HIV Infections May Rise After Affordable Care Act Ruling: Experts

March 30, 2023 — A federal judge in Texas on Thursday fell down The Affordable Care Act’s mandate for preventive services, stating that the requirement to provide these services violated the religious rights of plaintiffs.

One of the Reporters trial Steven Hotz, MD, is a Texas physician and conservative radio host. He said that providing health insurance for the drugs he takes daily to prevent HIV among his employees would make them complicit in behavior that he says goes against his religious beliefs.

The decision applies nationwide and public health experts were quick to criticize the decision.

“The human cost of this decision is very real,” said Meredith McNamara, assistant professor of pediatrics and pediatrics at Yale University. Ahead of the verdict, Yale researchers recently made a guess. Study Eliminating coverage of the drug known as pre-exposure prophylaxis (PrEP), mandated by health insurers under the Affordable Care Act, would result in at least 2,000 new HIV infections within a year.

The two brand-name drugs approved for PrEP, Truvada and Descovy, cost about $1,800 a month or more without insurance. Experts said generic versions are available for a lower price, but are not always available. Other financial programs, including some from drug companies, provide assistance to those who qualify. The right to provide PrEP coverage began in June 2020, when the US Preventive Services Task Force (USPSTF), an independent panel of experts, gave it an “A” recommendation. Federal law requires that all preventive services be covered under either A or B.

The ruling could affect far more than just PrEP insurance coverage. Jack Resneck Jr., MD, president of the American Medical Association, said in a statement that the ACA is designed to cover dozens of preventive health services at no cost to patients for things like early detection of cancer, high blood pressure, diabetes and sexually transmitted diseases. Insurers and health plans are needed. Communicable disease. Infection.

“Millions of patients could lose first-dollar coverage for cholesterol treatment, smoking and alcohol cessation, vaccinations and childhood screening for lead poisoning, hearing loss and autism,” he said. “Critical care to reduce maternal mortality will also be at risk. These preventive care needs that have enabled millions of Americans to improve their health for up to 10 years may be missing as a result of this erroneous pronouncement.

“The government will certainly appeal, and it has every right to do so,” said Nicholas Bagley, a law professor at the University of Michigan. “The big question is whether the courts will enforce the suspension pending an appeal. I expected them to do so, but we’ll see.

Even without the stay, Bagley said, most insurance plans are annualized, so coverage may not change immediately, but it’s not a certainty. The ruling applies to preventive care guidelines issued after 2010, when the Affordable Care Act went into effect. The birth control mandate has been challenged in this case, Bagley said, but it was dismissed in September. He is expected to appeal the decision.

HIV Prevention: Key Strategies

Prevention, including the use of PrEP, is a major strategy of the federal government. Initiative The goal of ending the HIV epidemic in the US is to reduce the number of new diagnoses to 3,000 by 2030. The number of new diagnoses has decreased 8% from 2016 to 2019, according to the CDC, but there is work to be done to meet the 2030 target. In 2020, there were 30,635 new HIV diagnoses. When taken correctly, PrEP reduces the risk of getting infected by up to 99% CDC.

around 2020 25% According to the CDC, of ​​the 1.2 million people in the US for whom PrEP was recommended, it was actually prescribed, up from about 3% in 2015.

One of them is Dan, a gay marketing professional in the Midwest who asked that his real name not be used. He has been using PrEP for about ten years. Her employer’s health insurance covers it, and it’s important to her.

“I’m sexually active, but not that much,” he said. Still, he relies on the drug for protection as he does Is sexually active. If the cover is removed? “I’ll probably quit,” he said.

Yale Research and the Impact of Terminating Coverage

Yale University researchers estimate that eliminating PrEP coverage would have minimal consequences 2,000 Fully preventable HIV infections next year as PrEP use declines without mandatory coverage. This estimate only takes into account the impact on men who have sex with men, not other people who are also at risk for HIV infection and who may benefit from PrEP, such as those who inject drugs. Or women having sex with an infected … person.

As a result, the estimate is very conservative, says study leader A. David Paltiel, PhD, a professor of health policy at the Yale School of Public Health. His team used data from the US on current rates of HIV infection, PrEP coverage and effectiveness, and the estimated reduction in coverage if access to private health insurance is restricted.

“We are underestimating the number that would drop out of PrEP coverage” if the repeal goes national, he said. Currently, about 28% of all men who have sex with men are on PrEP, Paltiel estimates. “For every 1% drop from 28%, there would be 114 new infections,” he said. The researchers also calculated that the percentage of people using the drug would drop to about 10%. “If that happens, it would result in about 2,000 new infections next year. OK? There are people who will stay high and dry.

More on Braidwood Management v. basera

In the lawsuit, Braidwood Management v. Becerra, several Christian businesses, and several people in Texas sued the federal government, saying that the mandate of preventive services violates their religious freedom under the Religious Freedom Restoration Act of 1993, a federal law that protects interests in religious liberty. violates beliefs. Freedom is protected.

The plaintiffs also argue that the Affordable Care Act’s requirement to provide recommended preventive services violates the Constitution’s Nominations Clause, which requires confirmation by the Senate of those appointed to positions by the president. Members of the Preventive Services Task Force are instead appointed by the heads of agencies within the Department of Health and Human Services.

Since its inception in 1984, the task force has considered a number of preventive measures, such as when to screen people for diseases and other issues, and evidence-based research to help healthcare providers care for patients. have made recommendations.

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The Yale report “highlights the critical need to consider the public health implications of court decisions,” Bruce J. Packett, executive director of the American Academy of HIV Medicine, said in a statement.

He said the effects of eliminating coverage could be devastating for efforts to reduce HIV. And, he added, “the report only considered the effects of not requiring insurers to cover PrEP for one year; the authors did not count primary HIV transmissions that would occur well after one year and Secondary infections of those primary infections.

Also at risk, Packett said, is the authority of the Preventive Services Task Force.

“Eliminating the USPSTF’s ability to recommend key evidence-based preventive health care services would be detrimental to the entirety of the United States’ public health goals,” he said.

According to McNamara and other Yale researchers, the Braidwood management case is “misrepresenting the science”. In mid-February, he posted a reports, Explain how the PrEP mandate promotes public health, not just for a portion of the population, but for the entire population. PrEP benefits public health, as does any vaccine or other preventive measure to prevent infection.

The researchers call PrEP “one of the most celebrated biomedical achievements in the global fight to end the HIV epidemic.”

McNamara said the drawbacks of granting a nationwide injunction against requiring health insurance to cover PrEP would disproportionately affect certain ethnic groups. Most affected, she said, are black and Latino gay and bisexual men, as well as transgender women.

Young high-risk groups would also be at a disadvantage, said McNamara, who cares for adolescents in her clinic. “I can tell you that not having cost-sharing for HIV prevention essentially means they will not use it at all,” she said.

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