House Votes to Strip Billions in Health Care Funding
On Thursday, May 10, the House of Representatives passed the Sequester Reconciliation Act of 2012 (H.R. 5652). Championed by Budget Committee Chairman Paul Ryan and conservative House leadership, it would reduce the deficit on the backs of the nation’s poor and uninsured by reducing or eliminating billions in funding for health care and nutritional aid, while brazenly dismissing any tax increases on even the nation’s wealthiest citizens.
Among many troubling provisions, this legislation would eliminate funding to help states establish health insurance exchanges; eliminate increases in Medicaid funding for U.S. territories such as Puerto Rico, despite considerably higher rates of poverty; eliminate requirements that states maintain current Medicaid eligibility standards until 2014; abolish the Prevention and Public Health Fund; and reduce subsidies to assist low-income Americans to purchase health insurance.
While the legislation is likely dead in the Senate, it further highlights the appalling disregard House Republicans have shown for the health of America’s poor and vulnerable, including individuals living with HIV. NMAC will continue to work with its allies in Congress to protect both the Patient Protection and Affordable Care Act and HIV/AIDS funding, and update its constituents on any further attacks on these programs.
FDA Panels Consider In-Home HIV Test and Prevention Pill
As the House was voting to strip billions in health care funding, a panel of experts at the U.S. Food & Drug Administration (FDA) voted to recommend approval of the medication Truvada to prevent HIV infection – also known as pre-exposure prophylaxis (PrEP). Truvada, which contains two antivirals and is already widely used to treat HIV, has also been shown in studies to reduce the risk of HIV infection among individuals who are HIV-negative, when taken daily. While controversy continues to surround the use of PrEP as an effective intervention, a thorough examination of the research led the panel to recommend it by an overwhelming majority.
On Tuesday, May 15, another panel of experts at the FDA voted unanimously to recommend approval of the OraQuick In-Home HIV Test. NMAC submitted written comments to the panel urging them to approve the test, which would provide an important supplement to current HIV screening efforts by providing an accessible, relatively inexpensive device that can be used in the privacy of one’s own home. This is especially important for minority communities, where HIV stigma often prevents individuals from utilizing traditional testing services.
Recently, the Institute of Medicine (IOM) examined the extent to which current policies and practices present barriers to HIV testing. It concluded that minority populations are not only infected at a higher rate than their White counterparts, they shoulder a considerably higher percentage of undiagnosed HIV/AIDS cases. According to the Centers for Disease Control and Prevention, while the percentage of unrecognized HIV infection among Whites is 18.8, its 29.5 among Asians and Pacific Islanders, 25.8 among Americans Indians and Alaskan Natives, 22.2 among Blacks and African-Americans, and 21.6 in Latinos.
While the FDA is not required to follow the panels’ recommendations, it generally does. NMAC will continue to track the progress of both products and update its constituents as developments arise.
NMAC Urges CMS to Update Treatment Guidelines and Surveillance Methods
On May 7, NMAC submitted written comments to the Centers for Medicare & Medicaid Services (CMS) urging the agency to update its electronic health record (EHR) incentive program to reflect the revised treatment guidelines released by the U.S. Department of Health & Human Services in March, which recommended that all U.S. residents living with HIV be placed on antiretroviral therapy. The comments also urged the agency to continue tracking viral load data while removing the requirement that care providers submit a plan to achieve viral suppression in patients, arguing that it is unduly burdensome to have to document these plans through EHRs.
Additionally, NMAC urged CMS to include more nuanced racial and ethnic classifiers in its proposed Electronic Health Record incentive program. There are currently five categories for race and two for ethnicity. For culturally and linguistically diverse groups, such as Asian American subgroups, Native Hawaiians, and Pacific Islanders, and American Indians/Alaskan Natives, data collected using these standards has often been inadequate to identify significant health issues, inform policy, and provide for appropriate interventions. Expanded racial and ethnic categories are critical to improving the quality and caliber of collected data, as well as the identification and reduction of health disparities.