The American Academy of HIV Medicine’s Congressional Agenda
As the new 117th Congress returned to Washington for its next two-year term, the American Academy of HIV Medicine began its year by reviewing the potential HIV issues that could come up in the next Congress and reviewing our legislative agenda. The Academy will pursue that agenda even as the country weathers unprecedented political turmoil as we approach the inauguration of President-Elect Biden on January 20th.
The newly elected members of Congress were sworn in on January 3rd and Nancy Pelosi (D-CA) was reelected Speaker of the House for a fourth term in a close vote, 216 – 209. The closeness of the vote is notable since it draws attention to the narrow majority that Democrats hold with 222 votes as opposed to 211 Republicans. It is clear that achieving legislative success will likely be determined by the Speaker’s ability to hold various coalitions of Democrats together and to attract the few moderate Republicans who might consider voting across party lines.
The new Congress comes together with many issues likely to affect its ability to govern. Among them, the ongoing COVID-19 pandemic (with some members refusing to wear masks on the House floor), far-right demonstrations against the election that have caused Capitol Police to erect barriers around the Capitol, an election in Georgia that will determine control of the Senate and the bitter effort by President Trump to retain the Presidency. Consequently, the House has been immediately pitched into an unprecedented fight by some Republican members to vote against certification of states in which they have falsely claimed a fraudulent election. This has created an intra-party battle among Republicans which may continue past the effort to challenge the certification.
Despite this unusual political churn affecting the early dynamics of this Congress, the American Academy of HIV Medicine remains singularly focused on achieving an end to the HIV epidemic. As a result, we are closely following the bills and issues most likely to impact ending the HIV epidemic.
Congress’s health care agenda will remain a major priority due to the COVID-19 pandemic and ongoing attacks on the Affordable Care Act through the courts. One overlooked issue is that overdose rates have steadily climbed since the beginning of the pandemic, potentially resulting in over 100,000 overdose deaths this year alone. This would represent a nearly 40% increase in deaths over the highest level ever. However this crisis, along with the HIV epidemic, continues to be overshadowed by the pandemic. Despite the unfortunate situation, there are still potential avenues for legislative action in other health care arenas.
One issue that may come up in this Congress is the status of the 340B Drug Discount Program which allows Ryan White Program providers, Federally Qualified Health Centers and other safety net programs to purchase drugs at a discount and use the savings to provide comprehensive care and support services to their clients. This has been an important resource in providing care to people with HIV across the U.S. The issue continues to attract attention at the state level as states seek to shore up their budgets. The Academy supports continuing the program to ensure ongoing care and will continue to follow this issue closely.
Ending the HIV Epidemic
During the campaign, President-Elect Biden announced support for ending the HIV epidemic by 2025, a position strongly supported by HIV advocates across the board and which is endorsed by the Academy. Many key members of Congress have offered their support for this idea and it is likely that legislation will emerge to implement such a plan.Advocates, including the Academy, will push for support for ending the HIV epidemic at the earliest possible moment; but it would not be surprising if it takes until the Fall or later for a bill to come together. Nevertheless, the Academy urges Congress to move rapidly to focus on this issue so that the window to end the epidemic does not close.
Pre-Exposure Prophylaxis (PrEP) is likely to play a major role in ending the HIV epidemic and there have already been several bills introduced in Congress to increase the availability of PrEP. Look for the PrEP Access and Coverage Act sponsored by Rep. Adam Schiff (D-CA) and the PrEP Assistance Program Act by Rep. Bonnie Watson Coleman (D-NJ) to be quickly reintroduced. However, it would not be surprising if they are held in committee until a comprehensive HIV bill appears.
One question that comes up is whether the Ryan White Program should be reauthorized. Right now, the Academy along with other national advocacy organizations have held off on calling for a reauthorization for two reasons. The first is that, given the ongoing fights over the status of the Affordable Care Act, it is unclear exactly what gaps the relatively flexible Ryan White Program may be called on to cover in the future. Secondly, given the interest in legislation to end the HIV epidemic, it does not necessarily make sense to make major changes to the Ryan White Program without coordinating it next to the larger project of ending the epidemic. As of now, the Academy advises caution about bringing major change to Ryan White Program since it continues to operate reasonably well and allows relatively flexible spending of funds.
Of course, Congress will also need to provide enough funding to reach the goal of ending the HIV epidemic. The appropriations process will begin in earnest as early as March. Although it typically begins with the release of the President’s budget, given that this is a new budget for a new President (and that there has been delayed and minimized cooperation during the transition) it is likely that the budget will be delayed. We expect both the House and the Senate to begin hearings and markups as early as March with the process continuing into at least the summer. Depending on who controls the Senate following the Georgia election this week, this process may continue past the beginning of the Fiscal Year on October first. The Academy calls for a return to a normal appropriations process allowing for more predictability in funding, particularly following the extraordinary partisanship and fever pitch of general political rancor of the last year.
Other HIV Legislation
Every year advocates for HIV issues have worked in support of many specific bills that would affect HIV. In particular the Academy has championed and worked strongly in support of the HELP Act which, if passed, would create a loan repayment program for the HIV clinical and dental workforce. It was originally introduced by Rep. John Lewis (D-GA). Sadly, Rep. Lewis, a true civil rights hero and a champion of ending the HIV epidemic, passed away last year. Consequently, the Academy is working in coalition with other organizations to identify a new champion and to seek introduction as early as possible this year, perhaps as early as February. We hope this bill will honor his legacy even as it helps people to pursue a career helping people living with HIV.
The Academy also supports both the Real Education for Healthy Youth Act and the REPEAL HIV Discrimination Act. The Real Education for Healthy Youth Act awards grants for comprehensive sex education for adolescents. The REPEAL Act would require the federal government to conduct a national review of federal and state criminal and civil commitment laws and policies and to create best practices to eliminate discrimination. Both bills are both likely to be reintroduced relatively early in the new Congress.
In addition to this specific legislation, the Academy continues to note that there are a number of serious workforce issues for our members in the HIV field and we continue to seek ways to provide support for the physicians, physician assistants, nurse practitioners, pharmacists, dentists, and other allied health care professionals who provide prevention services, treatment, and care for people with and at risk for HIV. Given that this is likely to be another tumultuous Congress, we are working to keep our eye fixed firmly on the needs of our members and of the HIV community at large. This Congress, no matter who is in control, must take this opportunity to enact appropriate legislation to end the HIV epidemic at the earliest possible moment, and it seems that – at least when it comes to HIV in the US – there is at least some bipartisan agreement on this imperative.
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