IN THE LOOP

President Trump made several moves earlier this month intended to undermine the stability of the health insurance marketplaces in the Affordable Care Act (ACA), but a compromise measure crafted by two senators and released last week may come to the rescue.

Trump effectively pushed Congress to act by ordering an immediate end to the ACA cost sharing reductions (CSR), payments to insurers that help lower out-of-pocket costs for millions of low- and moderate-income Americans. Trump also signed an executive order calling on federal agencies to expand the availability of health insurance plans that cover fewer benefits and offer fewer consumer protections that could be sold across state lines.

Luckily Trump’s actions will not have a big impact immediately. Most states have already allowed insurers to account for the CSR payment cut off and federal agencies still need to adopt regulations implementing the executive order. Make no mistake, however, these actions threaten to destabilize the ACA health insurance exchanges as early as 2019 and would result in significantly higher premiums for millions of people.

The impact for now will be minimal in California. Covered California has already added a premium surcharge to Silver plans in anticipation of the CSR payments ending and consumers who are eligible for advanced premium tax credits (APTCs) should not be affected by the higher premiums. Consumers who are not eligible for APTCs may need to move to a non-Covered California plan. You can learn more about these changes here.

Shortly after Trump issued his orders, Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) announced compromise legislation that would guarantee the CSR payments for two years and allow states greater flexibility with ACA regulations, including the sale of high-deductible catastrophic plans to people over 30. The President immediately voiced support for the legislation, but then waffled. Some key Republican members of Congress have said they would be opposed, while Senate Democrats have come out in support of the measure. Also, 18 states including California have asked the courts to force Trump to make the CSR payments.

You would think Congressional Republicans would be happy to punt on their failed efforts to repeal the ACA until after the midterm elections in 2018. But some seem wedded to the idea that they promised to repeal the ACA for the past seven years, and they’re sticking to it.

On October 6, Gov. Jerry Brown signed legislation to modernize California’s outdated and discriminatory HIV criminal laws. Senate Bill (SB) 239 was authored by Sen. Scott Wiener (D-San Francisco) and Asm. Todd Gloria (D-San Diego) and co-sponsored by APLA Health, Equality California, ACLU of California, Black AIDS Institute, Lambda Legal and Positive Women’s Network – USA.

Here’s a brief summary of what the bill does and why it matters:

• SB 239 updates California criminal law to approach exposure to HIV in the same way as exposure to other serious communicable diseases. Previously, HIV was singled out for harsher punishment than other communicable diseases including serious diseases such as Ebola, hepatitis C, and tuberculosis. The new law makes it a misdemeanor to intentionally transmit, or attempt to transmit, any serious communicable disease to another person.
• SB 239 ensures that California law reflects a science-based understanding of HIV prevention, treatment and transmission. For example, the new law ensures that people living with HIV and other communicable diseases cannot be prosecuted if they take measures to reduce the risk of transmission—such as using a condom or being on treatment.
• SB 239 repeals outdated criminal laws related to donation of blood and other bodily fluids by people living with HIV. Since these laws were passed, scientific technology for detecting HIV has become much more advanced. Standard screening procedures are now sufficient to protect the blood supply in the rare event that someone would knowingly donate blood while living with HIV.
• SB 239 repeals a law that increased penalties for sex workers living with HIV. This law was generally used in situations with no possibility of HIV transmission and disproportionately impacted women and people of color. Instead of making our communities safer, the law further criminalized an already vulnerable community and made them less likely to access HIV testing and treatment.

We thank Gov. Brown and the California Legislature for their commitment to protecting people living with HIV from discriminatory and unfair prosecution. With the passage of SB 239, California has become a leader in the national movement to reform outdated HIV criminal laws.

For more information, visit eqca.org/chcr/faq.

The California Department of Public Health recently released its 2016 STD Surveillance Report, highlighting a surge in STD rates for the third year in a row. Los Angeles County reported some of the highest rates in the state, according to the report. In 2016, there were 59,176 cases of chlamydia (a 4% increase from 2015), 22,361 cases of gonorrhea (a 27% increase), and 4,018 cases of syphilis (a 16% increase). In addition, the report noted that the majority of the cases were among young people, African Americans, and gay and bisexual men.

LA County’s Division of HIV & STD Programs (DHSP) Director Mario Perez noted that part of the rise in STDs is that condom use has declined, and people aren’t getting tested frequently enough. It’s important to stay protected and get tested often, as most STDs are asymptomatic at first, and those that go untreated can lead to serious health problems, especially for people living with HIV.

The Board of Supervisors has asked the Department of Public Health to report back on the STD crisis in LA County, including a survey of how often residents are getting tested and accessing services available from county clinics, community health centers, and private medical centers. Perez said that funding for STD prevention programs has continued to decline, but that the public health department will use the report to determine how to “align resources and programming to address the disproportionate impact of STDs in communities of color, and among young people, transgender persons and men who have sex with men.”

Remember to get tested every 3-6 months. APLA Health offers free and confidential HIV and STD testing and treatment at our Gleicher/Chen Health Center in Baldwin Hills and at our Long Beach Health Center.
Walk-ins are welcome!