$10.4 billion owed to insurers for premium stabilization program starts flowing again

As reported last week, the Trump administration stopped payments earlier this month to ACA-participating insurers. The interruption occurred because U.S. District Judge James Browning in New Mexico ruled, according to Modern Healthcare, that the Centers for Medicare and Medicaid Services (CMS) “did not adequately justify its payment methodology for the payments and it needed to do so via rulemaking that’s subject to public comment.”

The suspended payments, totaling $10.4 billion, are subsidies due to insurers to compensate them for the reduced deductibles and out-of-pocket costs they incur in the course of providing coverage to approximately 7 million low income people through the ACA. The money for them comes from companies with healthier clients and is redistributed to companies with sicker (and thus more costly) clients.

On July 25, the New York Times reported that “in an abrupt reversal”, the administration said last Tuesday “that it would restore the program because otherwise health plans could become insolvent or withdraw from the market, causing chaos for consumers”. Associated Press adds that, “the administration has faced widespread criticism for its original move” and that “Republican lawmakers were concerned about political fallout affecting the midterm elections.”

A 2020 International AIDS Conference in San Francisco – In what political climate?

As the International AIDS Society’s (IAS) massive Conference unfolds in Amsterdam this week, informal demonstrations and hallway debates about the venue for its 2020 conference is abounding. IAS announced last March that IAC 2020 would be held jointly in San Francisco and Oakland, CA. Hundreds of US activists, led by American networks of people living with HIV (PLHIV), immediately expressed their strong opposition and are asking IAS to reconsider that decision.

In TheBody.Com, advocates and activists – led by the Positive Women’s Network-USA, the Harm Reduction Coalition, Housing Works, Inc., the Southern AIDS Coalition and others – contend that holding the conference in the US will exclude many people living with or affected by HIV. It “flies in the face of ample and undeniable evidence that the Trump administration violates human rights, targeting of vulnerable communities for harm, and exacerbating HIV-related stigma worldwide”.

In their open letter to IAS, they note that “even the more HIV-community-friendly Obama administration wasn’t able to suspend or overturn permanent bans that blocked sex workers and people who use drugs — two deeply HIV-affected populations worldwide — from entering the U.S. for the 19th International AIDS Conference (AIDS 2012), which took place in Washington, D.C.” adding that, “It is completely predictable that conditions for those seeking entry for AIDS 2020 will be demonstrably worse.”

Science Speaks reported in 2012 that “the US travel bans on people involved in sex work and people who have used illegal drugs had kept many of the people at highest risk from coming to the conference.” Allan Clear, then Director of the Harm Reduction Coalition, observed that, “”When you have doctors and scientists talking about people’s lives, and you don’t have anyone talking about their lived experience, you don’t have a balanced view. The biomedical side is only half the picture.”

Science Speaks also quoted Jonathan Cohen, director of the Open Society Foundations’ Public Health Program, who said that, “Sex workers and drug users we spoke to chose to stay home from the conference rather than disclose their status on a visa application. This is not a choice anyone should be forced to make.”

Advocates now calling for a new 2020 venue point out that this exclusion of populations hit hardest by HIV can only be expected to recur in 2020 – especially given that the conference is scheduled mere months before the 2020 election which, “like 2016, may well be marked by heightened violence, intentional promotion of stigma and the need to mobilize to protect our communities.”

Their full letter appears here, including the names of signatories as of April 2018.




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