Biden Wins 2020 Election, Results in Congress and the Impact on HIV

In a nail biter of an election and after several days of waiting for final results, the Associated Press and most other press organizations called the Presidential election in favor of Joseph R. Biden becoming the President-Elect.  Assuming that the States ultimately certify the election and that legal challenges from President Donald Trump are overcome, as is generally expected, Mr. Biden will take office at 12:00 noon Eastern on January 20^th, becoming the 46^th President of the United States.

The Academy has been following the election closely and continues to review House and Senate seats as they are being counted.  As of Monday, Nov. 9^th it is expected that the House Democrats will retain their majority, with Nancy Pelosi (D-CA) retaining her position as Majority Leader.  The Senate is more unsettled, as there are still four outstanding Senate races.  It seems likely that seats in Alaska and North Carolina will go to Republicans with two seats in Georgia likely headed to a January 5^th runoff.  If Democrats win both of those races, the Senate would be split 50/50 and deciding votes would go to the new Vice President-Elect Kamala Harris (D-CA).  Senator-Elect Mark Kelly, a Democrat from Arizona, will be seated by the end of the month.

In the House of Representatives, there are now at least 216 Democratic seats – 2 seats flipped from Republican to Democratic – and 196 Republican seats with at least 8 seats flipped from Democratic to Republican.  A particular loss for the HIV community is the expertise of Rep. Diana Shalala, a former Secretary of Health and Human Services who lost her Miami area seat to Maria Elvira Salazar, a former television journalist who campaigned strongly on retaining sanctions against Cuba.

Overall, it is expected that there will be approximately 55 new members of Congress.  The Academy plans to research the backgrounds of all members and to reach out especially to those members who are strongly committed to public health and ending the HIV epidemic.

Following the announcement of his presumed win, President-Elect Biden announced the formation of a transition team that would focus on four key issue areas, COVID-19, economic recovery, racial equity and climate change.  The Academy is focusing on several key members of the transition team who have health care experience including Representative Cedric Richmond (D-LA), New Mexico governor Michelle Lujan Grisham (a former member of Congress), Vivek Murthy the former Surgeon General of the United States under President Obama and Gautam Raghavan, a former Chief of Staff to Representative Pramila Jayapal (D-WA), vice president of policy at The Gill Foundation and an associate director of public engagement (particularly for LGBTQ and AAPI issues) under President Obama.

President-Elect Biden hit the ground running with this COVID-19 response, immediately calling for Americans to join together to wear masks and bring the epidemic under control.  The transition team also announced a new COVID task force that has already started work.  The COVID task force includes:

• David Kessler, co-chair, former FDA commissioner
• Marcella Nunez-Smith, co-chair, Yale associate dean for health equity research
• Vivek Murthy, co-chair, former surgeon general
• Luciana Borio, former assistant FDA commissioner
• Rick Bright, former BARDA director
• Zeke Emanuel, former Obama administration health policy adviser
• Atul Gawande, Brigham and Women’s hospital professor of surgery
• Celine Gounder, NYU Grossman School of Medicine assistant professor
• Julie Morita, former Chicago public health commissioner
• Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota
• Loyce Pace, executive director of the Global Health Council
• Robert Rodriguez, UCSF emergency medicine professor
• Eric Goosby, former Ryan White Care Act director

Notably, doctors Gawande, Goosby, Murthy and Osterholm all have significant expertise in HIV issues.

Attention has also turned to who is likely to become a cabinet secretary in various positions.  The Secretary of Health and Human Services has particular impact on HIV policy with many notable names said to be in contention.  Some of the names that the Academy has been hearing include: Dr. Mandy Cohen (the current North Carolina Secretary of Health), Dr. Emmanuel, Governor Lujan Grisham, Dr. Murthy, and Andy Slavitt (a former Acting Administrator of the Centers for Medicare and Medicaid Service under President Obama).

The Secretary of Housing and Urban Development is also important in the HIV response due to the Housing Opportunities for People With AIDS (HOPWA) program.  Rep. Karen Bass (D-CA), Mayor Keisha Lance Bottoms of Atlanta, Mayor Alvin Brown of Jackson, MS, and Diane Yentel, President & CEO of the National Low Income Housing Coalition, have all been rumored as potential picks.

There is additional speculation that an upcoming Biden administration would restore the position of the Director of Office of National AIDS Policy, a position that has not been filled by the Trump Administration.  It is not clear what will happen with the Trump Administration’s Ending the HIV Epidemic plan.  President-Elect Biden has said that he would support ending the epidemic by 2025, which may include absorbing the plan into a new Biden Administration effort.  The Academy strongly supports both restoring ONAP and Ending the HIV Epidemic.

In the meantime, during the final months of the year, Congress is expected to move forward on both new emergency funding to combat COVID-19 and appropriations funding for fiscal year (FY) 2021.  Both Democrats and Republicans are well positioned to try to make something happen at the end of what is now a lame duck session of Congress.   Senator Richard Shelby (R-AL) released all of the FY ‘21 appropriations bills on November 10^th (the most prominent bills for HIV are listed under “Labor, Health and Human Services, Education, and Related Agencies, 2021” and “Transportation, Housing and Urban Development, and Related Agencies, 2021.”)

Given the time constraints, advocates are expecting that both regular appropriations and a COVID-19 package could move forward together.  One concern is whether enough funding will be provided in a COVID-19 package, and the Academy is expecting to fight hard alongside key allies to ensure that appropriate levels of funding in both will be included.  Contentious parts of the COVID-19 package legislation include ensuring adequate funding for state and local jurisdictions that have had their budgets depleted by the need to respond to COVID-19, extending liability protections to businesses from lawsuits related to COVID-19 and extending funding from the CARES Act through December 2022.

Although it is unclear how well the transition will operate as President Trump continues to contest the election, the American Academy of HIV Medicine stands ready to move forward on priorities seeking an end to HIV, COVID and related epidemics.