When President Trump stood in front of a joint session of Congress for his Washington State speech In February, he called on Republicans and Democrats alike to support the boldness of to spread HIV within a decade to stop. "Together, we will defeat AIDS in America and beyond," he said.
White House Budget 2020, released this week, proposes a further $ 291 million in down payment for a new HIV initiative. However, the US $ 4.7 trillion budget also requires a drastic cut in spending on Medicaid, the public insurance program for the poor, to which more than two out of five Americans depend on the virus.
Such a contradiction, which goes through the take-away and take-away, runs through budget arithmetic for many priorities of the Trump administration. In addition to tackling HIV, the President has dealt with childhood cancers and the opioid crisis, but his budget would undermine all of these efforts by shrinking the health infrastructure that supports people struggling with these issues while protecting the health of those living with them Spending money on cancer research It offers discrete pots of money for these causes, politicians say.
"If you cut Medicaid, you'll take your legs off the system" to help people with the AIDS virus, said Jennifer Kates, director of the Kaiser Family Foundation's Global Health and HIV Policy.
Keith Humphreys, a psychiatry professor at Stanford University, called the budget a "truly neglectful" grand scale to combat the opioid crisis – another promise mentioned in Trump's state of the Union speech. "The budget would raise $ 4.8 billion to the Department of Health and Human Services to fight the epidemic. But as with HIV, Medicaid is the top payer of addiction treatment, paying $ 1 billion a year and cutting back on this program – and Medicare – everything the government says it does.
"If you use Medicaid and Medicare, you take a lot more out of the pool than you use," said Humphreys. And he criticized the budget recommendation for cutting most of the funding for the White House National Drug Control Office – an idea on which Trump had set all three of his budgets.
"They have an office in the White House that uniquely positions policy against the epidemic," said Humphreys, "and now you will cut them off. "
To fight childhood cancer, the White House's budget would increase research funding by $ 50 million next year – another priority for the president of the trade union speech – would be reversing the overall funding for the National Cancer Institute Reduce $ 897 million, almost 18-fold.
And despite the President's promise not to harm Medicare, his budget envisages changes that would reduce spending on the population program by $ 845 billion over the next decade – Dollars – with the biggest savings associated with payment cuts to providers and new efforts to combat fraud and abuse.
Some of the household's boldest ideas for redefining health policy should not disappear from the page, as they did during Trump's term were rejected, even if the Congress was full e control of Republicans had – with less momentum, since the Democrats hold the house. One of these is the call to convert half-century Medicaid as a claim program in which the government pays a certain share to the claimants to set block grants or strict limits on those who are unaffected by economic change
At the Capitol Hill appears to be growing support from both parties for funding HIV and pediatric cancer. Republicans and Democrats pushed back this week against cuts to the National Institutes of Health and its cancer institute.
"I was alarmed to see" the cutback for the NIH Cancer Research, Rep. Fred Upton (R-Mich.), A former chairman of the House's Energy and Commerce Committee said on Tuesday in a subcommittee hearing on the budget Health and Social Affairs Minister Alex Azar.
"I understand the pain," Azar replied, saying the cut was in line with a total of 12 percent less HHS budget. "It's a difficult budget environment."
The Democrats were even more vehement about the nation's primary source of insurance for the poor. "If this administration is serious about allowing or otherwise redefining Medicaid as we know it," said Rep. G.K. Butterfield (NC) warned Azar, "We're going to see a real firestorm, not just from Congress, but from the American people."
Charles N. "Chip" Kahn III, president of the Federation of American Hospitals, said even though "there is almost an idea for every president that a budget is dead on arrival, and that's generally the case," The political priorities listed in Trump's budget should be taken seriously.
"Households have a lot." Objectives – set priorities and make political statements, "Kahn said, adding that the proposals" give some credibility. It gives people protection for change. "Well, it was in the President's house, so it must be alright."
Previous presidents, including Barack Obama, attempted to slow spending on Medicare, partly to extend the life of a financially weak trust fund for a section of the program that covers hospital stays. However, this year's budget was "on a different level and had far-reaching implications". It is proposed to slow down the funding of medical education and reduce the reimbursements for doctors and hospitals, which care for a large proportion of patients who can not pay their bills, said Kahn.
The Medicare changes do not directly affect the benefit to patients, although care could be compromised by the withdrawal of doctors for the purpose of reducing payments.
However, the proposed changes to Medicaid could have a profound impact on people, both with HIV and with addiction. Kaiser figures show that Medicaid is the largest single source of insurance for drug addicts and HIV-positive people.
In particular, the goal of the budget to end Medicaid's expansion under the Affordable Care Act "harms our efforts to end HIV," said Carl Schmid, deputy executive director of the AIDS Institute in Washington. The expansion into about three dozen states "was crucial for HIV," he said, because for the first time single men and women who are infected are allowed to reassure themselves, even if they do not have full AIDS long Time was considered a disability that qualifies people for the program.
Proponents say that while the budget for the HIV initiative is welcome, it can not achieve what it needs to achieve the president's goal of halting the spread of the virus for a decade. Of the $ 291 million, according to Schmid, about 60 million US dollars from funds that have already been spent on community health centers and other purposes.
And a key strategy – identifying people in communities who are "hot spots" for the disease and who are not infected A protective drug known as PrEP costs about $ 20,000 a year, experts say. According to estimates from the Centers for Disease Control and Prevention, 1.1 million people should take the medication – much more than the budget could cover.
"It's great to have this problem on the radar, and it's great to finally see new money." said Rochelle Walensky, specialist in infectious diseases at Massachusetts General Hospital. "But those numbers give you a sense of how we'll think about it."