The Current Landscape Challenges and Opportunities in HIV

The Current Landscape: Challenges and Opportunities in HIV Care Emily Mc. Closkey NASTAD

ABOUT NASTAD • WHO: A non-profit association founded in 1992 that represents public health officials who administer HIV and hepatitis programs funded by state and federal governments. • WHERE: All 50 U. S. states, the District of Columbia, Puerto Rico, the U. S. Virgin Islands, and the U. S. Pacific Islands. Africa, the Central America region, and the Caribbean region. • HOW: Interpret and influence policies, conduct trainings, offer technical assistance, and provide advocacy mobilization for U. S. health departments and ministries of health.

OUR MISSION AND VISION • • MISSION: NASTAD’s mission is to end the intersecting epidemics of HIV, viral hepatitis, and related conditions by strengthening domestic and global governmental public health through advocacy, capacity building, and social justice. VISION: NASTAD's vision is a world free of HIV and viral hepatitis.

Overview • • • Administration Positions & Appointees Administration Actions The 115 th Congress Budget & Appropriations ACA Repeal & Replace Other Legislative Issues

ADMINISTRATION POSITIONS & APPOINTEES

Secretary of HHS Tom Price 6

OMB Director Mick Mulvaney 7

CMS Administrator Seema Verma 8

Assistant Secretary for Health Brett Giroir 9

Assistant Secretary for Mental Health and Substance Use Disorders Elinore Mc. Cance-Katz 10

HRSA Administrator George Sigounas 11

2 CDC Director Brenda Fitzgerald

3 Surgeon General Jerome Adams

Domestic Policy Council (Healthcare) Katy Talento 14

Who is Still Here? Richard Wolitski, Ph. D. Director, Office of HIV/AIDS and Infectious Disease Policy Laura Cheever, M. D. , Sc. M. Associate Administrator for HIV/AIDS Bureau Jonathan Mermin, MD, MPH, Director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) Eugene Mc. Cray, MD, Director of the Division of HIV/AIDS Prevention (DHAP)

Looking Forward • Of 557 key positions requiring Senate confirmation: – 368 - No nominee – 0 - Awaiting nomination – 106 - Formally nominated – 117 – Confirmed • What is causing this delay?

ADMINISTRATION ACTIONS

8 Memorandum for the Heads of Executive Departments and Agencies • Halts new federal regulations until reviewed by the new administration • Impacts the 340 B Drug Pricing Program Omnibus Guidance

9 Establishing the President’s Commission on Combating Drug Addiction and the Opioid Crisis • Executive Order: Establishing the President’s Commission on Combating Drug Addiction and the Opioid Crisis – Led by New Jersey Governor Christie and administrated by ONDCP – Will submit a report in the fall that focuses on: • Identify existing federal dollars to combat drug addiction • Assess availability and access to treatment & overdose reversal and identify underserved areas • Measure the effectiveness of state prescription drug monitoring programs • Evaluate public messaging campaigns about prescription and illegal opioids

Comprehensive Plan for Reorganizing the Executive Branch • • Instructs all agencies to examine their operations and draft plans for reorganization within 180 days HHS Reimagining Process has begun: – Silo-busting – Technology – Patient-Centered Medical Care – Drug Pricing – Supporting physicians

1 Presidential Advisory Council on HIV/AIDS • • Six members of PACHA recently resigned citing the Administration’s lack of focus on HIV as the reason A seventh member also recently resigned Fourteen members remain on PACHA Reps. Barbara Lee (D-CA-13) and Ileana Ros. Lehtinen (R-FL-27), the co-chairs of the Congressional HIV/AIDS Caucus, sent a letter to President Trump following the resignations. – Called for the White House to back off proposed budget cuts to HIV programs, restoration of the ONAP website and the appointment of an ONAP Director

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Teen Pregnancy Prevention Program • Teen Pregnancy Prevention Program grantees were notified by HHS’ Office of Adolescent Health that their grant cycle would be cut from 5 to 3 years – Applies to 81 grantees • National Capacity-Building Assistance Providers were notified that their project was terminated as of June 30, 2017

THE 115 TH CONGRESS

Power Players 25

BUDGET & APPROPRIATIONS

7 FY 2018 Budget • • The Budget Control Act of 2011 set legislative budget caps for future fiscal years, with sequestration as an enforcement mechanism These budget caps were raised for FY 2016 and FY 2017, but caps are set to return to original legislative levels for FY 2018 – $516 billion for non-defense discretionary • programs, decrease of $14 billion from FY 2017 enacted levels President Trump has proposed eliminating parity between defense and non-defense discretionary funding, which would deepen cuts to nondefense discretionary programs

8 FY 2018 Budget • • Congress can provide partial sequestration relief, let sequestration take effect for the first time, or lower nondefense discretionary levels The Tuesday Group, a centrist Republican group of legislators, sent a letter to Speaker Ryan on the need for a bipartisan budget deal that will offer sequestration relief

9 FY 2018 Budget • The House Budget proposed deep cuts for non-defense discretionary funding -$1. 3 trillion over the next decade – 17% below the inflation-adjusted 2010 level in • FY 2019 – By 2027, 44% below 2010 levels Chairwoman Diane Black (R-TN) has indicated that the budget will be considered on the House floor, but has not guaranteed passage

0 FY 2018 Appropriations • Despite no budget resolution, the House Appropriations Committee has been marking up appropriations legislation – Transportation-HUD - flat funded HOPWA – Labor, Health & Human Services - 302 b • allocation $5 billion less than FY 2017 • Flat Funded NCHHSTP • Flat Funded Ryan White Program • Eliminated Secretary’s Minority AIDS Initiative Fund House will vote on a spending package that exceeds caps when they return from recess

1 FY 2018 Appropriations • Senate has begun work on Appropriations – Cut HOPWA by $26 million – Anticipate a hearing on LHHS next week • Administration Funding Priorities?

Secretary’s Minority AIDS Initiative Fund • • SMAIF funds are allocated for crossagency demonstration initiatives and other projects to test innovative strategies and solutions, provide outreach, education, and technical assistance Funds THRIVE, Partnerships for Care, and Project PRIDE, as well as many other projects

ACA Repeal and Replace

5 What Happens Next • • It’s not over ‘till it’s over… – Many potential bills to be dropped in the fall, but not likely to see much movement We could see movement on smaller market stabilization bills – Bipartisan Senate Hearings have been announced to • focus on stabilizing premiums in the individual marketplace President Trump tweeted “Let Obama. Care fail and then come together and do a great healthcare plan” – Highlights the large role that the Administration plays in making the ACA work

6 In the Meantime… • • Open enrollment for the 2018 plan year will be challenging, with more plans opting out of the Marketplace, citing uncertainty created by Congress CMS has issued Request for Information on potential changes to ACA regulations States are beginning to submit new 1115 Medicaid waivers in light of CMS guidance – Waivers could increase cost sharing, impose work requirements, and put in place other limitations on coverage

OTHER LEGISLATIVE ISSUES

340 B Drug Pricing Program • Office of Management and Budget (OMB) marked the final 340 B Omnibus Guidance as withdrawn – 340 B Program will continue as is and without change for • the time being House Energy and Commerce (E&C) Committee sent letter to HRSA Administrator – Focused on the growth of the program and the lack of – • oversight by HRSA Requested all documents related to HRSA audits of covered entities in FY 2015 & FY 2016 E&C Oversight & Investigations Subcommittee hearing - “Examining HRSA’s Oversight of the 340 B Drug Pricing Program” – Focused on legislative authority for HRSA to provide oversight

Ryan White Reauthorization • • • President’s budget did signal a willingness to work with Congress on the next authorization Due to the full legislative agenda, NASTAD doesn’t anticipate Ryan White Reauthorization in 2017 The Ryan White Work Group is in regular communication with key Congressional offices in case Ryan White becomes a topic of conversation amongst Hill staffers

Contact Information Emily Mc. Closkey emccloskey@NASTAD. org 202 -434 -8067