President Trump will pledge to end HIV/AIDS in his State of the Union address tonight, Politico reported on Tuesday. Though the speech isn’t finalized, early details indicate that Trump will announce a ten-year strategy “to reduce transmissions by 2030”:
“Under Trump’s HIV strategy, health officials would spend the first five years focusing on communities across roughly 20 states where the most HIV infections occur. The ultimate goal is to stop new infections over a 10-year period, said two officials, with some parallels to how the Trump administration is targeting the opioid epidemic.”
According to Politico, the strategy will be overseen in part by Brett Giroir, the Department of Health and Human Services assistant secretary. If that name sounds familiar, it could be because he is also responsible for a different, and once much-vaunted, Trump initiative: overseeing the HHS response to the opioid crisis. And that’s a red flag. It’s been a year since Trump promised the nation that his administration “is committed to fighting the drug epidemic” during his last State of the Union address, and little has changed. “Experts have described the legislation he has signed to tackle the epidemic as ‘simply tinkering around the edges’ and insufficient in terms of funds. After Trump declared an emergency over the opioid crisis, a government watchdog agency found the declaration didn’t lead to much actual policy change,” German Lopez reported for Vox on Tuesday.
Trump’s evaporating interest in the opioid crisis may be attributed to his administration’s legislative priorities. To Trump, the opioid crisis largely functions as a rhetorical justification for his border wall, rather than a real danger that needs to be addressed concretely. Meanwhile, his administration remains committed to a vision of small government that drastically cuts the social welfare spending that would help ameliorate the damage done by opioids. But public health crises — whether they’re due to substance abuse or to HIV/AIDS — threaten the welfare of the public. People who are chronically ill need health care they can afford, and that takes public spending, which the Trump administration manifestly abhors.
With Seema Verma at the helm of the Centers for Medicare and Medicaid Services, the administration has approved and defended Medicaid waivers for states that amount to massive funding cuts for the program. That’s a problem for people living with HIV or AIDS. According to the Rural Health Information Hub, only 17 percent of people with HIV or AIDS were insured prior to the passage of the Affordable Care Act. Not only did the ACA prohibit insurance companies from refusing coverage to individuals with preexisting health conditions like HIV or AIDS, it allowed states to expand Medicaid. The Kaiser Family Foundation reported in 2016 that 40 percent of people living with HIV or AIDS are enrolled in Medicaid, making the program “the single largest source of coverage for people with HIV in the U.S.” And the expanding Medicaid has led to more coverage for those with HIV: KFF found that “Medicaid coverage for people with HIV in care rose six percentage points” between 2012 and 2014, a trend the think tank attributed to Medicaid expansion.
Advocates for people with HIV or AIDS have opposed Medicaid reforms that would cut people from the program. In January 2018, members of the HIV Health Care Access Working Group submitted a letter to CMS urging the agency to reject Ohio’s request to add work requirements to Medicaid. “Ohio’s proposal to impose work requirements on vulnerable populations threatens to reverse the progress in providing access to prevention, care, and treatment and reducing health care costs,” the letter stated.
CMS has not yet issued a decision on Ohio’s request. But, if past is truly prologue, CMS will probably approve the waiver, just as it’s done for other states seeking to reduce Medicaid spending by adding onerous work requirements as a condition for benefits. As long as the Trump administration remains hostile to programs like Medicaid, people living with HIV or AIDS are at risk for losing vital care. Whatever strategy Trump announces tonight, it will be hollow posturing.