AIDS United

Supreme Court Hears Oral Arguments on the Affordable Care Act

March 30, 2012 in Policy/Advocacy

by William McColl, Director of Political Affairs, AIDS United

On Monday, the court heard arguments around the question of whether the penalty prescribed by the ACA to individuals who have not obtained health insurance is actually a tax. If it is a tax, then the Anti-Injunction Act would bar a review of the law’s constitutionality until the provision actually goes into effect in 2014. Most observers of the court appeared to agree that both conservative and liberal justices do seem to judge the ACA as a whole and would likely issue a ruling that the penalty is not actually a tax.

On Tuesday the court studied the constitutionality of the individual mandate provision in the ACA. From the transcript it is clear that Solicitor General Donald Verilli faced extremely skeptical questions and the justices spent considerable time trying to find what they called a “limiting principle” (e.g. a reason that the federal government’s power to intervene in the market was both necessary and that it would be constrained).

The final arguments both took place on Wednesday, with time devoted to the question of “severability” – what part, if any, of the ACA could survive if the court ruled that the individual mandate was indeed unconstitutional. The choices ranged from striking just the individual mandate all the way to the idea that the entire law should be struck. In the afternoon the court heard arguments about the constitutionality of the Medicaid expansion scheduled to take effect on January 1^st, 2014. Essentially the states argued that the federal government’s expansion of Medicaid, even the offer to pay for most of it, is so large that it is coercive, leading to the compromise of the state’s own sovereignty. Again, the aggressive questioning seemed to confirm that the conservative justices might be tempted to strike down that part of the law. Lyle Denniston, a long time court reporter, observed that such a ruling would sacrifice the Medicaid expansion that serves the needy “to a historic expression of judicial sympathy for states’ rights.” Click here to read more.

It is nearly impossible to predict the final outcome of these arguments. Although the justice’s questions during oral arguments occasionally telegraph an outcome, it is also true that cases are not dependent on the oral arguments themselves, particularly in a well briefed case such as this one. Perhaps what is now clear is that it is indeed possible that the justices might decide the law is unconstitutional. Perhaps given the tone of politics and the strong opposition to the law, thisshould not be too surprising. Yet many legal observers, including me, argued that the law was likely to be upheld. (See this video for more details.)

Justice Anthony Kennedy is likely to be the 5^th vote either to uphold the law or to strike it down. Certainly it was clear from the questioning that he has the potential to rule against it. Yet at the end of the arguments regarding the individual mandate, Kennedy also seemed to come up with his own definition of a limiting principle, one that would allow him to uphold the law. For now, the only thing to do is wait – the ruling will likely be out by the end of June.

The transcripts and audio recordings of the oral arguments are below.

Oral Arguments:

Day 1 – Anti-Injunction Act

Day 2 – Individual Mandate

Day 3 – Severability

Day 4 – Medicaid Expansion

Transcripts:

Day 1 Anti-Injunction Act

Day 2 Individual Mandate

Day 3 – Severability

Day 4 – Medicaid Expansion

The Female Condom: Safe, Sexy, and Cost-Effective

in Policy/Advocacy

North Carolina Harm Reduction Coalition (NCHRC) Organizes North Carolina Advocates to Participate in the National Day of Action on Syringe Exchange

March 26, 2012 in Southern Initiatives

By Robert Childs, Executive Director
North Carolina Harm Reduction Coalition

On Wednesday, March 21^st, 2012, North Carolina Harm Reduction Coalition (NCHRC) organized local clergy, law enforcement, diabetics, people of transgender experience, lawyers and drug users from around North Carolina to particpate in the National Day of Action on Syringe Exchange. Congress recently reinstated the ban on federal funding for syringe exchange programs (SEPs).  SEPs provide sterile syringes and collect used syringes to reduce transmission of viral hepatitis, HIV, and other bloodborne infections associated with reuse of contaminated injection equipment by drug users and diabetics.  Most SEPs are part of a comprehensive health promotion effort that includes HIV & hepatitis testing, education on reducing sexual and drug use-related health risks, and referrals to drug treatment & other medical and social services. Republicans in the House were successful in reversing policy on syringe exchange through FY 2012 Appropriations in December 2011. They re-imposed a complete ban on the use of federal funding for SEPs despite overwhelming scientific evidence showing decreased HIV, viral hepatitis and drug abuse among SEP participants, not only improving public health but also saving tax payers millions of dollars.

On March 21^st NCHRC organized three actions: a mass letter writing campaign, a phone bank and a meeting with Senator Hagan’s office in Raleigh, NC.  We asked Senator Hagan to be our champion on this public health issue and to commit to the following actions:

1. Ensure negotiations restore Congress’ FY 2010 syringe exchange language for both the federal and Washington, DC jurisdictions in FY 2012 appropriations legislation.
2. Include language from FY 2010 on syringe exchange in the programmatic appropriations request letters due March 29^th.
3. Release a statement in support of restoring federal funding for syringe access programs.
4. Encourage the North Carolina legislature and governor to decriminalize syringes and/or legalize syringe exchange.

Sen. Hagan’s office personnel gave us an indication of support, but promised to run the issue by Senator Hagan for a definitive answer on her position. At our meeting in Raleigh with Hagan’s office, we brought together advocates from various backgrounds to discuss the issue during our 30 minute meeting. As Executive Director, I covered an overview of SEPs and the history of federal funding while Ronald Martin (one of NCHRC’s law enforcement consultants with over 20 years of law enforcement experience) explained why law enforcement benefit from SEPs.  He stated, “Why would we not want syringe exchange? Research has shown a 66% reduction in law enforcement needlesticks in communities where SEPs exist. One out of three law enforcement can expect a needlestick in their career and I support any measure to reduce harm against our officers.” Reverends Jenna and Andy outline the moral imperative for life-saving SEPs, and our diabetic and transgender allies discussed the need for syringe access among these populations. To round out the meeting, Lucas Vrbsky from the NC Chapter of the National Association of Social Workers discussed the social justice benefits of federal funding for SEPs, Lisa Hazirjian from the NC AIDS Action Network demonstrated the financial benefits of SEPs as well as HIV prevalence among injection drug users, Faina Shalts (from Harvard’s SHARP crew) explained SEPs’ public health benefits and Tessie Castillo (NCHRC’s Harm Reduction Coordinator) completed the ask.

We would like to thank our allies and NC coalition members from Wilmington to Franklin who made this day a success and allowed us to put a southern stamp of support on this national issue.  Even though NC does not have legal syringe exchange, we support federal funding for syringe exchange because if the federal government shows support by allocating federal dollars for SEPs, it assists us in making the case for southern states to adopt these measures as well.   NCHRC hopes to see the US Senate, especially our representative Kay Hagan, champion this issue and send the message that our state supports an initiative that would improve NC and the nation’s public health and safety.

North Carolina Harm Reduction Coalition is a grantee of AIDS United’s Southern REACH initiative

Ryan Budget Released: AIDS United Opposes

March 23, 2012 in Policy/Advocacy

by Donna Crews, Director of Government Affairs

On Tuesday, March 20 Rep. Paul Ryan (R-WI) chairman of the House Budget Committee introduced his Fiscal Year 2013 (FY13) budget entitled “The Path to Prosperity – A Blueprint to American Renewal.”  The total spending called for in the proposed budget is $1.028 trillion.  That amount is $19 billion below the bipartisan agreement for FY13 reached last August in the Budget and Control Act (BCA) and $15 billion below the current Fiscal Year 2012 level.

The possible program cuts in the Ryan budget for FY 13 could be:

• Severe cuts to Supplemental Nutritional Assistance Program (SNAP), formerly known as food stamps.
• Elimination of the Affordable Care Act.
• Cuts to housing programs to assist those in foreclosure.
• Changes in the structure of the Medicare and Medicaid programs.

The resolution would also decrease the tax burden for wealthy individuals by lowering the top tax bracket by 10 points from 35% to 25%.  Everyone else’s tax rate would be 10 % thus increasing the tax rate on many low income individuals.  Rep. Ryan’s resolution calls for permanently extending the “Bush era tax cuts” and eliminates the alternative minimum tax rate.

The budget resolution was debated in the Budget Committee on Wednesday, March 21 and adopted on a 19-18 vote.  All 16 Democrats on the committee voted against the proposed budget; they were joined by 2 Republican committee members who thought the total spending amount was too high.  Rep. Jason Chaffetz (R-UT) was the only committee member not present for the vote.  The budget debate will now move to the full House for an expected vote next week.  There are indications that the views of the 2 Republicans who voted against the budget in the committee are reflected in the total Republican caucus in the House.  If this dissension holds up, the fate of the Ryan budget in the full House may be a cliff hanger.

AIDS United is firmly opposed to Rep. Paul Ryan’s (R-WI) budget FY 13resolution.  We believe it would l have a devastating impact on people living with or affected by HIV and AIDS.  We must ensure that the Affordable Care Act is implemented so that HIV positive low income individuals with incomes up to 133% of the federal poverty level (FPL) will be able to have access to care and medications through Medicaid prior to an AIDS defining diagnosis.  The only way to tackle the fiscal crisis is to have a balance of revenue growth and cuts in spending.  All of deficit reduction  cannot be borne by the non-defense discretionary portion of the budget.  We believe the debate between the Ryan  budget and President Obama’s FY 13 budget request show the stark differences between  the philosophies of the House Republicans and the Administration.  Rep. Ryan’s budget increases the coffers of the wealthy and President Obama’s budget continues to work to provide affordable healthcare programs for all.

AIDS United will continue to monitor the Ryan Budget as it moves through the legislative process and will keep you updated.  We encourage you to take action with calls to your Representative to urge a “No” vote when the resolution comes to the House floor.

Helping Latinas in San Diego Prevent HIV

in GENERATIONS

by Veronica Tovar,  MPA
HIV Research and Education
Chicano Federation

For the past five years, Chicano Federation has been conducting the National HIV Behavioral Surveillance (NHBS) in San Diego. NHBS is a Center for Disease Control and Prevention (CDC) program that interviews populations at risk for HIV to track behavioral trends in twenty-one cities in the U.S. with the highest HIV prevalence.

During counseling and testing sessions through this project, Chicano Federation found that many Latinas had never been tested for HIV.  Furthermore, many shared that their male partners were engaged in extramarital affairs, but continued to have unprotected intercourse.  Quite a few others shared that they did not know whether their partner was monogamous.  Both Latinos and Latinas, usually the older, lower-economic status couples, revealed not knowing how HIV is transmitted or how to use a condom.

According to the CDC, Latinas represent nearly one quarter (24%) of new HIV infections in the U.S. (CDC, 2010).  When compared to the United States, California and San Diego County had the largest proportion of Hispanic HIV cases (Epidemiology Report, 2010). In 2003-2007, the most common mode of HIV transmission in females was heterosexual contact (75% of all cases). Additionally, according to the CDC, high HIV risk in heterosexuals is linked to regions of high poverty and high STI rates.

In response to these overwhelming findings, with the financial and technical support of AIDS United and Johnson & Johnson, Chicano Federation created the De Mujer a Mujer curriculum (From Woman to Woman).  This unique health curriculum specifically aimed at educating traditional, mono-lingual, migrant Latinas living in one of five high-risk zip codes in San Diego, structured to cover a wide spectrum of health issues with the end goal being to de-stigmatize HIV and empower women to take control of their sexual relationships, get tested for HIV, and start making better decisions related to their own overall health and their children’s health.

AIDS United and Johnson & Johnson provided the opportunity to create an innovative program by allowing a formative and pilot phase prior to implementation.  Staff found that in order to address HIV, some basic needs and issues must first be acknowledged.  The curriculum was designed to address the overall encompassing needs of women, and gain trust and confidence before indulging in the taboo subjects of sex, HIV, and communicating with partners and children. The model consists of seven sessions, as follows: 1.Information/Introduction, 2. Gender empowerment, 3. Healthy relationships, 4. Reproductive anatomy, 5. HIV/STI 101, 6. Communication, and 7. Graduation. The three main objectives are 1. Increase self-efficacy and a personal sense of empowerment 2. Improve inter-personal communication skills, and 3. Improve safe sex practices through sexual health knowledge.

In 12 months Chicano Federation has held 63 weekly sessions for 128 women.  Of those 128 Latinas who participated, 112 graduated with 88% having attended all of the seven weekly sessions.  The comparisons of pre- and post- evaluations show statistically significant, positive improvements in all three areas.  More Latinas are getting tested for HIV and using condoms as a result of this intervention. But perhaps the most interesting results come from personal testaments to the impact that this program has had on the individuals.  Many participants have shared stories of how their participation in De Mujer a Mujer has acted as a catalyst for healthier choices in their lives.  The participants start showing positive improvements in their appearances, they share stories of terminating unhealthy relationships, have fun explaining the creative ways they have introduced condoms in their sex lives, and their experiences of communicating about safe sex with their children, to name a few.  The letter below from a De Mujer a Mujer participant explains both the impact and the continued need for this intervention in our community.

“I want to thank the instructors in the De Mujer a Mujer for giving me the opportunity to attend their class…The exercises we did in class were fun and smartly put together and I found myself laughing but at the same time really thinking about the impact it could make in my everyday life.  I was surprised that the Latinas in our community are still not informed about HIV and the myths they still hear.  I believe our culture has a lot to do with it.  I hope De Mujer a Mujer continues and more Latinas are aware of it because it is greatly needed in the Latina community.  I’m definitely telling every Latina in the community I come across about De Mujer a Mujer.” –Adriana Lopez

Two years ago, Chicano Federation went through a change in leadership, something that had not happened in 20 years.  This change, along with the support from AIDS United, has allowed Chicano Federation to invest in innovative projects like De Mujer a Mujer; it has provided the opportunity to bridge the gap between HIV research and the social services it provides to the community.  The creation of the program, not only brought new energy to the organization, but also to the community at large.  Stakeholders and media alike welcome the opportunity to learn more about De Mujer a Mujer, despite the difficult subject, and they are eager to help make this program succeed.  Chicano Federation and this program are being viewed as a model to delivering mission driven services in a relevant and effective way. Chicano Federation now has social services for HIV prevention and has demonstrated success implementing an innovative project.  Thank you AIDS United and Johnson & Johnson for this wonderful journey!

Proposed House Budget Committee’s FY 2013 Budget: Unfair and Unbalanced but a Clear Choice

March 21, 2012 in Policy/Advocacy

by Ronald Johnson, Vice President, Policy and Advocacy

Its déjà vu all over again as House Budget Committee Chairman Paul Ryan (R-WI) released a proposed budget blueprint for FY 2013 and proposed legislative language for a budget resolution.  With some noted variations, the budget proposal is a repeat of the mean-spirited budget that the full House adopted for FY 2012 on a largely party line vote.  Even the name is the same: “Path to Prosperity.”  The recycled title is just as misleading today as it was last year.  Given what is being proposed, a more complete and correct title would be “Path to Further Prosperity for Those who are Already Very Prosperous.”  The subtitle should be changed to “A Blueprint for Misery and Pain for Everyone Else.”  And make no mistake; the “everyone else” includes the majority of people living with HIV/AIDS.

Like most documents dealing with the federal budget, Chairman’s Ryan’s proposal for FY 2013 is a mass of numbers and projections.  The proposed budget can, however, be boiled down to a few key elements, most dusted off from last year’s proposal:

• The budget proposal sets the overall discretionary federal spending level at $1.028 trillion. This is $19 billion below the FY ’13 level called for in the Budget Control Act (BCA) and represents a disturbing break with the bipartisan agreement that was forged last summer to avoid the country defaulting on its debt.

• Defense discretionary spending would increase by $8 billion while non-defense discretionary spending would be reduced by over 5%. Non-defense spending includes health care and HIV/AIDS programs and already has been cut by nearly $1 trillion over 10 years under the BCA.

• The budget proposal assumes repeal of the Affordable Care Act, including of course Medicaid expansion in 2014 to individuals whose income is at or below 133% of the federal poverty level (FPL).  This alone would mean that the large number of people living with HIV who have low incomes and are currently uninsured would continue to have limited or no access to the care and treatment that can save their lives. The impact on people living in the South could be especially dire.

• The plan calls for a fundamental and drastic restructuring of Medicaid and Medicare.  The entitlement nature of both programs essentially would be eliminated and federal support slashed.  Much of the costs would be shifted to the states, in the case of Medicaid, and to the individual, in the case of Medicare.  Together, the programs are the top two providers of health care coverage for the overwhelming majority of people living with HIV and AIDS.

• Existing tax breaks that benefit the wealthiest individuals and many corporations would be maintained and new tax cuts created.  The cost, estimated to be over $3 trillion over 10 years would be paid for by higher taxes for middle class individuals and families and deep cuts in spending for programs that benefit the “99%.”

• The proposed budget shreds the intricate web of safety nets not only for low-income individuals and vulnerable populations but for middle class people as well.  Funding for food stamps and other programs that provide direct assistance would be reduced significantly. Equally draconian would be the cuts to investing in education, the country’s infrastructure, and to public health.

In many ways, the proposed FY 2013 plan is less a budgetary document and more a political manifesto.  Chairman Ryan himself sees the proposed budget as setting a clear difference with President Obama over the role and function of government.  It is also a clear difference between a fair and balanced approach, with shared responsibility, to reducing the federal deficit and achieving fiscal stability and a one-sided approach that destroys the social compact, stresses austerity for the many, and awards huge benefits for the very few.  The Ryan budget is one more indicator of how important the upcoming November elections are.  This election year will provide us with a clear choice.  We can choose a path that leads to a true American renewal that can include an end to the AIDS epidemic or we can choose a path that adds to more inequality, more health disparities, and more social and economic injustice.  If we can recognize and rise up to meet this challenge, maybe the recycled Ryan budget will have been a service after all.