In the bleary morning after the 2016 United States presidential election, I asked William McColl, a dedicated policy advocate on HIV issues who serves as director of health policy at AIDS United, what we know of the road ahead. On a very busy and difficult day, he generously sent along his take, along with a statement from AIDS United's interim president and CEO Jesse Milan Jr.
First, I do think we should acknowledge that this is the worst electoral defeat for the moderate democratic coalition of our lifetime.
I want to say that the HIV community is extremely resilient, and I would expect there to be a strong move back toward activism. The community will need to up our messaging game, and we're going to have to prepare to fight. We always have done that, and we're going to do it in the future.
Lame Duck Session Key
I would expect a shave in terms of appropriations, but it's not clear how much. Probably, they will begin to make across-the-board cuts. It probably immediately will look like the sequester -- so somewhere around a 0.5% cut. For fiscal year 2017 (FY'17), it's practically level spending.
The lame duck session [while President Obama is still in office] will be key -- advocates will likely need to advocate for a full-year continuing resolution.
As far as the FY'18 budget, Congress will not necessarily wait for the president's budget to move forward on appropriations. So, this might be an area where there is a divide between the White House and Congress. At the top line, this will likely mean an increase in defense spending and a decrease in non-discretionary spending, including HIV funding.
The Ryan White Program and Likely PEPFAR Will Remain in Place
The Ryan White Program will remain in place. Conservative states rely on funding from the Ryan White Program and there has generally been bipartisan support. We should be aware that there may be cuts, but it won't be so threatening that the whole program will go away.
The President's Emergency Plan For AIDS Relief (PEPFAR) is bipartisan and considered to be one of President Bush's main achievements, so that seems likely to stay in place.
Research and prevention funding will likewise remain in place but again subject to cuts. Research has been a target for other disease areas [in terms of reallocating HIV/AIDS funds to research on other conditions], and that will be one of our hardest fights.
Funding for fighting the opioid epidemic will likely remain in place, although some of the funding may shift away from treatment and toward law enforcement. I do not know if the ban on funding for syringe services programs will be restored -- I am hopeful that since that was led by Harold Rogers and Mitch McConnell that the current language will remain in place.
The Affordable Care Act (ACA) Will Be Repealed
Some popular elements may remain, things such as people under 26 remaining on their parents' policies; the "minimum essential benefits" requirement will likely be removed or relaxed, and it's likely they will allow policies to cross state lines. Probably they will have to retain the prohibition on denying coverage of pre-existing conditions. How you do that without the universal mandate is hard to know; they will get pushback from insurers, so that's going to be an issue.
The HIV community will need to rethink our relationship to insurance and marketplaces. This may be an opportunity to regroup and start pushing for universal coverage sometime in the near future.
We need to be prepared for Medicaid to be block granted -- this would essentially create a cap on funding and potentially a move back toward more reliance on the Ryan White Program.
This interview has been lightly edited for clarity.
JD Davids is the managing editor for TheBody.com and TheBodyPRO.com.