Policy Updates: Hill Happenings and Administration Activities
*Editor’s note: There will be no weekly newsletter on the week of September 5.
Hill Happenings
Democrats Advance Social Spending Package via Budget Reconciliation
On August 16, President Biden signed the Inflation Reduction Act (H.R. 5376), a $750 billion health care, tax, and climate spending package. Democrats advanced the landmark bill through the budget reconciliation process, bypassing Republican opposition through a consensus, party-line effort with a tie-breaking vote cast by Vice President Harris. The legislative package marks a years-in-the-making compromise between moderate and liberal Democrats on policy priorities, delivering key health policy wins ahead of the midterm elections.
The Inflation Reduction Act builds upon the Affordable Care Act (ACA) to improve access to affordable coverage and lower the cost of prescription drugs. Notably, the Inflation Reduction Act includes a provision that empowers the Department of Health and Human Services (HHS) to directly negotiate with manufacturers to lower the price of certain prescription drugs for the Medicare program. The package also includes a three-year extension of ACA Marketplace plan subsidies afforded by the American Rescue Plan Act, saving an average of $800 yearly per enrollee.
However, the Inflation Reduction Act did not include provisions that would fix the Medicaid coverage gap, a key priority for health advocates. The coverage gap fix would have provided more pathways to affordable coverage for people with low incomes living in states that did not expand their Medicaid program, a critical step towards reducing health coverage disparities by state and a key tool for ending the HIV and hepatitis epidemics. NASTAD signed onto a coalition letter on July 28 urging Democratic leadership to include the Medicaid coverage gap fix in the budget reconciliation package.
Fiscal Year 2023 Appropriations
Following the ratification of the Inflation Reduction Act, Democrats will return to August recess before taking up Fiscal Year 2023 (FY2023) discussions in September. Lawmakers are expected to issue a continuing resolution (CR) to extend federal funding past the October 1 deadline in order to provide more time for appropriators to land on a bipartisan spending framework amid Republican opposition to advancing the spending bills before the November elections. House and Senate Democrats advanced their set of appropriations bills earlier this month, providing a starting ground for spending negotiations to begin in earnest in the fall. The appropriations bills included increases to key health programs, but Democrats will need to secure Republican support to advance the spending package. NASTAD will continue to monitor the appropriations process and advocate for the highest funding level on behalf of HIV and hepatitis programs.
Congressional LGBTQ+ Equality Caucus Urges Biden Administration to Request Monkeypox (MPV) Funding
On August 23, over 85 lawmakers from the Congressional LGBTQ+ Equality Caucus called on the Biden Administration to send a formal request to Congress for supplemental funding to combat the spread of MPV. The Caucus applauded the Administration for declaring MPV a public health emergency but highlighted the urgent need to allocate additional resources through a supplemental appropriations package. The lawmakers call for greater financial and technical assistance, including expanding testing and vaccination capacity, reducing the cost of treatment, increasing availability of vaccines, and launching culturally competent and equitable public education campaigns. Additionally, the Caucus called for sufficient funding to ensure that providers can simultaneously test for HIV and STIs during MPV testing.
Administration Activities
CDC Director Announces Agency Overhaul After Identifying Gaps During the COVID-19 Pandemic Response
On August 17, Centers for Disease Control and Prevention (CDC) Director Rochelle Walensky announced a plan to overhaul agency-wide operations and improve the CDC’s capacity to quickly respond to public health threats. The agency revamp was spurred by widespread criticism of the CDC’s response to the COVID-19 pandemic, including confusing guidance messaging and lengthy data review timelines. The agency-wide review process, which began in April, identified gaps in the CDC’s workflows that impeded effective action during the pandemic. Director Walensky announced a series of initial actions towards implementing the plan, including: increasing the use of preprint scientific reports to publish timely and actionable data, restructuring the CDC communications department and improving the website, elevating the Office of Minority Health and Health Equity, and establishing an Office of Intergovernmental Affairs. Additionally, Director Walensky appointed Mary Wakefield, the former Administrator of the Health Resources and Services Administration (HRSA) under the Obama Administration, as senior counselor to fully implement the plan.
HHS Announces Over $20 Million in Funding to End the HIV Epidemic
On August 23, the Department of Health and Human Services (HHS) Secretary announced that HRSA awarded more than $20 million in Ending the HIV Epidemic in the U.S. (EHE) funding to expand HIV prevention, testing, and treatment services at 64 community health centers nationwide. The awarded health centers will leverage the funding to expand access to PrEP, connect people to coordinated care, and strengthen partnerships with community organizations and health departments.
White House Releases NHAS Implementation Plan
On August 26, the White House Office on National AIDS Policy (ONAP) released the National HIV/AIDS Strategy (NHAS) Federal Implementation plan. The Federal Implementation plan reflects the commitments of 10 federal agencies to implement the programs, policies, research, and other activities needed to meet the goals laid out in the NHAS in fiscal years 2022-2025. The Federal Implementation Plan is the most expansive plan to date, including more federal agencies than ever before and introducing five new NHAS indicators of progress focused on quality of life among people with HIV to expand the plan’s focus beyond just clinical measures for people with HIV to include self-rated health status, mental health, food insecurity, employment status, and unstable housing or homelessness. Finally, the NHAS includes a call to action for stakeholders in all sectors of society to engage in a re-energized national response to HIV.
HRSA Releases 2020 RWHAP ADAP Annual Client-Level Data Report
On August 23, HRSA HIV/AIDS Bureau (HAB) released the Ryan White HIV/AIDS Program (RWHAP) AIDS Drug Assistance Program (ADAP) Annual Client-Level Data Report, 2020. The annual report includes client-level data collected through the ADAP Data Report (ADR) reporting system for all ADAP enrollees during calendar years 2016 through 2020. The report found that the total number of people with HIV enrolled in ADAP increased by nearly 35,000 clients. Additionally, Seven out of 10 ADAP clients are from racial and ethnic minority populations, and over one-third of all ADAP clients have no health care coverage. The report findings underscore the critical role of ADAP programs across the country in providing safety-net HIV treatment and care for people living with HIV.
CDC Observes Inaugural National Fentanyl Prevention and Awareness Day
On August 21, CDC observed the first National Fentanyl Prevention and Awareness Day. The event was founded by grassroots fentanyl awareness organizations representing affected families and their determination to address the public health problem of deadly illegally made fentanyl. This day of remembrance honors the loved ones who have lost their lives due to illicit fentanyl and acknowledges the devastation this drug brings to hundreds of thousands of impacted family members and friends.
Resources
NASTAD Blog: White House Convening on Prosecution of HIV Criminal Laws
NASTAD: HIV Criminalization Resources
The HIV Criminalization Resources Document includes general, academic, and educational materials on HIV criminalization in the United States that will help public health professionals broaden their knowledge on this subject.
NASTAD Resource: RWHAP Part B/ADAP Coordination with Medicare
This resource walks through some of the basic elements of the Medicare program and provides information to support RWHAP Part B/ADAP staff in adapting program activities to better coordinate with Medicare coverage, including providing premium and cost-sharing assistance for clients.
AAHM: Long-Acting Agent Resource Center
The American Academy of HIV Medicine launched a new online resource to expand the knowledge base for long-acting antiretroviral agents (LAAs) used for the treatment of HIV and prevention of HIV acquisition by providing information related to the availability of products, payment coverage, and prescribing guidelines.
All Students Count Coalition Report: Exploring How Disparities in Experiences of Violence and Substance Use Between Transgender and Cisgender Students Differ by Gender Expression
“The All Students Count Coalition (ASCC), a network of national and state organizations led by Advocates for Youth, released a new report that uses Youth Risk Behavior Survey (YRBS) data from 18 state and local education agencies and/or health departments (sites) that included both the transgender identity and gender expression questions. Our researchers found that transgender students were significantly more likely than their cisgender peers to report lifetime and current tobacco and illicit drug use and were significantly more likely to experience or be involved with physical violence. The report is accompanied by a webinar that explores several other critical findings.”
O’Neill Institute Issue Brief: Strengthening Linkage and Engagement in HIV Care
“The O’Neill Institute has released a new Big Ideas Brief and accompanying two-page summary, both of which are titled, Strategic Changes Are Needed to Strengthen Linkage and Engagement in HIV Care. Diagnosing, connecting to care, and providing a range of social and clinical supports to facilitate continued engagement in care for all people living with HIV is complex, yet achievable. This brief (and accompanying summary) acknowledges that targeted responses are needed to address existing disparities in access and outcomes and to improve linkage and engagement across the HIV care continuum.”
The NIH Research Education Program (R25) supports research education activities in the mission areas of the NIH. The overarching goal of this Office of Research on Women’s Health R25 program is to support educational activities that complement and/or enhance the training of a workforce to meet the nation’s diverse biomedical, behavioral and clinical research needs. As sex and gender influence multiple domains of health, courses, curricula, and methods covering a broad range of topics are appropriate for this FOA, as long as sex, gender, or both is a primary domain of focus, including HIV and women, including HIV cure, prevention, and treatment.
Job Postings
NASTAD RFP: Leading with Lived Experience Training Consultants, Hepatitis Network for Education and Testing (HepNET)
RFP Close Date: August 31, 2022
Summary: NASTAD and partners are seeking applications for our Leading with Lived Experience (LLE) Consultant Cohort. LLE Consultants will be paid to participate in a training course on leadership from the perspective of lived experience with viral hepatitis and/or harm reduction services. LLE Consultants will then be contracted to facilitate a learning community through the Hepatitis Network for Education and Testing (HepNET).
Deputy Medical Director, HIV/STI/Viral Hepatitis/Harm Reduction – Nashville, TN
This position will serve as the Statewide Deputy Medical Director in the HIV/STI/Viral Hepatitis section. The position has cross-cutting responsibility in all program areas with potential for promotion in succession plans. Primary responsibilities include leadership and oversight of cross-cutting programs related to End the Syndemic Tennessee to tackle HIV, sexually transmitted infections, viral hepatitis and substance use disorder in an integrated manner with an outward-facing, community-engaged process.
CSTE RFP: Continuous HIV Surveillance and Epidemiology TA and SME
Council of State and Territorial Epidemiologists is seeking a consultant to provide continuous technical assistance (TA) and subject matter expertise on HIV surveillance and epidemiology to improve HIV surveillance capacity and provide support on activities and convenings related to HIV surveillance technical assistance and programmatic planning and execution. If interested in this opportunity, please submit an application to Symone Richardson (srichardson@cste.org) by Wednesday, September 7, 2022 according to the process detailed in the RFP.
Surveillance Section Chief – Sacramento, CA
This position supports the California Department of Public Health’s (CDPH) mission and strategic plan by working collaboratively with state and federal agencies, local health jurisdictions (LHJ), universities, and community-based organizations to ensure efforts to combat the HIV/AIDS epidemic are targeted and effective by leveraging data and technology to advance goals, inform action and accountability, strengthen the science base of our services, and expand surveillance systems for evidence-based decision making. The Research Scientist Supervisor II (RSS II) directs and manages all aspects of HIV case and incidence surveillance in California, including managing the activities of the Quality Management Unit (QMU) and the Medical Monitoring Project (MMP)
End Hep C SF Strategic Director – San Francisco Public Health Foundation
The EHCSF Strategic Director will assist all work groups and members by supporting the overall execution of the initiative’s strategic plan while supporting the direction of day-to-day operations. This position will focus on engaging impacted populations through the community navigator program and community meetings, manage initiative grants and budgets, and conceptualize and execute EHCSF community events. Applications close August 19.
Program Content and Training Specialist, Supporting Harm Reduction Programs (SHaRP) – University of Washington
This position is part of a cooperative agreement award from the Centers for Disease Control and Prevention to provide technical assistance about monitoring and evaluation to syringe services programs (SSPs) as part of the National Harm Reduction Technical Assistance Center. One of the primary projects of this award is to provide technical assistance (TA) to SSPs for monitoring and evaluation activities. The University of Washington is working in collaboration with the CDC, SAMHSA, NASTAD, the National Harm Reduction Coalition, and other TA partners to provide a suite of technical assistance support to individual programs.
Social Innovations Team Lead – Baltimore, MD
Baltimore City Health Department is seeking to fill the position of the Social Innovations Team Lead for the Bureau of Clinical Services and HIV/STI Prevention. The HIV/STI Social Innovations Team is a unique and visionary program at Baltimore City Health Department that utilizes a human-centered design approach to engage with the Baltimore community on issues related to HIV and Sexually Transmitted Infection (STI) prevention. The team creates innovative, original, and engaging programming to involve the community in the heart of the Health Department’s work.
Project Data Manager, Syringe Service Program – University of Washington
We are hiring for a Project Data Manager (Research Consultant) to work closely with the principal investigator, project coordinator, survey site staff, CDC personnel, and other support staff to enact all data-related components of Project NEXUS. This position will supervise the NEXUS data team, including two research assistants, lead data analysis, and be the main point of contact for the CDC data management team. They will also provide support for the Dave Purchase Memorial Survey and the National Harm Reduction TA Center as needed.
Communicable Disease Epidemiologist – Cheyenne, Wyoming
This position will serve as the Communicable Disease AIDS Drug Assistance Program (ADAP) Coordinator, Wyoming TB Controller, and Disease Intervention Specialist (DIS) for the Communicable Disease (CD) Treatment Program. Assist in outbreak response to ensure the safety of Wyoming residents; by interviewing cases for exposure information, updating news outlets on the progress of outbreak control, and analyzing exposure data utilizing epidemiological and statistical methods.
Assistant Commissioner - Health Department – Baltimore, Maryland
The Baltimore City Health Department (BCHD) is seeking an Assistant Commissioner to lead the Bureau of Communicable Disease and Outbreak Control. This senior management position will lead a talented team responsible for communicable disease investigation, outbreak control and emergency preparedness programming. The incumbent will also be responsible for developing and implementing agency-wide policies related to health department readiness to respond to public health emergencies. The incumbent will report directly to the Deputy Commissioner for BCHD’s Division of Population Health & Disease Prevention.
Open Positions – New York State
The New York State Department of Health, in partnership with Health Research, Inc, has various job openings, including some within the AIDS Institute. Please visit this link to learn about their current opportunities.
News Bulletin
A Needle Exchange Project Modeled on Urban Efforts Aims to Save Lives in Rural Nevada
“Cusolito is a peer recovery support specialist and received training through Trac-B Exchange, a Las Vegas-based organization that provides a range of harm reduction services throughout Nevada…Cusolito has run the exchange program since 2020, when the Elko City Council approved a resolution that gave him permission to hand out needles and syringes at the city’s camp for homeless people. The agreement was originally for one year, but the council recently renewed it for three. Elko officials’ approval of Cusolito’s work comes as leaders in small, often conservative cities have been asked to adopt policies forged in large, more liberal cities, such as New York and San Francisco.”
Public Health Agencies Adapt Covid Lessons to Curb Overdoses, STDs, and Gun Violence
“The pandemic laid bare the gaps and disparities in the U.S. public health system, and often resulted in blowback against local officials trying to slow the coronavirus’s spread. But one positive outcome, in part fueled by a boost in federal dollars, is that health workers have started adapting lessons they learned from their covid-19 response to other aspects of their work.”
History doesn’t have to repeat itself with stigma and monkeypox
“Had this outbreak been among young children in classrooms and summer camps across the country, the public health response would almost certainly have been swift to protect them. But it happened among a community whose lives are undervalued and whose rights are under attack, and has escalated into a mass trauma event for the LGBTQ+ community. There’s a palpable sense of frustration among my infectious disease colleagues since it feels like we haven’t learned at all from the past. But lessons from the history of HIV/AIDS might show a path forward in policy and approach to prevent stigma from influencing the spread of monkeypox and the treatment of people with it.”
HHS says it plans to extend Covid-19 public health emergency
“State and local public health officials — having not heard differently this week — are expecting the Biden administration to extend the Covid-19 public health emergency for another 90 days in mid-October. An extension would ensure expanded Medicaid coverage, telehealth services, boosted payments to hospitals and other pandemic measures remain in place beyond the midterm elections even as public health experts and lawmakers debate the merits of a PHE that was first declared in January 2020.”