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Congressional Forecast: Proceed With Caution
An Editorial

Spring 2011

Congressional Forecast: Proceed With Caution
After the 2010 elections, it was clear that the 112th Congress would be heading in a drastically different direction from the previous session, during which Democrats held a majority in both Houses. Running on a platform of drastic budget cuts and lower taxes, a new, fiscally conservative House of Representatives has convened. Many HIV advocates, who had seen significant gains for HIV care and prevention from the 111th Congress, worry that this will mean a reverse. To understand our challenges, we must examine the differences between the two Congresses, and which policies and legislation may be affected.

In 2010, the 111th Congress passed the Patient Protection and Affordable Care Act (ACA), popularly known as health care reform, which promises to benefit people with HIV in several ways. Insurers will no longer be allowed to deny coverage based on preexisting conditions (including HIV) or impose lifetime caps on benefits. The "doughnut hole" in Medicare Part D prescription drug coverage will be closed, and substantial funds will be set aside to address health disparities by community.

Several elected representatives, however, are making repeal of health care reform a top priority. The "Repealing the Job-Killing Health Care Law Act," aiming to stop implementation of the ACA and remove all funding, passed the House by the wide margin of 245 to 189. This assault on a law that provides a comprehensive approach to care and prevention of HIV was a symbolic act, since the Senate leadership did not bring the bill to a vote, but it is an unmistakable indication of the fierce opposition ACA faces in the House.

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Other troubling initiatives have been introduced this year. One bill seeks to give governors greater control over their states' Medicaid programs by repealing the sections of the ACA that require states to maintain current eligibility requirements for Medicaid until 2014. Many people with HIV who depend on Medicaid for their health care could become suddenly ineligible. If this bill were to pass, as many conservatives in Congress hope it does, it would deal a heavy blow to HIV care in the U.S.

Comprehensive sex education is another area that is threatened. Until recent years, abstinence-only sex education programs received significant federal funding. These programs teach children to "save" themselves for marriage, pressure them to take virginity pledges, and are rampant with anti-gay rhetoric. They typically teach nothing about protection and often give blatantly false information. All the while, rates of sexually transmitted infections were rising dramatically among teens over the last decade.

Fortunately, the 111th Congress defunded the largest funding stream for abstinence-only programs, and both Houses passed the Consolidated Appropriations Act of 2010, which removed federal funding for abstinence-only education. Unfortunately, as a bargaining chip to gain conservative support, $50 million in abstinence-only funding was included in health care reform. With the greater numbers of socially conservative members of Congress, this funding will likely grow.

AIDS Drug Assistance Programs, which help more than 200,000 people access HIV medications, are another concern. 2011 has seen the worst program shortages in history. State funding for ADAP in recent years has also seen the sharpest drops since the program began. Florida was set to discontinue ADAP for the rest of the fiscal year until activists and drug companies stepped in and ensured people could get their drugs free through a non-profit mail-order pharmacy. More than 8,000 people with HIV are on waiting lists across the country. Although this year's budget proposals include an increase in federal funding for ADAP, it is not nearly enough to keep up with increasing demand. Because HIV care and medication double as prevention by reducing viral load and thus transmission risk, this funding shortage and the consequent waiting lists may result in additional HIV infections.

After a comparatively progressive 111th Congress and the promising legislation that it passed, we are starting to see conservative push-back in the new session. Attempts to repeal legislation that provides HIV-positive people with greater care and allows for more robust prevention efforts are frightening. If the critical gains that have been made to fight HIV are not going to be lost, we must make it clear to the current, more conservative Congress that Americans won't compromise on saving lives.




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