In what could amount to a significant setback in the fight against HIV, Trumpcare could soon make PrEP—a once-a-day preventative drug that is seeing a rise in use among men who have sex with men due to its nearly 99 percent effectiveness rate against the virus—unaffordable. Republicans are always about that pro-life stance—unless you happen to be lower-income or LGBTQ, apparently:
House Republicans released a long-awaited blueprint to replace the ACA on Monday, confirming plans to eliminate Medicaid expansion and other key Obamacare features. The proposed plan would complicate PrEP access, particularly for low-income Americans in the 31 states, plus the District of Columbia, that adopted the Medicaid expansion.
The new bill would begin phasing out federal money for the expansion in 2020, likely blocking new applicants and access to meds like PrEP. If the plan passes in its current form, traditional Medicaid will be replaced by per-capita grants, a fixed-sum per person, which could result in cuts over time. And a proposed repeal of the ACA's cost-sharing assistance, which paid insurers to reduce the burden of enrollees based on their income, would make coverage more expensive for poor Americans, says Lindsey Dawson, senior HIV policy analyst of the Kaiser Family Foundation.
The drug is expensive, costing up to $1,500 a month without insurance, and anywhere from free to $500 with insurance, but those costs are vastly cheaper compared to a lifetime of HIV treatment and care. While Gilead, the drug’s manufacturer, currently provides some co-pay assistance, “it’s unclear of how that program will fare after the ACA repeal.”
This could be particularly devastating for black and Latino men who have sex with men, two groups at higher risk of HIV infection but who already have less access to critical health and social services.
Now Donald Trump and congressional Republicans could make access to this life-saving drug even more difficult thanks to Trumpcare:
The new bill would begin phasing out federal money for the expansion in 2020, likely blocking new applicants and access to meds like PrEP. If the plan passes in its current form, traditional Medicaid will be replaced by per-capita grants, a fixed-sum per person, which could result in cuts over time. And a proposed repeal of the ACA's cost-sharing assistance, which paid insurers to reduce the burden of enrollees based on their income, would make coverage more expensive for poor Americans, says Lindsey Dawson, senior HIV policy analyst of the Kaiser Family Foundation.
To be clear, these are uncertain times for many facets of health care. But gutting PrEP access would mean losing a critical shield in the fight against HIV.
“No matter which way you spin it, a repeal would be devastating,” says Noël Gordon Jr., a senior program specialist for HIV prevention & health equity at the Human Rights Campaign. “It would not only halt the progress we’ve made, but it has the potential to turn the tide the other direction, where we could potentially see the spread of HIV.”
Mike Pence’s home state of Indiana has already seen the devastating effects of eliminating funding for health and social services, when a Planned Parenthood in Scott County closed and the ensuing public health crisis resulted in the worst HIV outbreak in the state’s history:
Nearly 20 percent of Scott County residents live below the poverty line. Injection drug use there is a major problem, increasing the risk of HIV outbreak.
Fast-forward to 2015. Local health officials began to report HIV cases linked to intravenous prescription opioid use in Scott County. Scott County residents were sharing needles to inject their opioids, and nobody was getting tested.
The situation quickly spiraled out of control. At the height of the outbreak, 20 new cases of HIV were being diagnosed each week, reaching a total of nearly 200 cases by the time the outbreak was finally under control.
It’s worth noting in light of this profoundly homophobic administration that former Sec. Hillary Clinton proposed increasing access to PrEP as part of her plan “to usher in an AIDS-free generation”:
As we continue to increase HIV and AIDS research, we should also invest in the promising innovations that research is producing. For example, PrEP and other medications, when properly used, have proven effective in preventing HIV infections. As a result, both the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) have recommended widespread use of PrEP, particularly among members of at-risk groups. The CDC has funded grants to state and local health departments to increase knowledge about and uptake of PrEP. Clinton will increase the CDC’s investment to ensure populations at greatest risk of infection have access to preventive medicines.
Wow. What could have been.