Tag Archives: HIV/AIDS

The Kids Aren’t Alright

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

For nearly three years, healthcare officials and epidemiologists have been sounding the alarm: the face of the Hepatitis C (HCV) epidemic is changing – it’s getting younger by the minute. We, here at HEAL Blog, have been beating that drum alongside them, and yet, the U.S. Centers for Disease Control and Prevention (CDC) has yet to formally change the screening recommendations to reflect the new reality. As more evidence piles up that new Acute HCV infections are largely being driven by prescription opioid and heroin Injection Drug Use (IDU) among Americans aged 15-45.

A piece written by the Digestive Health Team out of the Cleveland Clinic – Why Is Hepatitis C on the Rise in 20- to 29-Year-Olds? – explicitly says as much. In addition, while African-Americans share a disproportionate burden in the epidemic (as a percentage of the population), these issues are particularly pronounced in white, non-urban (suburban and rural) populations living primarily in Appalachia, the Midwest, and New England.

So, what is it about these areas that drives people to abuse prescription opioids, heroin, and/or other illicit drugs? There isn’t just one answer. A lot of the areas where these outbreaks and epidemics are so pronounced share several similarities – struggling economic circumstances; higher-than-average unemployment; less access to and utilization of healthcare services; high rates of Social Security Disability Insurance utilization; economies driven by high-intensity labor industries (mining, for example). Any combination of these factors can lead people to develop substance addictions; that these areas are more remote with fewer outlets and opportunities for employment, entertainment, or social engagement essentially creates enclaves where people can all but disappear into a considerably isolated world of addiction.

Where the kids come in often has to do with the friends, relatives, and other adults whose legitimate opioid prescriptions get unknowingly diverted by experimenting teens who inadvertently become addicted to the highly addictive substances. As a young adult living in a small city in Tennessee in the 2000s, virtually all any of my friends and co-workers wanted to do was find “pills” (primarily OxyContin). Whereas I grew up in the cocaine-fueled 80s and ecstasy-addled 90s, parties in the 2000s were, for my generation, comparatively somber affairs, with everyone pilled out on opioids and barely able to function. Once the U.S. Food & Drug Administration (FDA) started to catch on and legislators began tightening prescribing guidelines, they turned to cheaper and more readily available heroin.

With IDU comes a whole host of risks that, for much of the 80s and 90s – particularly as it related to HIV/AIDS – were made explicitly known. Every health and D.A.R.E. (Drug Abuse Resistance Education) I was made to attend as a child, pre-teen, and teenager included a very graphic section on the dangers of injecting drugs. Almost every school in the 90s had a rumor going around about some random person who was dancing at a nearby club and got stabbed with a used needle and got AIDS. While a lot of hyperbole was involved in these stories, the sense of horror we were expected to evince – “WHAT?!?! A DIRTY NEEDLE?!?!” – led a lot of us to become more risk averse, particularly in our younger years.

Twenty years later? A lot of those fears have been forgotten. We no longer see horrific images of people dying from AIDS – the treatments are amazing, tolerable, and don’t kill you. We aren’t afraid of diseases like HIV or viral hepatitis, anymore, because…well, HIV isn’t a death sentence, and HCV is curable. Hepatitis B is still a huge problem, as it has no cure. But, the reality is that neither the fear of becoming addicted, nor the fear of becoming infected are presently palpable enough to prevent people from even starting. What starts out as a way to kick back with your friends and loosen up can quickly turn into a daily habit and morph into a physical dependency. Once you’re dependent and addicted, the risks become less frightening.

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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.

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Are Hepatitis C “intentional exposure” Criminalization Laws on the Horizon?

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

One of my favorite things about growing up in the 1980s/90s was hearing all about how “…this guy spit on someone, and it turned out…he had HIV.”

Inevitably, the “guy” they were talking about was supposedly arrested and charged with a felony for trying to infect someone with AIDS, and everyone would gasp in horror – how DARE someone try to spread AIDS by spitting on an innocent bystander?! If I happened to be in or around the group talking about this, I would always (not so calmly) explain to them that it is a scientific improbability that one could transmit the HIV virus by way of spit, because the concentration of the virus in spit is so low that there is almost a 0% chance that it can be transmitted outside of incredibly extreme circumstances and a concerted effort. Mind you, this was back in the late-80s/early-90s, when the AIDS panic was still in full swing. Even THEN, I wasn’t stupid enough to believe this kind of nonsense.

States that criminalize biting, spitting, or throwing of bodily fluids by people who have HIV

Little did I know, at the time, that these kinds of arrests were an actual thing. In 2017, there were 16 states that criminalize spitting, biting, and blood exposure for HIV-infected citizens (The Center for HIV Law & Policy, 2017).

I mean…

It’s 2018. These laws aren’t even based on good science!

So, because everything is awful, and America is totally known for basing their laws on good data and research, of course these fatuous laws would be extended to Hepatitis C (HCV) – one of the least effectively externally transmitted viruses.

Photo of a 27-year old man with Hepatitis C charged with spitting at Cleveland police officers.In Cleveland, OH, for example, a 27-year-old man who was drunk has been charged with First Degree Felonious Assault…for spitting on a police officer. He’s being held on $75,000 bond in the Cuyahoga County Jail, because he was drunk and spat in a police officer’s face while being put into an ambulance (Jankowski, 2018). Matthew Wenzler, the accused, has been called a “carrier” of HCV, and Cleveland Police reports state that they were “told” he is a “heroin addict.”

This isn’t even the first time Ohio has prosecuted someone for Spitting While HCV – in both State v. Price (2005) and State v. Bailey (1992), Ohio courts have upheld convictions for assault for spitting in an officer’s mouth. The neighboring state, Indiana, classifies Spitting While HCV as Class 5 or 6 felony battery…but only:

…if the accused in a rude, angry, or insolent manner places bodily fluid/waste on another person AND knew or recklessly failed to know that his or her bodily waste or fluid was infected with hepatitis [for Class 6].

…if the accused in a rude, angry, or insolent manner places bodily fluid/waste on another person AND knew or recklessly failed to know that his or her bodily waste or fluid was infected with hepatitis AND places the bodily fluid/waste on a public safety official [for Class 5] (Paukstis, 2017).

In South Dakota, a (Republican) state lawmaker has introduced legislation to make the transmission of HCV a Class 3 Felony punishable by up to 15 years in a state penitentiary and a $30,000 fine (Mercer, 2018). What makes this trouble is that this legislation is for “intentional exposure” which applies to “…transferring, donating or providing blood, tissue, organs or other infectious body parts or fluids” (Mercer). For anyone who’s paid attention over the past two years, the transplantation of HCV-infected organs has been repeatedly done, because there is now a functional cure for the disease. These organs are desperately needed at a time when the disease can be cured, and this legislation would making numerous people criminally liable for completing these procedures – the donor and anyone who approved or performed the transplant.

It should go without saying that criminalization of Viral Hepatitis (of any variety) and HIV is based not on good data or science, but upon efforts to shame and stigmatize those with the disease. It’s time for this nonsense to stop.

References

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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.

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Young Adults Most at Risk of Hepatitis C Infection Via Injection Drug Use

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

Statistical analyses from around the country don’t lie: our nation’s young adults are driving the Hepatitis C (HCV) epidemic in the United States, and prescription opioids and heroin are the primary risk factor. These data, released by the U.S. Centers for Disease Control and Prevention (CDC) in December 2017, indicate that adults aged 18-39 saw a 400% increase in HCV, 817% increase in admissions for injection of prescription opioids, and a 600% increase in admissions for heroin injection (CDC, 2017). This analysis was made by compiling data from the CDC’s hepatitis surveillance system and from the Substance Abuse and Mental Health Services Administration (SAMHSA) national database that tracks admissions to substance use disorder treatment facilities in all 50 U.S. states from 2004 to 2014.

Photo of the CDC Headquarters

Source: George Mason University

The findings “…indicate a more widespread problem than previous studies have shown,” researchers led by the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) wrote (Connor Roche, 2018). The largest increases were among persons aged 18-29 and 30-39 (400% and 325%, respectively), non-Hispanic Whites, and Hispanics (Zibbell, et al, 2018). Admissions for both men and women attributed to Any Opioid Injection Drug Use (IDU) increased significantly, as did admissions for heroin IDU, and Prescription Opioid Analgesics (POA). Amontg non-Hispanic Whites, admissions for Any Opioid IDU increased 134% over the 11-year period (Zibbell).

What makes this frustrating as an advocate for both HCV and for Harm Reduction measures is the pushback from Conservative and Libertarian organizations and “think tanks” who consistently claim that there is no “opioid epidemic;” that the only real problem we have is heroin and fentanyl (Singer, 2018). The Cato Institute – one such Libertarian organization (founded as the Charles Koch Foundation in 1974) – has consistently misrepresented data about the opioid epidemic in America by focusing only on overdose statistics. Even the statistics they cite – “Digging deeper into that number shows over 20,000 of those deaths were due to the powerful drug fentanyl, more than 15,000 were caused by heroin, and roughly 14,500 were caused by prescription opioids” – come with some caveat that portends to excuse their galling lack of accuracy.

The purpose of the Cato Institute and Mr. Singer’s positions is to attempt to persuade “rational” people that prescription opioids aren’t the real problem, and any efforts to restrict or regulate the dosages, supply days, or “well-meaning, hardworking” healthcare providers who prescribe prescription opioids is obviously absurd. Why, any rational human being would never abuse prescription opioids, and the people who do are the ones at fault; not those innocent physicians who prescribe the highly addictive substances. (/sarcasm)

Counter to the alternate reality created by Mr. Singer, where addiction to the effects of opioids just magically appears, and can’t possibly be related to prescription drugs, that isn’t how addiction works, nor do any of the surrounded data – drug abuse statistics, treatment facility admission records, and HIV/HCV infection data – support his nonsensical claim.

These findings from the CDC should be concerning to Americans. These problems are going to get far worse, before they get better, particularly if people who are addicted lose access to government-, employer-based, and/or privately-funded healthcare coverage. With the removal of the Individual Mandate from the Affordable Care Act in 2017, analysts consistently predict that chaos will ensure within the health insurance marketplaces, which will inevitably result in fewer people having access to affordable healthcare, an increase in unpaid medical and emergent care expenses, and increased prices for everyone.

References:

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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.

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HIV/HCV Co-Infected Patients Show Similar Cure Rates As Monoinfected

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

Patients who are co-infected with both HIV and Hepatitis C (HCV) demonstrated similar cure (Sustained Virologic Response – SVR) rates as patients who were monoinfected with HCV, according to research published in Hepatology, a journal published on behalf of The American Association for the Study of Liver Diseases. These findings were gathered using a review of studies dated January 2004 to July 2017, and came to the conclusion that the designation of patients co-infected with HIV/HCV as a “special population” by the U.S. Food & Drug Administration (FDA) should be reconsidered, given the advent and increasing use of Direct Acting Antivirals (DAAs) to treat HCV.

aasld-primary-logo

The special population designation by the FDA is designed to allow physicians and researchers to take into consideration populations who, for a variety of reasons – weight, existing disease morbidity, age, body composition, pregnancy, et cetera – may not respond in a typical fashion to standard treatment regimens. For patients living with HIV, many of the HIV-specific treatment regimens, until the past decade or so, made treating co-morbidities not HIV-related difficult, as other drugs would hamper or have their effects hampered by the medications used to treat patients’ HIV. The advent of newer, more easily tolerated, and more effective HIV medications has allowed for more flexibility.

Thus is the case with HIV/HCV co-infection. Prior to the entry of HCV DAAs to the market in 2013, interferon-based treatments were the only way to actively achieve SVR in HCV-infected patients. Notoriously difficult to tolerate and with a high treatment abandonment rate, interferon-based regimens resulted in very low SVR rates for both mono- and co-infected patients. This, along with the fact that co-infected populations experience accelerated progression of HCV-related liver disease, as well as existing barriers to care, led the FDA to designated HIV/HCV co-infected patients as a specific population with unmet medical needs.

The newer regiments, which are both easier to tolerate and exponentially more effective at achieving SVR, have produced similar SVR rates in both mono- and co-infected populations. This serves as good news to physicians and patients, alike. While these findings are welcome news, physicians must still be certain to determine if HCV regimens will have any counterindications with existing HIV therapies. Current treatment recommendations advise against stopping HIV therapy to pursue HCV treatment.

References:

  • Sikavi, C., Chen, P. H., Lee, A. D., Saab, E. G., Choi, G. & Saab, S. (2017, November 06). Hepatitis C and Human Immunodeficiency Virus Co-Infection in the Era of Direct-Acting Antiviral Agents: No Longer A Difficult to Treat Population. Hepatology. Alexandria, VA: The American Association for the Study of Liver Diseases. Accepted Author Manuscript. doi:10.1002/hep.29642

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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.

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Iowa Prison Systems Prepare for HIV & HCV Uptick

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

Iowa’s Department of Corrections (IDOC) has put in a request for additional funding for the 2019 fiscal year (FY19) in anticipation of potential upticks in new HIV and Hepatitis C (HCV) infections within Iowa’s jails, prisons, and youth correctional facilities as a result of increased abuse of prescription opioids and heroin. Jerome Greenfield, Health Services Administrator for IDOC, has requested an addition $1 million budget increase to accommodate increased pharmaceutical costs for the treatment of HIV and HCV (Pfannenstiel, 2017).

State Seal: Iowa Department of Corrections

Photo Source: IDOC

For each year from 2010 to 2015, between 12%-14% of Iowa’s incarcerated population tested positive for HCV, though these data account only for the individuals incarcerated at any given point in time, and do not account for the movement in and out of IDOC facilities (Iowa Department of Public Health, 2017). Of those entering into the IDOC system and who warranted screening, over 91% were screened for HCV in FY14, with a 5.6% testing positive; in 2015, over 78% were screened, and 4.5% tested positive. While the number of positive tests results decreased in 2015, that may be a result of fewer inmates being screened.

The budget request comes at a time when the state is grappling with a potential $75 million budget shortfall as a result of lower-than-expected revenue returns during the last fiscal year that ended June 30th, 2017. The IDOC, itself, suffered a $5.5 million budget cut in FY17, and a $1.6 million cut for FY18, making the likelihood of this request being fulfilled dubious, at best. For its part, IDOC officials believe that, should any more cuts be implemented, they will have to reduce staffing in order to deal with those losses. This means fewer correctional employees, which can create a hostile environment, leave inmate needs and concerns unmet, and foment distrust and enmity between inmates and correctional facility staff. As we saw in Delaware, earlier this year, this type of environment can lead to prisoners protesting and/or rioting (Oh, 2017).

Iowa’s also dealing with an explosion of new HCV diagnoses, which have more than quadrupled since 2009 among people between 18 and 30 (Carver-Kimm, 2017). For those from whom data were collected, over 51% reported Injection Drug Use (IDU) as a risk factor (Iowa Department of Public Health, 2017). The state is also making considerable inroads to combating the HCV epidemic within the state with seven local health departments and one Federally Qualified Health Center (FQHC) that administer HCV testing and Hepatitis A and B immunizations. These agencies, known as Counseling, Testing, and Referral (CTR) sites, are located in the state’s most populous counties, test only people who have ever injected drugs, and offer free HCV screening for anyone who reports having ever injected drugs.

In 2016, former Iowa Governor, Terry Branstad, signed a bill expanding access to Naloxone, a drug that reverses or blocks the effects of opioid medications. While advocates cheer the move as an excellent tool to save the lives of People Who Inject Drugs (PWID), they are also pushing the Iowa state legislature to legalize Syringe Services Programs (SSPs – Needle/Syringe Exchanges). Research consistently shows that SSPs lead to reduced rates of HIV, HCV, and HBV infections among PWID, as well as those who are sexually involved with PWID.

References:

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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.

 

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Scott County and Indiana’s Steep Learning Curve on HIV and Hepatitis C

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

In early 2015, Scott County, Indiana was thrust into the global spotlight for an HIV outbreak among injection drug users abusing opioid prescription drugs and heroin (Hopkins, 2015). In a county that averaged a total of 5 new HIV infections each year, even doubling that number would’ve been a statistical anomaly. By the end of 2016, the county had 216 new HIV infections in the span of just two years, and of those, 95% were co-infected with Hepatitis C (HCV). So rare was the disease that county health department officials had never handled HIV cases, instead sending them all to the regional Sexually Transmitted Diseases Department in Clark County (May, 2016).

The outbreak in Scott County was, and still is, both instructive and reflective of several concurrent health crises faced by most of rural America. In one county, virtually every major health risk met in the middle: a prescription opioid addiction problem, the resultant heroin usage problem, and an access to comprehensive healthcare problem all walked into a bar, and out came one of the worst concentrated HIV epidemics in the U.S. in the past decade. Throw in a paucity of drug addiction, recovery, and Syringe Services Programs (SSPs), and you had the perfect case study for how outbreaks occur.

To be fair to Indiana’s legislature and then-Governor Mike Pence, the state responded intelligently to the crisis by legalizing for the first time SSPs…under certain previsions. Counties had to apply for approval, had to show that they had funding, and had to be located in a high-risk zone. Since Mike Pence’s departure from the state to swampier D.C. pastures, his replacement has actively attempted to ease those restrictions. Earlier this year, the Indiana General Assembly passed a bill allowing local governments to establish syringe or needle exchange programs without having to receive state approval (Rudavsky, 2017). His efforts have not, however, managed to convince everyone.

Map showing states with syringe exchange programs.

Source: HIV/HCV Co-Infection Watch

Madison County, for example, recently voted to remove all funding from their SSP, run by the county’s health department, and prohibited appropriations of funds for paying for both supplies and labor (Fentem, 2017). The ordinance, approved by five of the seven-person council, immediately shuttered the only operating SSP in the county, and was largely driven by stigma-based fears: discarded syringes were going to litter front lawns and public parks; drug addicts were going to wander over from neighboring counties, bringing their drug problems with them; “What about the innocent children?!” These well-worn excuses and arguments against the establishment and funding of SSPs have plagued the proven Harm Reduction measure since its inception. The fears are also unsupported by anything other than anecdotal evidence and hearsay, few assertions of which are backed up by any credible research or quantifiable proof.

Worse, still, is that the council members did nothing on their part to allay these fears. Council member Fred Reese is quoted as saying the following:

Some say if you don’t do the needle exchange, you’re going to have a spread of HIV, you’re going to have a spread of hepatitis C, but my concern is the innocents. I don’t want these needles out (Fentem).

This kind of statement on the part of an elected officials shows cowardice, rather than leadership. Part of the job of county councils is to do what’s in the best interests for everyone, rather than kowtowing to fear-based arguments that bear little resemblance to reality.

Clark County – where Scott County once sent its HIV cases for management – recently renewed their SSP for one year, after which it will be up for renewal in August 2018. About half of the program’s 150 participants have HCV, many of whom were diagnosed through the program (Beilman, 2017). Their hopes for the program include seeing a more balanced rate of return on needle collection. Of the nearly 16,000 needles distributed, the exchange collected almost 8,000 (Beilman).

In Boone County, where no SSP currently exists, Prosecutor Todd Meyer sent the following communique to county leaders:

A needle exchange program does not help in fighting the demand side, in fact, it will do the exact opposite by providing the users/addicts with the tools they need to continue to abuse illicit drugs…(Davis, 2017).

That this opinion was issued by a prosecutor should shock no one. Meyer’s position, however, is reflective of those espoused by [mostly Conservative] voters, legislators, and law enforcement officials, but again, bear little resemblance to reality. Instead, they rely upon fear and stigmatization, along with two terrifyingly short-sighted sentiments: “Not in my back yard!” and “It can’t happen here!” While Meyer contends that Boone County doesn’t have an HIV problem, now, let’s see if it has one in two years.

Back in Scott County, the SSP, run by the Scott County Health Department (SCHD), has another issue: it doesn’t keep track of HCV cases (de la Bastide & Filchak, 2017). For some reason, SCHD officials are only worried about their HIV problem. If that seems counterintuitive, that’s because it is. It was, in fact, a spike in new HCV cases that led to the discovery of the HIV epidemic. Additionally, with a 95% co-infection rate in the 216 HIV cases identified in the initial outbreak, as well as the more aggressive spread of HCV in the U.S. compared to HIV, it makes no sense, whatsoever, for the SCHD to fail to keep track of HCV.

The concurrent HIV and HCV outbreaks in Scott County, Indiana were just the beginning. Already, rural states and counties are beginning to see an uptick in new infections of both diseases as a result of Injection Drug Use (IDU). More concerning is the fact that most of those counties are deeply Conservative, which creates significant challenges for those hoping for proactive healthcare policies, rather than reactive cleanup measures. As for Scott County, there are several families with multiple generations infected with HIV, and very likely with HCV, as a result of prescription opioid and heroin abuse. Unfortunately for them, their county’s health department doesn’t see fit to track their issues.

Download the latest edition of the HIV/HCV Co-Infection Watch.

References:

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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.

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The 2016 Election, and What This May Mean for Healthcare

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

The passage of the Affordable Care Act (ACA), also known as Obamacare, included a provision that gave states the option to expand Medicaid coverage in order to cover citizens whose incomes were above the Federal Poverty Level (FPL), but whose incomes still present a significant barrier to purchasing health insurance. Of the 50 United States and the District of Columbia, 32 states (including DC) have opted to expand their Medicaid programs. Nineteen states have opted not to expand access.

Expanding access to Medicaid is an essential piece of the ACA, as it was designed to help increase the number of people with access to affordable healthcare. Because the ACA envisioned low-income people receiving coverage through Medicaid, it does not provide financial assistance to people below poverty for other coverage options. As a result, in states that do not expand Medicaid, many adults fall into a ”coverage gap” of having incomes above Medicaid eligibility limits, but below the lower limit for Marketplace premium tax credits (Garfield & Damico, 2016). Since the expansion of Medicaid under the ACA, 73,137,154 Americans were enrolled in Medicaid/CHIP as of August 2016 (Henry J. Kaiser Family Foundation, 2016).

There are an estimated 2.6 million Americans who currently fall into that coverage gap, and of the states that did not expand Medicaid, four states represent 64% of those people (TX – 26%, FL – 18%, GA – 12%, NC – 8%). When looking at the geographic distribution of those 2.6 million Americans, 91% are in the American South (Garfield & Damico, 2016). Demographically, 46% are White non-Hispanics, 18% are Hispanic, and 31% are Black, and over half are middle-aged (age 35-54) or near elderly (55 to 64). Additionally, the majority of people in the coverage gap are in poor working families.

Donald J. Trump

Photo Source: NBC News

President-elect, Donald J. Trump, as well as the incoming Republican-led Congress and Senate, have openly stated that their first priority, at the beginning of the next legislative session, is the repeal of the ACA. There are very few comprehensive plans being proffered to replace the ACA, and healthcare professionals, providers, payers, patients, and advocates, alike, are currently unsure about the future of the expansion, and whether or not that aspect of the ACA will be retained in the forthcoming repeal.

It bodes poorly for those existing people infected with viral hepatitis, especially Hepatitis C (HCV), who stand to lose coverage if the Medicaid expansion does not survive the repeal, even with the existence of drug manufacturer and private Patient Assistance Programs (PAPs). In order for those PAPs to be accessed, however, people must first know about them; without the aid of social workers, healthcare aides, and advocates, people living with HCV are unlikely to find out about these PAPs, unless this information is provided to them by a doctor or nurse.

An additional concern exists for those recipients of the Ryan White Program. Over the past eight years, HIV/AIDS advocates and policy wonks have been in a near-constant debate about whether to reopen the Ryan White Care Act for reauthorization to address some of the ways in which the current law has not necessarily aged well, in terms of keeping up with newer treatments, costs, and funding paradigms. The concern over the past five years has been that the Republican-controlled Congress would “gut” the bill, cutting out many of the provisions upon which organizations and patients have come to rely. With repealing the ACA having played such a large role in this year’s election, concerns about reopening the act are likely to deepen, rather than abate. It is important to note that many states include HCV therapies under their AIDS Drug Assistance Program’s drug formularies.

The HEAL Blog  will pay close attention to both programs, as well as other HIV and HCV-related issues throughout 2017.

References:

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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.

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