HIVMA KEY TALKING POINTS FOR LEGISLATORS
- For FY2018, urge them to support at minimum the FY2017 funding levels for HIV/AIDS programs, PLUS restoration of the $4 million cut to Part C of the Ryan White program, the $5 million cut to STD prevention at the CDC, and a bump up for CDC’s program to address the viral hepatitis epidemic.
The Ryan White HIV/AIDS Program:
- A well-funded Ryan White Program is critical to improving patient outcomes and public health by supporting the range of services needed to help patients achieve and maintain suppression of the virus -- keeping them healthy and reducing their risk of transmitting the virus to near zero.
- Describe how the Ryan White Program is important to your ability to provide cost effective comprehensive to patients without other sources of coverage and explain how this also benefits public health. Download and share this infographic on the improvements in viral suppression among individuals who receive Ryan White services.
- Request that Congress at minimum restore the FY2017 cut of $4 million to the RW Part C Program in FY18 for a program level of $205.1 million.
- The AIDS Educational and Training Centers play an important role in responding to provider shortages and keeping the current workforce up-to-date on the latest clinical issues, such as advances in hepatitis C treatment and managing substance use and addiction issues. Do not support the President’s proposal to eliminate the AETCs.
- The Special Programs of National Significance is a cutting edge program that evaluates innovative models for improving care delivery and health outcomes that are replicable. The program is always looking ahead at how best to respond to the latest clinical challenges. Current initiatives include building HIV capacity in Federal Qualified Community Health Centers and developing medical homes for individuals with HIV who are homeless. Do not support the President’s proposal to eliminate this program that evaluates ways to more effectively deliver care and improve health outcomes for some of the most vulnerable populations with HIV.
HIV RESEARCH AT THE NIH:
- Explain the role of NIH-supported research in advancing HIV prevention, care and treatment and the impact of flat funding or cuts in HIV research funding. Download and share this two-pager on HIV research and its cross-cutting benefits to people with HIV and others with life-threatening illnesses.
- A decade of flat funding imperils discovery of the next game-changer in HIV research. Key priorities and opportunities include:
- Developing a Cure: In July 2016, NIH awarded $30 million over five years to six research collaborations working to advance basic medical science toward an HIV cure that would permanently suppress the virus without the need for ongoing lifelong treatment.
- Improving Implementation on the Ground: Understanding how to effectively deploy biomedical prevention interventions, such as Pre-Exposure Prophylaxis (PrEP)
- Developing a Vaccine: The discovery of an antibody that can neutralize many variants of the most common strain of HIV holds promise for a vaccine that could protect against HIV infection
- Addressing Health Disparities: Reducing the higher HIV infection rates and poorer health outcomes occurring among adolescents and young black men in particular
- Improving Prevention Options for Women: Improving prevention interventions for women who represent 51% of people living with HIV worldwide.
- Responding to HIV & Aging: Learning more about the impact of HIV infection on the aging process
- NIH-supported research funding opportunities play a critical role in attracting and retaining physicians in infectious diseases and without this funding it is difficult for physicians to stay in the field. Restricting research opportunities now will have a long-term impact on our country’s ability to prevent and treat deadly infections by limiting research discoveries and eroding infectious diseases workforce capacity.
NATIONAL OPIOID EPIDEMIC:
- The Centers for Disease Control and Prevention estimates that more than 200 counties in the U.S. are at risk for HIV outbreaks linked to injection drug use. Look up and share data for your state available from the interactive amfAR opioid and health indicators database.
- Expanding access to all effective HIV prevention interventions, including syringe exchange services, is important to reduce the spread of HIV and other infections among injection drug users.
PATIENT PROTECTION AND AFFORDABLE CARE ACT:
- Effective treatment improves not only individual health but reduces transmission of HIV to others, an important strategy to end the HIV epidemic.
- Prior to the ACA, many people living with HIV were denied healthcare coverage or it was unaffordable. In most states, people with HIV did not qualify for Medicaid coverage until they became sick and disabled by AIDS.
- After one year, the percentage of people living with HIV who were uninsured decreased by 4 percent nationally and six percent in Medicaid expansion states.
- Rather than repealing the ACA and leaving millions of Americans uninsured, support bi-partisan solutions to stabilize the individual insurance market in communities where that is needed; commit to funding the cost sharing subsidies and ensure continued support for enrollment activities.
- Maintaining the federal commitment to the Medicaid program is important to the more than 40% of people living with HIV in care who count on program for their healthcare coverage.
- The significant cuts in federal Medicaid funding estimated to occur under capped Medicaid funding would limit Medicaid eligibility for patients with HIV and weaken the Medicaid coverage available to those who are eligible.
- Prior to the Medicaid expansion many people with HIV were not eligible for Medicaid coverage until they were sick and disabled by AIDS, no matter how poor they were.
- If your state expanded Medicaid: Please describe how the expansion has helped your patients and what the impact on your patients would be if expansion coverage ended.
- If your state did not expand Medicaid: Please share how important it is to leave this option open to states and how it would benefit your patients if relevant to your state’s situation.
HIV MEDICAL WORKFORCE:
- Infectious Diseases-trained physicians represent 60% of HIV medical providers. Since 2011, there has been a decline in the number of physicians applying for ID fellowship program slots with nearly one-third of ID training programs going without fellows in 2016. This year more programs filled their fellowship slots but around 20% of ID training programs still went without trainees.
- The two primary and related issues discouraging residents from pursing infectious diseases specialization are lower salaries relative to other physician specialties and high debt burden from medical school.
- HIV physicians primarily provide comprehensive evaluation and management of patients with acute or chronic, often very serious, conditions as well as extensive counseling and ongoing care coordination. Current reimbursement methodologies undervalue the evaluation and management services relative to procedural-based care.
- A re-evaluation of reimbursement methodologies for cognitive services is needed along with targeted loan forgiveness for ID/HIV medical providers working with underserved patient populations, including those affected by hepatitis C, HIV and the opioid epidemic.