In this edition of Policy Watch: NASTAD’s Top 10 Policy Issues to Watch in 2013

Policy Watch

Volume 23, February 14, 2013
Policy Watch is a newsletter for state and territorial health department staff that provides updates, analysis, and highlights on the impact of national politics on HIV and viral hepatitis programs. Please visit NASTAD’s website at www.NASTAD.org for more information or contact Oscar Mairena or Emily McCloskey.

NASTAD’s Top 10 Policy Issues to Watch in 2013
 
With the start of a new year, a new Congress, and a new presidential term, NASTAD has identified ten policy-related issues to watch in 2013 (not in any particular order):
  1. The 113th: A Congress of Firsts
  2. Obama 2.0: President Obama’s Second Term
  3. The Fiscal Cliff and Budget Distress
  4. Reauthorizations: Ryan White and PEPFAR
  5. Getting to Zero: Advancing the Response Among Gay Men
  6. Obamacare: Preparing for 2014 Implementation
  7. HIV and the Law: Decriminalization and Modernization
  8. Testing: HIV, HBV, HCV and the US Preventive Services Task Force
  9. Viral Hepatitis Action Plan: What’s Next?
  10. Ending the Epidemics: Cure Research and the Medical Pipeline


1. The 113th: A Congress of Firsts

The 113th Congress has a record-high number of women, people of color and out LGBT Members, including the first LGBT Senator and the first LGBT person of color in the House. The new Congress is also the most inexperienced in decades with upward of 155 members having served less than four years in government. Following the loss of Senator Daniel Inouye (D-HI), former chairman of the Committee on Appropriations, committees and subcommittees in the Senate saw a number of leadership changes. In the House, the Labor-HHS Appropriations Subcommittee will also have a new Chairman. See here for a list of committee changes in the House and the Senate, particularly changes in your Congressional delegation.

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2. Obama 2.0: President Obama’s Second Term

In his first term, President Obama showed a commitment to fighting the HIV epidemic at home and abroad, with the release of the National HIV/AIDS Strategy and Implementation Plan, and the PEPFAR Blueprint: Creating An AIDS-free Generation. Although the National HIV/AIDS Strategy prioritizes ending stigma and discrimination, health inequities persist among gay men/MSM, transgender individuals, communities of color, women, youth and people who inject drugs. However, President Obama’s inauguration speech signaled that his second term will have a much more aggressive stance on many social justice issues intrinsically linked to HIV and viral hepatitis. What will his second term bring to HIV and viral hepatitis prevention, care, and treatment, and specifically, the continued implementation of the NHAS? In particular, key objectives of ending stigma and discrimination, and the fourth goal around federal coordination and reducing reporting requirements for HIV services grantees require heavy lifting.

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3. The Fiscal Cliff and Budget Distress

Automatic spending cuts in FY2013 and beyond, known as sequestration, continue to loom over HIV and viral hepatitis programs. According to the Office of Management and Budget, the cuts will be approximately nine percent for the remainder of FY2013. Though Congress and the President are opposed to sequestration, no formal plan has been offered to avoid the cuts. The possibility of sequestration and continued Congressional battles over deficit reduction will translate into massive cuts to discretionary spending, including HIV and viral hepatitis program funding for FY2013. Additionally, the budget debates have delayed the budget and appropriations process for FY2014. An illustration of the impact of sequestration on HIV programs is included in the White House’s fact sheet: Examples of How the Sequester Would Impact Middle Class Families, Jobs and Economic Security.

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4. Reauthorizations: Ryan White and PEPFAR

Both the Ryan White Care Modernization Act and the President’s Emergency Plan for AIDS Relief (PEPFAR) are up for reauthorization in 2013. However, neither contains a “sunset” provision – thus, both programs can continue without a formal reauthorization. NASTAD is working with the Administration, Congress, and key HIV/AIDS community stakeholders to determine and prepare for the best way forward for Ryan White, particularly in an era of health reform. For both Ryan White and PEPFAR, advocacy for adequate appropriations is high priority.

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5. Getting to Zero: Advancing the Response Among Gay Men

New Centers for Disease Control and Prevention (CDC) data show that, comparing 2008 to 2010, the number of new HIV infections among men who have sex with men (MSM) increased by 12 percent and MSM remain the population most heavily affected by HIV. Additionally, the estimated number of new HIV infections was greatest among Black MSM in the youngest age group (aged 13–24 years). Black and Latino MSM overall, and especially young Black and Latino MSM, continue to be disproportionately affected by HIV. As the flagship health department prevention cooperative agreement, PS 12-1201, enters its second year of implementation, NASTAD will continue to monitor resources and efforts, particularly in regards to the implementation of High Impact Prevention (HIP) and the Strategy’s goal of reducing health disparities for gay men. Additionally, this CDC fact sheet underscores how disparities persist across the stages of care in the U.S. NASTAD will continue to advocate for targeted resources, partnerships, and holistic policies that impact the lives of gay men/MSM, as stated in the organization’s Getting to Zero statement.

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6. Obamacare: Preparing for 2014 Implementation

As the Affordable Care Act (ACA) is implemented, it is imperative we build the best systems that integrate the Ryan White Program and increase access to care for all. We must ensure that the system has an accessible enrollment process and that it provides culturally competent care in order to truly reduce and eliminate health disparities for racial and ethnic minorities. As the federal government rolls out rules and guidance, NASTAD will continue to comment and ensure that the needs of people living with HIV and/or viral hepatitis are addressed. For more information on the ACA implementation process, please see the Health Reform Watch and read the Health Reform blog posts.

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7. HIV and the Law: Decriminalization and Modernization

The National HIV/AIDS Strategy calls for ending HIV-specific criminal laws that are out-of-touch with current science and public health knowledge of HIV. The Presidential Advisory Council on HIV/AIDS recently passed a resolution stating that “HIV criminalization is unjust, bad public health policy, and is fueling the epidemic rather than reducing it.” As advocates continue to address HIV-specific laws at the state level, NASTAD will continue to provide health departments with technical assistance to modernize and reform their internal policies, forms and procedures. View our work on HIV criminalization and read our blog posts on the topic.

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8. Testing: HIV, HBV, HCV and the US Preventive Services Task Force

Last year, the United States Preventive Services Task Force (USPSTF) issued draft recommendations on HIV and hepatitis C (HCV) testing. The USPSTF came out strongly in support of routine HIV testing by assigning it a grade “A”. However, USPSTF issued a “B” grade for HCV testing for persons who inject drugs and a “C” grade for HCV testing for baby-boomers. NASTAD submitted comments in support of the HIV grade recommendation and encouraged a change of the HCV grades. The HIV and viral hepatitis communities are awaiting the final USPSTF recommendations. Meanwhile, the USPSTF will also review their guidelines for hepatitis B (HBV) screening and behavioral counseling in 2013. NASTAD will continue to monitor all of these testing recommendations and the implication of these recommendations on screening costs/reimbursement to programs.

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9. Viral Hepatitis Action Plan: What’s Next?

In 2011, the first-ever roadmap to combat viral hepatitis was released with the Action Plan for the Prevention, Care and Treatment of Viral Hepatitis. The Action Plan’s recommendations, however, only spanned through 2013. With the CDC’s release of new HCV testing guidelines and the USPSTF review of their recommendations, 2013 will provide both opportunities and challenges to continuing the fight against the silent epidemic. NASTAD will continue to monitor implementation of the Action Plan, and provide recommendations to the Administration to ensure that the 5.3 million people living with viral hepatitis continue to be a priority.

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10. Ending the Epidemics: Cure Research and the Medical Pipeline

Over the last three decades, the response to the HIV and viral hepatitis epidemics have changed drastically – largely due to robust research, the medical/pharmacological pipeline, along with behavioral interventions. Data on many experimental interferon-free combinations for hepatitis C (HCV) were presented last year at the American Association for the Study of Liver Diseases (AASLD) Liver Meeting. The New England Journal of Medicine has already published two 12-week, all oral HCV regimens that produced promising cure rates. Similarly, many studies are currently underway exploring the possibility of a cure for HIV. As treatment and cure research continues to expand, NASTAD will continue to monitor the pipelines for HIV and viral hepatitis.

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