Policy Update Michael Ruppal Executive Director, The AIDS Institute Director, Center for Public Policy Research and Ethics at USF Health Division of Infectious Disease & International Medicine Mruppal@theaidsinstitute.org

Policy Update National HIV/AIDS Strategy Budget and Appropriations Ryan White Program HIV Prevention Health Reform Hepatitis

National HIV/AIDS Strategy Sets out Goals, Strategies and Activities to: Reduce New Infections Increase Access to Care & Viral Suppression Decrease Disparities Increase Government Coordination Timeline for Activities, Periodic Status Reports Future Steps Decided by Next President Community Advocacy to “End AIDS”

Budget & Appropriations FY17 Federal budget is operating under a Continuing Resolution (CR) thru 12/9/16 House and Senate Committees Passed Different Bills Each contains different increases and decreases Difficult to reconcile Both Maintain HIV and Hepatitis Funding for: CDC HIV Prevention ($789 m) CDC Hepatitis Prevention ($34 m) HUD HOPWA ($335 m) Both Increase Overall NIH Funding Senate: $2 b House: $1.25 b

Budget & Appropriations – FY17 Ryan White HIV/AIDS Program House Flat Funds ($2.3 b) Senate Proposed Cuts Part C ($4 m) Special Programs of National Significance ($25m) Secretary’s Minority AIDS Initiative House Flat Funds ($54m) Senate Proposed Cut ($6 m) Other House Cuts Teen Pregnancy Prevention Program & Title X ACA

Budget & Appropriations – FY18 Expect Difficult Budget Environment New President and New Congress Budget Control Act (Caps Discretionary Spending) Sequestration Kicks in w/o Congressional Changes Other budgetary demands Competing health issues (Zika, opioids) & other diseases Non-health related

Ryan White Program Authorization expired, but continuing through Appropriations Program evolving as clients gain health coverage (Medicaid & Marketplace Exchange Plans) Varies by state, Medicaid expansion key Ryan White is the payer of last resort Most funding based on Formula (case counts) Supplemental Funding and Direct CBO funding (Parts C & D) The AIDS Institute Analysis Parts A & B: Florida Ranks #15 by $/case count Add in C & D: Florida Rank moves to #34 Some flexibility to distribute money based on need with Supplemental Funding 340B Income creating difficulty in states spending money

Ryan White Program Unknown when Reauthorization will occur No community consensus on changes Desire to assist the South Interest by Congress unknown Next Administration? Issuers for Consideration Part Structure Formula and non-formula distribution Funding more need based Coverage of PrEP Hepatitis C

HIV Prevention Focus on right populations, right areas with the right tools Gay men, youth, African-Americans and Latinos etc. New tools PrEP Federal funding for Syringe Services Billing for HIV testing Focus on testing, linkage to care and remain on treatment Treatment is Prevention Accountability of grantees

Health Reform Ensuring it works for people with HIV, hepatitis and other chronic conditions Concern over Patient Cost-sharing, Drug Formularies, Utilization Management, Network Adequacy Florida Discrimination Complaint Enforcement of Patient Protections 2017 Plans to be made public soon & Open Enrollment Debate over ACA Future Improvements or repeal Drug Pricing

Hepatitis Opportunities to End Hepatitis B & C as a public health threat WHO Goals National Academies of Sciences Reports Federal HHS Action Plan Update to be released in October Very Small CDC Budget for entire country Hep C Cure Rx Medicaid restrictions (Florida Lifted Most)