By: Marcus J. Hopkins, Blogger
As it tradition for HEAL Blog, the final post for 2017 will be a look back at the topics we’ve covered over the year and a look forward to the future.
HEAL Blog releases 50 posts a year (including this post), and those posts fell within one of five categories: Hepatitis Increases, Incarceration, HCV Drug Discussions, Opioids, and Other. Posts related to Hepatitis Increases focused primarily on reports of increased infection/morbidity rates in various states and population, including Hepatitis A, B, and C. Those related to Incarceration focused primarily on increased infection rates and treatment within incarceration settings (prisons, jail, and juvenile detention centers). Posts related to HCV Drug Discussions focused on pricing, availability, and treatment outcomes. Opioid-related posts focused on the toll of the opioid epidemic in the U.S. and the role they play in increasing rates of infection for HIV and Viral Hepatitis (VH). Posts that fell outside of those specific topics are categorized as “Other.” The distribution of those posts are as follows.
- Hepatitis Increases – 17
- Incarceration – 4
- HCV Drug Discussions – 15
- Opioids – 9
- Other – 4
As the incidence of Viral Hepatitis infections continues to rise, there are specific patterns – most of the highest rates exists in states that are primarily rural or suburban (with few densely populated metropolitan areas); new Acute Hepatitis C (HCV) diagnoses tend to be in younger populations (ages 18-45) and are increasingly linked to Injection Drug Use (IDU) as the primary risk factor for infection within this age demographic. Prescription opioid abuse and heroin are playing an increasing role in the spread of HCV, not only in America, but across the globe. In the U.S., many of the rural states where HCV rates are exploding are racially and ethnically homogenous (read: primarily Caucasian/White). Despite this, even in states with low numbers of racial and ethnic minorities, African-Americans are disproportionately impacted by HCV infections as a percentage of the population – despite being fewer in number, the percentage of African-Americans infected is higher than other racial and ethnic groups.
In addition to HCV-related infection increases, homeless and indigent populations are facing vast increases in Hepatitis A (HAV) infections, particularly in metropolitan areas where homeless encampments are more densely packed and infections are more easily spread. Arizona, California, and Minnesota have all experienced high rates of HAV within their respective homeless populations, with California facing the highest rates of both morbidity and mortality. California’s HAV crisis is also quickly spreading along the coastline, heading northward. HEAL Blog will continue to monitor the situation.
As for the forecast into 2018…it’s not looking good for the U.S. With the installation of the Trump Administration’s various secretaries and their approach to management and governance, both healthcare advocates and institutional healthcare presences are considerably concerned with the path being laid before us. In addition to concerns about the appointments being made by the Trump Administration (of which there are many concerns, and far fewer appointments), the Legislative Branch’s stewardship under Republican majority in both houses has proven both hostile to the healthcare concerns of Americans, and incredibly clumsy in their attempts to address virtually any issue put before them. Both the Executive and Legislative Branches have inspired little confidence that anyone – healthy or otherwise – are going to come away from their agendas unscathed.
Both branches have, in 2017, created an environment of legislative and administrational chaos and uncertainty, both of which are reflected in the higher increases in health insurance premiums offers on the Affordable Care Act’s (ACA) insurance marketplaces. Between shortened enrollment periods and all-but-eliminated advertising and outreach budgets, enrollment is expected to fall short of its goals for insuring Americans in 2018. Moreover, this type of chaos, unreliability, and unpredictability tend to breed contempt, which may result in Republicans losing their majority in one or both houses during the 2018 midterm elections.
Of significant concern is the Republican Senate’s approach to bill crafting, which has largely been conducted in secret, without input from Democratic lawmakers, and is heavily influenced by the very special interest groups against which many of these politicians campaigned. After failing twice to repeal the ACA in 2017 despite having a majority in both houses, Senate Republicans have repeatedly attempted to cripple the law through various means, the most recent of which involved slipping into their “Tax Reform” bill an effort to repeal the individual mandate provision that requires virtually every American to purchase some sort of qualifying health insurance plan in an effort to stabilize costs once sicker clients entered the market.
In the Administrative Branch, the heads of the various Departments nominated by President Trump have done little to inspire confidence, as well. Tom Price, who was Trump’s initial pick for the Department of Health and Human Services, was forced to resign after reports indicated that he racked up $400,000 in privately chartered flights for personal and professional reasons. This was a significant departure, as previous heads took commercial flights, save for rare exceptions. Now that Price is out of the way, Trump has nominated Alex Azar, a former pharmaceutical company executive whose tenure at Eli Lilly saw a three-fold increase in the cost of the insulin over a ten-year period. Needless to say, it is less than certain that a person who oversaw such price increases will be the “…star for better healthcare and lower drug prices,” as President Trump stated in his tweet announcing his pick for the position.
Given the chaotic and unsteady stewardship of the country, it is hard to express any optimism going forward unless circumstances change dramatically.
Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.