October 2017 policy watch


State policy updates

By Courtney Mulhern-Pearson

September 15 marked the end of the legislative session in Sacramento, the date by which bills need to pass out of the legislature if they are going to move forward. San Francisco AIDS Foundation had been tracking two bills this session—SB 239, which would update several California laws that currently target people living with HIV for criminal prosecution based on their HIV status, and AB 186, which would allow six counties to pilot safe consumption facilities.

SB 239: Updating California’s HIV criminalization laws

HIV criminalization laws in California developed in the 1980s and 1990s made it a felony—punishable by imprisonment for up to eight years in state prison—for people living with HIV not to disclose their HIV-positive status during consensual sex, even if there is little to no risk of HIV transmission. These laws do not further public health and raise barriers to HIV testing and treatment, two proven pathways to reducing transmission. Senate Bill 239 (SB 239), authored by Senator Scott Wiener (D-San Francisco) and Assemblymember Todd Gloria (D-San Diego), modernizes California law and brings HIV on par with other infectious diseases, and eliminates an HIV-specific law that served only to stigmatize people living with HIV.

The bill received bipartisan support in both houses of the California Legislature and on October 6, Governor Jerry Brown signed SB 239 into law.

AB 186: Safe consumption facilities  

Unfortunately Assembly Bill 186 (AB 186), co-sponsored by Assemblymember Susan Eggman (D-Stockton) and Senator Scott Wiener (D-San Francisco), was not able to gain enough votes to pass out of the legislature this year. Despite passing through the Assembly, the bill fell two votes short in the Senate and so was held over. The author and sponsors of the bill have indicated that they will reintroduce the bill in January when the two-year session resumes and are currently working to garner more votes.

Meanwhile, despite the setback in Sacramento, San Francisco is moving forward with a stakeholder process to look at the feasibility of and opportunities for operating safe consumption services (also often referred to as safe injection facilities) in the city. London Breed, the president of the Board of Supervisors, convened a Safe Injection Facilities Taskforce last April. This group held three public meetings over the summer. Those meetings are being used to inform a report, due out next month, which should include recommendations on if and how San Francisco should move forward.

Both Supervisor Breed and Senator Wiener have indicated their intent that the city should move forward with opening these facilities, regardless of the fact that the bill, which would have offered some legal protections, failed to pass. One option for getting around these laws is a tactic that the city has used in the past, when syringe distribution was illegal. Back in 1992, former Mayor Frank Jordan and the Board of Supervisors declared a public health state of emergency each month in order to temporarily allow syringe programs to operate, which helped stave off raids or prosecution by federal law enforcement. They continued doing this each month through the year 2000, when syringe exchange programs were finally made legal in California.

Federal policy updates

By Ernest Hopkins

The federal fiscal year ended on September 30, 2017. With it, ended Congress's last chance this year to pass a bill to repeal and replace the Affordable Care Act (ACA). After the failure of the 'Skinny Repeal' process, the advocacy community refocused its attention on the all-important Appropriations process to ensure that essential HIV programs were protected and fully funded for next fiscal year starting October 1, 2017.

In September, Senators Lindsey Graham (R-SC), Bill Cassidy (R-LA), Dean Heller (R-NV), and Ron Johnson (R-WI) proposed a disastrous idea: to block grand Medicaid (ending the Medicaid expansion), eliminate the health insurance subsidies, eliminate essential benefits coverage, end federal protections for pre-existing conditions, and eliminate both the individual and employer mandate to carry insurance. 

This draconian bill seemed too disruptive to be considered, but the Republican Party embraced the idea as the fulfillment of its campaign promise to end “Obamacare.” Suddenly, the bill had legs and was on its way to a vote. The entire healthcare community, including the American Medical Association, all 50 Medicaid Directors, AARP, and the entire health insurance industry was forced to mobilize itself like never before to hold the line until September 30, 2017 at 11:59 pm. 

The bill was hastily scored by the Congressional Budget Office on September 26, 2017. The partial analysis informed Congress that enacting the legislation would result in millions of people losing health care coverage in every sector, through Medicaid, and the individual and employer markets. There would also be billions of dollars of health care cuts in CA, NY, MA and MD. That was enough for Senator Susan Collins (R-ME) to announce her opposition to the bill, joining her colleagues John McCain (R-AZ) and Rand Paul (R-KY) in opposition to the legislation for both procedural and substance reasons.  

The failure of the latest push to repeal “Obamacare” is a great victory for health care advocates and the millions of Americans who were at risk of losing health care access.  Now, the Congress can shift its focus to reauthorization of popular and essential programs like the State Children's Health Insurance Program (SCHIP), and the Community Health Center Fund set to expire on September 30, 2017. SCHIP and Community Health Centers provide health care coverage and access to millions of Americans.

Although Congress will miss the deadline of September 30, the bills will be considered next week by both the Senate and House. San Francisco AIDS Foundation has been in the middle of these fights, thrilled by our recent success in keeping all the HIV funding intact despite proposed cuts from the Administration, and looking forward to our next opportunity to improve the health care access and health care funding for people living with HIV.  

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