Klein, “Teaching kids to wear seatbelts does not encourage reckless driving.”

Unfortunately, current law requires any sex education program receiving federal funds to include statements that only sex within a monogamous marriage is “good,” and that sex outside of marriage is harmful. To remedy this, both speakers support the Real Education for Healthy Youth Act of 2013 ( H.R. 725, S. 372), which would require sex education curriculums to be medically accurate, proven effective, and accepting of the LGBT community. AIDS United, which has long supported the REAL Act, strongly agrees.


CDC Issues Report on Applying Social Determinants of Health to Publc Health Practice.

This week the CDC announced a publication of a special Public Health Reports (PHR) supplement entitled Applying Social Determinants of Health to Public Health Practice. It focuses on a comprehensive public health approach that considers social determinants of health (SDH) to address health inequities and improve health outcomes. The articles featured in the supplement provide perspective on the application of SDH, and describe experiences integrating and implementing SDH into public health programs and research.

Families USA Announces new Affordable Care Act Resource Center!

Families USA is pleased to announce new resources for enrollment assisters, located on their online Navigator and Assister Resource Center. These resources have been developed as part of a larger project that Families USA - a national, no-for-profit health coverage advocay organization - is launching to support the work of Affordable Care Act navigators and enrollment assisters. The consumer-friendly materials can be found here.  

Syringe Access Fund Releases Eighth Grant Cycle Request for Proposals

The Syringe Access Fund is a national grantmaking initiative that supports service providers and policy projects to reduce the risk of HIV, hepatitis C and other blood-borne pathogens among people who inject drugs and their sexual partners through expanded access to sterile syringes. Established in 2004, the Syringe Access Fund has been a collaborative effort of various private foundations, corporations and public charities that together have granted almost $10.4 million.  Currently, leading partners include the Elton John AIDS Foundation, Irene Diamond Fund, Levi Strauss Foundation, Open Society Foundation, and AIDS United.  The Round Eight Grant Cycle Request for Proposals has been released, and grantseekers can click here for more information on applying for a grant.  

Internship and Fellowship Opportunity with amfAR

amfAR, The Foundation for AIDS Research is now accepting applications for The Allan Rosenfield Internship and Fellowship Program. This program is established for exceptional college undergraduates and graduates who aspire to become leaders in public health and in the fight against the HIV/AIDS epidemic. This program is based in Washington, DC. For more information visit amfAR’s website or email policyfellowship@amfar.org.

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