IN THE LOOP

Following the horrific events in Charlottesville, APLA Health stands united with organizations and individuals around the world in condemning white supremacy, anti-Semitism, and bigotry in all forms. Recent events are a stark reminder of the hate and intolerance that continue to plague this country and wreak havoc on the safety and wellbeing of our families, friends, and communities. APLA Health stands unequivocally against hate and calls on President Trump and members of Congress to do the same.

Last week the Trump administration announced that, for the month of August, it would fund crucial payments that make health insurance more affordable for low- and moderate-income individuals. These payments, known as cost-sharing reductions, help lower deductibles and other out-of-pocket costs for people who are enrolled in “silver-level” marketplace plans and make less than 250 percent of the federal poverty level (about $60,000 for a family of four). Trump has repeatedly threatened to end the payments and still will not commit to funding them through 2018 despite urgent pleas from both Republican and Democratic lawmakers.

A recently released analysis by the nonpartisan Congressional Budget Office found that ending these payments would raise premiums for “silver-level” plans by about 20 percent in 2018, cause more insurers to withdraw from the marketplaces, and increase the number of uninsured by 1 million next year. Ending the cost-sharing reductions would also increase the federal deficit by $194 billion over the next 10 years, as the federal government would be required to pay more in premium-tax credits for low- and moderate-income people to offset rising premiums.

Covered California, the state’s health insurance marketplace, announced earlier this month that it would need to impose an additional 12.4 percent average surcharge on “silver-level” plans if the Trump administration would not commit to funding the cost-sharing reduction payments through 2018. Fortunately, even if Trump decides not to make the payments, most consumers would not see a “net” change in what they would pay since their premium tax credit would also increase. Covered California is waiting until September 30th to make a final decision whether its health plans must add the surcharge.

To sum it up, not funding the cost-sharing reduction payments through 2018 would destabilize the markets and cause premiums to spike for millions of people across the country. President Trump should stop playing politics with America’s healthcare and pledge to continue the payments on a permanent basis.

An estimated 136,000 Americans now take PrEP (pre-exposure prophylaxis) to prevent HIV infection, a dramatic increase since 2012. But PrEP users remain overwhelmingly white and over age 25—meaning most young gay men of color who are most at risk for HIV are not accessing the medication.

Gilead Sciences, the manufacturer of Truvada (the HIV medication used for PrEP), presented this new data at the 9th International AIDS Conference on Science in Paris last month. The data show that PrEP uptake increased by 9 percent per quarter between 2012 and 2014; then by 17 percent per quarter between mid-2014 and the end of 2015. Since then, PrEP starts have levelled off to 1 percent increases per quarter.

Gilead had access to some 84 percent of Truvada scripts from retail pharmacies across the country. Their estimate on PrEP use did not include PrEP uptake in Medicaid and some private plans, which include thousands more PrEP users.

Some health insurers have created obstacles to PrEP access by imposing “prior authorizations” on Truvada for PrEP and, in the case of United Healthcare, by ludicrously denying PrEP for a gay man because he was engaging in “high risk homosexual” behavior. The denial letter then stated that Truvada for PrEP was intended for “pre-exposure prophylaxis (PrEP) to reduce the risk of sexually acquired HIV-1 infection in adults at high risk.”

Advocates are working to stall further moves to impose prior authorizations on PrEP. The prior authorization process is time consuming for physicians and puts patients at risk of delays and medication interruption. In the United Healthcare case, advocates nationally flooded United Healthcare with protest letters and ultimately convinced United to reverse its policy.

If you have had trouble accessing PrEP, let us know through GovernmentAffairs@apla.org. You can also learn more about PrEP at aplahealth.org/prep.

The California legislature is returning from recess this week, and the Assembly will consider a new package of bills aimed at increasing access to affordable housing and ending homelessness. Gov. Brown, Senate President Pro Tem de Leon, and Assembly Speaker Rendon have backed Senate Bills 2, 3, and 35, which would increase funding for low-income housing developments and related projects and reduce development regulations. There are about a dozen smaller bills around housing and homelessness that, if passed, would complement this package. You can read more about all of those bills at latimes.com.

While the three big bills have passed out of the Senate and there is broad consensus on the need to address the affordable housing shortage, opposition remains from legislators who are concerned about increased fees and taxes that would be necessary to fund the projects. The state would need to find a way to establish an ongoing funding source for development, as the need for affordable housing far outweighs the rate at which new low-income housing can be built. The legislature has until September 15 to send the bills to Gov. Brown for his signature.

APLA Health is keeping an eye on these efforts and applauds the Governor’s commitment to getting a comprehensive housing package through the legislature. Access to affordable housing is vital for people living with HIV, leading to better retention in care and improved health outcomes. It is also important for reducing new HIV infections. The state’s efforts to address homelessness and the affordable housing crisis are critical to ending the HIV epidemic and this housing package would be a constructive first step.