Download National Policy Update: The AIDS Institute

Policy Update
Michael Ruppal
Executive Director, The AIDS Institute
Director, Center for Public Policy Research and Ethics
at USF Health Division of Infectious Disease &
International Medicine
[email protected]
Policy Update
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National HIV/AIDS Strategy
Budget and Appropriations
Ryan White Program
HIV Prevention
Health Reform
Hepatitis
National HIV/AIDS Strategy
• Sets out Goals, Strategies and Activities to:
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Reduce New Infections
Increase Access to Care & Viral Suppression
Decrease Disparities
Increase Government Coordination
• Timeline for Activities, Periodic Status Reports
• Future Steps Decided by Next President
– Community Advocacy to “End AIDS”
Budget & Appropriations
• FY17
– Federal budget is operating under a Continuing
Resolution (CR) thru 12/9/16
– House and Senate Committees Passed Different Bills
• Each contains different increases and decreases
• Difficult to reconcile
– Both Maintain HIV and Hepatitis Funding for:
• CDC HIV Prevention ($789 m)
• CDC Hepatitis Prevention ($34 m)
• HUD HOPWA ($335 m)
– Both Increase Overall NIH Funding
• Senate: $2 b
House: $1.25 b
Budget & Appropriations – FY17
• Ryan White HIV/AIDS Program
– House Flat Funds ($2.3 b)
– Senate Proposed Cuts
• Part C ($4 m)
• Special Programs of National Significance ($25m)
• Secretary’s Minority AIDS Initiative
– House Flat Funds ($54m)
– Senate Proposed Cut ($6 m)
• Other House Cuts
– Teen Pregnancy Prevention Program & Title X
– ACA
Budget & Appropriations – FY18
• Expect Difficult Budget Environment
– New President and New Congress
• Budget Control Act (Caps Discretionary Spending)
– Sequestration Kicks in w/o Congressional Changes
• Other budgetary demands
– Competing health issues (Zika, opioids)
& other diseases
– Non-health related
Ryan White Program
• Authorization expired, but continuing through Appropriations
• Program evolving as clients gain health coverage (Medicaid &
Marketplace Exchange Plans)
– Varies by state, Medicaid expansion key
– Ryan White is the payer of last resort
• Most funding based on Formula (case counts)
– Supplemental Funding and Direct CBO funding (Parts C & D)
• The AIDS Institute Analysis
– Parts A & B: Florida Ranks #15 by $/case count
– Add in C & D: Florida Rank moves to #34
• Some flexibility to distribute money based on need with
Supplemental Funding
– 340B Income creating difficulty in states spending money
Ryan White Program
• Unknown when Reauthorization will occur
– No community consensus on changes
– Desire to assist the South
– Interest by Congress unknown
– Next Administration?
• Issuers for Consideration
– Part Structure
– Formula and non-formula distribution
– Funding more need based
– Coverage of PrEP
– Hepatitis C
HIV Prevention
• Focus on right populations, right areas with the right tools
– Gay men, youth, African-Americans and Latinos etc.
• New tools
– PrEP
– Federal funding for Syringe Services
– Billing for HIV testing
• Focus on testing, linkage to care and remain on treatment
– Treatment is Prevention
• Accountability of grantees
Health Reform
• Ensuring it works for people with HIV, hepatitis and
other chronic conditions
• Concern over Patient Cost-sharing, Drug Formularies, Utilization
Management, Network Adequacy
• Florida Discrimination Complaint
• Enforcement of Patient Protections
• 2017 Plans to be made public soon & Open Enrollment
• Debate over ACA Future
– Improvements or repeal
– Drug Pricing
Hepatitis
• Opportunities to End Hepatitis B & C as a public health threat
– WHO Goals
– National Academies of Sciences Reports
• Federal HHS Action Plan
– Update to be released in October
• Very Small CDC Budget for entire country
• Hep C Cure Rx
– Medicaid restrictions (Florida Lifted Most)