2019 Appropriations Moving through Congress

Temperaments in our two chambers of Congress seem to be on display as U.S. Senators and Representatives cobble together the appropriations bills that will form our national budget for 2019. AIDS United reports that “Senate appropriators passed proposals this week…with a minimum of conflict,” a departure from years past. Having agreed to do away with the “poison pill” policy riders that so often bog down spending bills in Congress…[they] have ushered in a welcome new age of civility and compromise, at least for now.”

This change of mood is not inevitably benefitting HIV-related issues, however. While the Senate did not increase funding of the Housing Opportunity for People with AIDS (HOPWA) program, the House added $18 million to its HOPWA line.

Representative’s votes are adhering more to party lines. AIDS United notes that the House Appropriations Committee passed legislation with some “wins for HIV care and treatment including level funding for the Ryan White program and a slight increase to $1.147 billion for HIV/Hepatitis/STI/TB work at the CDC.” Nevertheless, its aggregated HIV-related spending is $2 billion less than that proposed by the Senate.

The House has also embraced “a number of ideological policy riders that will prevent us from fully addressing both the HIV and opioid epidemics”, AIDS United observed. Specifically, they forbade use of federal funding for Safer Consumption Sites (or Supervised Injection Facilities) – despite the fact that these can reduce HIV, Hepatitis and overdose risk and facilitate users’ access to Substance Use Disorder Treatment.

The HIV Medicine Association also reports that House Appropriators’ funding bill increased research investment but simultaneously eliminated several essential services including “evidence-based programs to reduce teen pregnancy, HIV and other sexually transmitted infections (STIs) and risky sexual behavior among adolescents.” Further, they increased the budget for “scientifically disproven abstinence-only programs (misnamed ‘sexual risk avoidance’).” They also dropped $100 million from HRSA’s Bureau of Primary Health Care funding which, they note, “supports federal qualified health centers across the country on the frontlines of the HIV, STI and opioid epidemics.”

Oral Arguments Kick Off First Legal Challenge to Medicaid Work Requirements

Last Friday, The Hill reports, attorneys representing Kentucky Governor Matt Bevin and the federal Department of Health and Human Services (DHHS) confronted the 16 advocacy groups now suing them in federal court to halt implementation of Kentucky’s Medicaid 1115 waiver. The plaintiffs – represented by the National Health Law Program, the Kentucky Equal Justice Center and the Southern Poverty Law Center – assert that the waiver provisions, approved last January by DHHS Center for Medicare and Medicaid Services (CMS), contradict the very intent of Medicaid.
According to medicaid.gov, the program is “designed to provide health coverage for low-income people”.

Kentucky’s waiver allows the state to impose work requirements on “able-bodied” Medicaid recipients and require those with incomes at the poverty level or above to pay 4% of their income as premiums for their coverage. It also allows the state to lock participants out of Medicaid for up to six months if they fail to pay on time or to report changes in family circumstances.

Presiding Federal Judge James Boasberg asked how Medicaid’s stated goals would be advanced by Kentucky’s expectation to remove up to 95,000 people from the state’s Medicaid rolls. The defense responded that this reduction would be achieved by helping those people move from Medicaid to other forms of insurance coverage. Kentucky’s waiver program is slated to start on July 2.

Modern Healthcare notes that the outcome of this case will likely affect other states with similar, already approved waivers (Arkansas, Indiana and New Hampshire), as well as those that have submitted similar applications to CMS and are awaiting approval (Arizona, Maine, Mississippi, Michigan, Utah and Wisconsin). During his campaign, Governor Bevin ran on the promise that he would end Medicaid expansion (already in place in Kentucky), arguing that it was not fiscally sustainable. If the court decides against him, he may revive that commitment.


View the latest HIV Policy Update here.