In his State of the Union address in February 2019, Donald Trump vowed to end the HIV epidemic by 2030.
Related: ‘Rick Scott had us on lockdown’: how Florida said no to $70m for HIV crisis
But if Trump has his way and the supreme court strikes down the Affordable Care Act (ACA), the resulting seismic disruption to the healthcare system would end that dream.
Democrats have expressed grave concern that if Amy Coney Barrett is seated on the supreme court, the conservative jurist could cast a decisive vote to destroy the ACA in the California v Texas case scheduled for oral argument starting 10 November. The Senate judiciary committee will vote on Barrett’s nomination on Thursday. A full Senate vote is expected on Monday.
The brainchild of Dr Anthony Fauci and other top brass at the Department of Health and Human Services, the ambitious Ending the HIV Epidemic: A Plan for America has received for its debut year $267m in new federal spending, largely targeted at HIV transmission hotspots across the US.
The central aim of the Trump-backed plan is to improve access to antiretrovirals, given that successfully treating HIV with such medications eliminates transmission risk. For HIV-negative people, the plan promotes greater use of PrEP – a daily antiretroviral tablet that cuts the risk of HIV by more than 99% among gay and bisexual men, who are its predominant users and account for seven in 10 new infections.
Given antiretrovirals’ enormous cost, the ACA and its broadening of insurance access serves as backbone to the HIV plan, which seeks a 90% reduction by 2030 to the otherwise slowly declining or stagnant national HIV transmission rate of about 37,000 new cases annually.
“The plan is dead in the water if the ACA goes down,” said Amy Killelea, senior director of health systems and policy at Nastad, an HIV public policy non-profit.
“President Trump’s healthcare agenda, in particular his plan to get the supreme court to rule against families’ healthcare, does more to end access to HIV care than it does to end HIV,” said the Washington state senator Patty Murray.
‘Heartbreaking and morally indefensible’
Kaiser found that between 2012 and 2018, the proportion of the non-elderly HIV population lacking insurance declined from about 18% to 11%. This shift was mainly driven by the expansion of Medicaid in the states that opted under the ACA to open the program to all residents with incomes below 138% of the federal poverty level.
About 60% of non-elderly people receiving care for HIV fall into that lowest of income brackets. Forty per cent of people with HIV receive Medicaid, compared with 15% of the general population.
“Striking down the ACA would lead many people with HIV to lose insurance coverage,” said Jennifer Kates, director of global health and HIV policy at the Kaiser Family Foundation.
Not following the science to address HIV or Covid-19 primarily impacts
Public health experts are growing alarmed that the Trump administration is increasingly embracing scientists who argue against lockdowns and restrictions as a means to control the coronavirus pandemic.
Those scientists maintain that the costs of locking down society and closing schools and businesses outweighs their benefits in combatting the virus. In a document known as the Great Barrington Declaration, signed earlier this month, they embrace a concept known as “herd immunity,” in which a population builds up enough resistance to a pathogen that it runs out of victims to infect.
On a call with reporters on Monday, two senior White House officials cited the declaration, authored in part by an economist with close ties to Scott Atlas, the radiologist who has become one of Trump’s chief advisors on the coronavirus pandemic.
But to public health experts, allowing the virus to run its deadly and devastating course is an unacceptable option that would lead to hundreds of thousands of deaths beyond the 217,000 Americans who have already succumbed to the disease.
“If you just let things rip and let the infection go, no masks, crowd, it doesn’t make any difference, that quite frankly, George, is ridiculous,” Anthony FauciAnthony FauciTrump fields questions on coronavirus, conspiracy theories in combative town hall Chris Christie says he ‘was wrong’ not to wear face mask at White House Overnight Health Care: Georgia gets Trump approval for Medicaid work requirements, partial expansion | McConnell shoots down .8 trillion coronavirus deal MORE, director of the National Institute of Allergy and Infectious Disease, told George StephanopoulosGeorge Robert StephanopoulosSix takeaways from Trump and Biden’s dueling town halls Biden draws sharp contrast with Trump in low-key town hall Biden leaves door open to adding Supreme Court justices MORE on ABC’s “Good Morning America” on Thursday.
“You’ll wind up with many more infections of vulnerable people, which will lead to hospitalizations and deaths. So I think we’ve just got to look that square in the eye and say it’s nonsense,” Fauci added.
In a statement Thursday, groups like the National Association of County and City Health Officials, the American Public Health Association, the Association of Schools and Programs of Public Health and the Public Health Institute condemned the declaration and the flaws in its arguments.
“Covid-19 carries a much higher risk of severe disease and death than other infections where herd immunity was attempted before a vaccine was available,” the groups said. “It is illogical to ignore public health and scientific evidence when so many lives are at stake.”
Some experts pointed to an underlying flaw of the declaration: An assumption that someone who has recovered from the coronavirus will become immune to reinfection in the future.
“We just don’t really understand coronavirus immunology well enough to know whether this is going to be a minor, moderate or major concern,” said Michael Osterholm, director of the Center for Infectious Disease Research and Prevention at the University of Minnesota. “We have learned so much about Covid-19 over the course of