The ACA, Medicaid, and ADAP - A March Policy Update

Our policy team has been closely following the President, Congress, and our state representatives to see how laws and executive orders will impact our communities. This month, find out what has happened already and what to expect in the next few months.

An Update on the Affordable Care Act

Federal actions promised by the Trump Administration, designed to roll back Obama era policies on health care, have started more slowly than anticipated. The Congress, created its budget reconciliation resolution as the mechanisms to repeal financial components of the Affordable Care Act (ACA), but stalled action when confronted with exactly what to cut, and the implications on constituents.

The Republican-controlled Congress is also divided on how to repeal the ACA without cutting coverage to a significant number of the 20 million people currently insured through the ACA. Insurance companies have notified Congress that they will only write 2018 individual health insurance policies for ACA recipients with certainty that the federal subsidies that cover their premiums are guaranteed for 2018. Guaranteeing those subsidies delays the implementation date of any congressional action until at least 2019. The Trump Administration initially promised to present its ACA replacement legislation as soon as HHS Secretary Tom Price was confirmed, but now have notified Congress that it will not present a plan, and will await a plan from Congress. 

What’s Happening with Medicaid?

Reports from the Hill suggest that changes to the Medicaid program present the biggest challenge for the Congress. The 11 Republican Governors who expanded their state’s Medicaid programs have become dependent on the generous federal Medicaid match. The Medicaid program has seen a significant increase in recipients, many with untreated medical conditions, raising the initial cost of care.  However, the expanded coverage has also produced reductions in morbidity and mortality, an outcome Governors want to sustain.  If federal support is cut, Governors will avoid cost shifting by demanding flexibility through federal waivers, to create programs that cost less, are less accessible, and offer less benefits to consumers of health care.

What Can We Expect this Session of Congress? 

The federal appropriations process that funds the government is moving along in order to address the funding levels for fiscal year 2018 that begins October 1, 2017. The current continuing resolution funding the government ends on April 28, 2017, and Congress will have to act.  The February President’s Day congressional recess was highlighted by town hall meetings where angry crowds of constituents demanded a replacement for the ACA at least as good, and hopefully better to address their health care needs.

Former Speaker of the House, John Boehner said that the Congress has no plan for replacing the ACA and at best, it would tinker around the edges, putting  a more conservative cast on the program, but the infrastructure would be the same.  The House Republicans did release a blueprint for action, but no legislation has been introduced based on that blueprint that has the consensus of the party.

The legislative calendar is running out of time, with mandatory spending bills taking priority over the new anticipated legislative proposals from the Trump Administration.  San Francisco AIDS Foundation will participate with other community based agencies in the annual HIV/AIDS advocacy event on Capitol Hill in Washington, DC, AIDSWatch2017 on March 27-28, 2017. The event brings hundreds of people living with HIV, community based providers, health department representatives and advocates from across the country to educate Congress on the state of the HIV epidemic in rural and urban communities, and the role of federal funding for HIV in our communities and how it is being spent to serve people with HIV.  

A Look at California

While the fight over the future of the ACA continues in D.C. and congressional town halls across the country, the legislative and budget agenda in California is continuing to proceed. California HIV advocates are moving forward with a budget agenda that includes funding requests to backfill federal cuts to HIV and hepatitis C testing, increase provider reimbursement rates in the HIV Medi-Cal waiver program, and increase funding for the AIDS Drug Assistance Program (ADAP) enrollment worker network.

There are a number HIV-related bills that San Francisco AIDS Foundation supports that are making their way through the legislature including SB 239, introduced by Senator Scott Wiener and Assemblyman Todd Gloria, that would modernize California's outdated HIV criminalization laws, putting HIV on par with other communicable diseases and requiring an intended transmission for prosecution.

Senator Wiener has also introduced the HEAL (Help End Antiretroviral-related Lipodystrophy) Act which will require insurance companies, as well as government programs, to cover medical treatment for lipodystrophy, a fat-redistribution condition impacting many HIV-positive people who took life-saving early HIV medication that were highly toxic in this regard. And Assembly member Eggman has introduced AB 186, which will allow cities and counties to establish effective harm reduction programs such as supervised consumption services (SCS). The bill would give communities the ability to better address the increase in drug overdose deaths, link people to substance use disorder treatment, and reduce new HIV and hepatitis infections.

Finally, as we’ve been reporting, California’s ADAP continues to experience significant problems since changing contractors last summer.

However, we are pleased to report that the California Department of Public Health announced that they have terminated a contract with ADAP administrator A.J. Boggs, effective March 31. This decision comes after continuing complaints from ADAP clients and enrollment workers, and pressure from HIV advocacy groups and key members of the legislature concerned about the frustrations and difficulties that people living with HIV have been experiencing with the ADAP system.

Enrollment workers and HIV advocates are optimistic about the decision, and hopeful that the change will bring about much-needed improvements to the ADAP system.

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