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Public Health News Watch Wednesday: Report for May 10, 2017

MAY 10, 2017 | BRIAN DUNLEAVY
HIV/AIDS and hepatitis C are 2 troubling infectious diseases with, as of yet, no known cure.
 
Believe it or not, these diseases, along with pneumocystis pneumonia and urinary tract infections, are among the preexisting conditions that may cause millions of Americans to lose health insurance coverage under the American Health Care Act (AHCA), which was approved last week by the House of Representatives. Of course, most Washington insiders and pundits believe the bill will undergo significant modifications before it is even debated in the Senate, sometime later this spring.
 
As written, though, the AHCA has some potentially alarming implications for the patients of infectious disease specialists. Although House Speaker Paul Ryan (R-Wisc.) has emphasized that people with preexisting conditions cannot be denied coverage, the AHCA does allow insurers to charge higher premiums to—and establish higher deductibles for—those who have them.
 
As noted in an analysis of the new legislation, published on May 5th by BusinessInsider.com, “the difference between being denied coverage and not being able to afford coverage is the gray area that has people concerned.” Research published by the Kaiser Family Foundation in December suggests that as many as 27% of Americans under the age of 65 have preexisting conditions “that would likely leave them uninsurable if they applied for individual market coverage” without the safeguards established by the Affordable Care Act (ACA), the law (known as “Obamacare”) that the AHCA is intended to replace. Since 2014, the ACA has made it illegal for insurance carriers to deny coverage or charge increased premiums to people with preexisting conditions.
 
But others also imply that the law could have indirect implications for those with infectious diseases and those who are at risk for them. According to a report in The Washington Post, for example, the AHCA effectively eliminates the Prevention and Public Health Fund (PPHF), an initiative that finances 12% of the Centers for Disease Control and Prevention’s (CDC) annual budget and, among other efforts, provides $625 million annually to state and local health departments to support vaccination programs and programs designed to prevent and control food-borne infections and hospital-acquired infections. The PPHF also funds emergency response to infection-based public health crises, such as the Zika virus outbreaks in Florida and Texas.
 
“We will not have the high level of health all Americans desire if we reduce our commitment to protecting Americans… [and] we will never put America first if we are not prepared to address public health threats that may emerge from anywhere around the globe,” Jonathan Fielding, MD, distinguished professor of public health and pediatrics at UCLA, wrote in a commentary posted on TheHill.com, citing ongoing investigations into a hepatitis A case cluster in Virginia and cases of avian flu at Alabama chicken farms. “We do not know from where the next public health threat will come. Two years ago, Zika was just a four-letter word. Today, with the approach of mosquito season, public health officials are preparing for a second round of Zika virus exposure.”
 
Additional funding cuts proposed in President Trump’s first budget, have cut the budget of the US Department of Health and Human Services (DHHS) by 18%, which may impact important “safety-net” programs such as the Ryan White HIV/AIDS Program, according to the Kaiser Family Foundation. In addition, with Scott Gottlieb, MD, who has been described as a pharmacy “industry favorite,” receiving Senate approval on May 9th to take over as head of the US Food and Drug Administration, there are many advocates and activists expressing concern that the current administration’s focus is aimed at profits, rather than patients.
 
However, until the Senate begins to deliberate on the House bill, it is important to note that when it comes to the AHCA, there are still more questions than answers, in general, particularly since most of those commenting on it—as well as many of those who voted for it—have not yet read the bill. Indeed, Internet myth-buster Snopes.com noted that, unlike previous versions of the ACA replacement, the Congressional Budget Office has yet to score the current legislation, despite comments on the contrary.
 
Perhaps misinformation is a preexisting condition, too.
 
Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.
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In patients who are being treated with antiretroviral therapy (ART), it appears that a latent form of HIV residing in immune cells can continue to reproduce.
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