March 14, 2017

HIV Medical Professionals Urge Congress to 'Do No Harm' in Efforts to Repeal the ACA

Eric Brus READ TIME: 3 MIN.

Earlier this year, a group of more than 950 medical professionals sent an open letter to members of Congress urging them not to repeal the Affordable Care Act (ACA) without first establishing a viable replacement plan that will continue to offer affordable coverage to those eligible under the ACA, and to sustain the federal commitment to the Medicaid program.

The letter was signed by members of four HIV medical groups: the HIV Medicine Association (HIVMA), American Academy of HIV Medicine (AAHIVM), Association of Nurses in AIDS Care (ANAC) and the Ryan White Medical Providers Coalition (RWMPC).

The letter states that, "Prior to the Affordable Care Act, a majority of our patients [living with HIV] were either denied health insurance coverage because of their condition or were unable to afford the extraordinary high cost of the coverage available to them. In most states, Medicaid coverage was available to patients only after they became sick and disabled by AIDS.

The ACA leveled the health care playing field by barring plans from denying coverage or charging higher premiums based on health status, setting minimum health coverage standards, and providing premium and cost sharing assistance. Importantly, it modernized the Medicaid program by expanding coverage to families and childless adults up to 138% of the federal poverty level regardless of disability status."

The medical professionals strongly recommend that any changes to the ACA be grounded on three key principles:

  • "Do no harm" by fully taking into account "the medical needs of low income individuals with complex conditions, like HIV, to avoid dangerous disruptions in healthcare coverage for our patients with HIV and millions of others. Meaningful health insurance coverage options must offer uninterrupted, affordable coverage for a range of necessary medical services, including prescription drugs, preventive services, laboratory testing, and substance use and mental health treatment."

  • "Sustain the federal commitment to the Medicaid program. Maintaining the current funding structure, including the federal entitlement, to the Medicaid program is critical so that states can respond to fluctuations in the demand for Medicaid coverage due to economic downturns, public health outbreaks such as the HIV and hepatitis C outbreaks in Scott County, Indiana, and medical advances, such as the recent development of curative hepatitis C treatment."

  • "Continue Medicaid expansion. In the 32 states (including the District of Columbia) that have expanded Medicaid, our poorest patients were offered access to comprehensive, affordable coverage with consumer protections tailored to their socioeconomic and medical needs. Withdrawing this coverage will threaten the health of millions of Americans and be a significant setback to our nation's public health, including to our efforts to end AIDS."

    NIH Launches First Major Trial of a Long-Acting HIV Prevention Drug

    The first major clinical trial of a long-acting injectable drug for HIV prevention (HPTN 083) began late last month. The study, which is sponsored by the National Institutes of Health (NIH), will evaluate whether the antiretroviral drug cabotegravir, injected once every 8 weeks, can safely protect men and transgender women from HIV infection at least as well as Truvada. Truvada, a once-daily pill that contains two antiretroviral drugs, is currently the only regimen that has been approved for HIV preexposure prophylaxis (PrEP).

    The study will enroll 4,500 men who have sex with men and transgender women who have sex with men at 45 sites in eight countries in the Americas, Asia, and Africa. To be eligible for the study, participants must be at least 18 years old and at high risk for HIV infection. Results from the trial are expected in 2021.

    If injectable cabotegravir is found to be effective for HIV PrEP, it may be easier for some people to adhere to than daily oral Truvada.

    "We urgently need more HIV prevention tools that fit easily into people's lives," noted Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. "Although daily oral Truvada clearly works for HIV prevention, taking a daily pill while feeling healthy can be difficult for some people. If proven effective, injectable cabotegravir has the potential to become an acceptable, discreet, and convenient alternative for HIV prevention."

    Eric Brus writes about HIV policy. His HIV/AIDS Disparities Report is produced by the New England AIDS Education and Training Center Minority AIDS Initiative Project. The full version is available online.

    by Eric Brus

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