National
Higher AIDS drug costs under Obamacare?
Sebelius urged to allow drug company subsidies in exchanges
AIDS groups sent a letter to HHS Secretary Kathleen Sebelius urging her to allow drug company discount programs to operate under Obamacare. (Washington Blade file photo by Michael Key).
AIDS advocacy organizations say people with HIV could be forced to pay hundreds of dollars more each month for life-saving prescription drugs through health insurance plans required under the soon-to-be implemented Affordable Care Act known as Obamacare.
Leaders of more than 160 national and local organizations advocating for people with AIDS and other diseases sent a joint letter on Monday to Kathleen Sebelius, the U.S. Secretary of Health and Human Services, urging her to allow drug company discount programs to operate under Obamacare.
“We, the undersigned organizations and individuals, are writing to urge that the HHS issue clear guidance on the allowance of drug industry-provided co-payments, co-insurance, or other out-of-pocket discount cards and coupons in the Affordable Care Act’s Health Insurance Marketplaces,” the letter to Sebelius says.
“As people living with, and organizations serving people with HIV, HCV [Hepatitis C Virus], and other life-threatening and chronic health conditions, we are alarmed by the possibility of the prohibition of these critical financial lifelines,” the letter says.
The signers of the letter were referring to a controversy that erupted last month when Sebelius released a letter she sent to U.S. Rep. Jim McDermott (D-Wash.) saying HHS determined that the Obamacare health insurance exchanges were not “federal health care programs” as defined by a separate federal law aimed at curtailing health care fraud.
By declaring that the exchanges are not federal health care programs HHS, among other things, made the exchanges and the insurance plans sold under them exempt from a provision of the Social Security Act that bans pharmaceutical companies from providing insurance co-payment discounts or subsidies to patients for the purchase of prescription drugs.
Although this initial action by HHS drew strong support from AIDS organizations it surprised and angered many private health insurance companies and federal and state consumer protection regulators, who argued that the exemption would take away an important tool for preventing and prosecuting health care fraud.
Critics, including U.S. Charles Grassley (R-Iowa), noted that the Social Security Act prohibits pharmaceutical companies from providing co-payment assistance to patients under Medicare and Medicaid and that the Affordable Care Act should be considered as a similar federal health program.
Possibly due to the criticism of Sebelius’s initial determination on the issue, a short time later the HHS Center for Consumer Information and Insurance Oversight, which oversees insurance-related matters, issued a memo that appeared to contradict Sebelius’s interpretation of the Social Security Act.
The latter development prompted the AIDS organizations and allied groups to send their Dec. 2 letter to Sebelius urging her to hold firm on her initial determination that the insurance exchanges are exempt from the Social Security Act’s ban on drug company subsidies for prescription drug coverage.
The D.C.-based national group Health HIV participated in efforts to recruit groups to sign the letter.
According to the Wall Street Journal, drug companies spent about $4 billion on co-payment assistance programs for patients with HIV and other illnesses in 2011. The paper cited experts in the pharmaceutical industry that said the assistance programs often lowered a patient’s co-payment from $250 or more per month to just $5 per month for a prescription drug.
Critics of the program say the subsidies often are given for brand-name drugs and encourage patients not to request cheaper generic drugs. This forces insurance companies to pay more for the name-brand drugs, resulting in higher premiums for everyone in the long run, critics have said.
But in their letter to Sebelius, the AIDS organization officials said most AIDS-related drugs needed by people with HIV are not available in generic forms.
“[W]e urge you to consider the unintended consequences of suddenly removing industry-provided out-of-pocket assistance for brand-name drugs without generic equivalents from the patchwork of programs that so many people with serious and chronic conditions rely on,” the joint letter says.
“It could potentially threaten access to lifesaving medications for thousands of people living with HIV; bar millions of people with hepatitis C from benefiting from the new short-course curative treatment combinations; and keep countless people with cancer and other debilitating and life-threatening illnesses from the treatment they need to stay alive,” the letter says.
“We fear this will be a major setback to the goals of the Affordable Care Act,” it says.
HHS spokesperson Mike Robinson said he would make inquiries in response to a request by the Blade for Sebelius’s response to the joint letter by the AIDS organizations, but he did not immediately respond.
“We’re still waiting for a clear determination from HHS,” said Carl Schmid, deputy director of the AIDS Institute, one of the groups that signed on to the letter to Sebelius. “There have been some mixed signals from the department.”
Schmid said the drug company assistance programs seek to help people with HIV who are not eligible for the federal-state AIDS Drug Assistance Program known as ADAP, which provides AIDS drugs to low-income people who don’t have insurance.
Although people being helped by the pharmaceutical company assistance programs often are employed and have moderate incomes, the high cost of prescription drug co-payments could be devastating to them, Schmid and others familiar with the programs said. Some people with HIV need more than one drug for their treatment regimen, and co-payments under their insurance plans often result in co-payments of more than $200 per drug per month.
Dan Mendelson, president of the heath care consulting firm Avalere Health LLC told the Wall Street Journal that the average “silver” health insurance plan under the Obamacare exchanges has a required annual deductible of $2,500. He told the WSJ that the average deductible for the “bronze” plans under the exchanges, which are said to be the cheapest plans, is $5,000.
Schmid said these costs are often prohibitive for patients with modest incomes. The elimination of the drug company assistance programs under the Affordable Care Act’s exchanges would create a serious burden on HIV patients and others who now rely on the assistance programs.
Vice President JD Vance and his wife, second lady Usha Vance, will visit Hungary next week.
An announcement the White House released on Thursday said the Vances will be in Budapest, the Hungarian capital, from April 7-8.
JD Vance “will hold bilateral meetings with” Hungarian Prime Minister Viktor Orbán. The announcement further indicates the vice president “will also deliver remarks on the rich partnership between the United States and Hungary.”
The Vances will travel to Hungary less than a week before the country’s parliamentary elections take place on April 12.
Orbán, who has been in office since 2010, and his Fidesz-KDNP coalition government have faced widespread criticism over its anti-LGBTQ crackdown.
The Associated Press notes polls indicate Orbán is trailing Péter Magyar and his center-right Tisza party.
President Donald Trump removed Attorney General Pam Bondi from her post Thursday, following growing criticism over how she and the Department of Justice handled a range of issues, including matters related to sex offender and Trump ally Jeffrey Epstein.
Trump announced Bondi’s removal on Truth Social, where he also said Todd Blanche will serve as acting head of the Justice Department.
“Pam Bondi is a great American patriot and a loyal friend, who faithfully served as my attorney general over the past year,” Trump wrote on the platform. “Pam did a tremendous job overseeing a massive crackdown on crime across our country, with murders plummeting to their lowest level since 1900.”
Trump was seen as recently as Wednesday with the now-former attorney general at a Supreme Court hearing on citizenship.
The decision contrasts with Trump’s previous public praise of Bondi, the 87th U.S. attorney general and former 37th attorney general of Florida, who served in that role from 2011-2019 before joining the Trump-Vance administration. He has frequently lauded her loyalty and said he speaks with her often. Bondi was also one of president’s defense lawyers during his first impeachment trial.
Privately, however, Trump had grown frustrated that Bondi was not “moving quickly enough” to prosecute critics and political adversaries he wanted to face criminal charges, according to multiple sources. The New York Times reported that her inability to charge former FBI Director James B. Comey and New York Attorney General Letitia James with any crimes is a large factor in the president’s choice to fire her from the government’s primary law enforcement agency.
The move comes as Trump has sought to minimize public turmoil within his administration, avoiding the perception of a revolving-door Cabinet that defined his first term.
Lee Zeldin, a former Republican congressman from New York who unsuccessfully ran for governor, has emerged as a leading contender to lead the Justice Department. He has been one of Trump’s most reliable allies.
“He’s our secret weapon,” Trump said of Zeldin in February during a White House event promoting the coal industry, adding, “He’s getting those approvals done in record-setting time.”
Bondi has also growing faced scrutiny from Congress.
The House Oversight Committee recently subpoenaed her to testify about the department’s handling of certain files, where she declined to answer key questions during a contentious House Judiciary Committee hearing in February.
The Tampa native has a long history of opposing LGBTQ rights through her roles in government. As Florida attorney general, she fought against the legalization of same-sex marriage, arguing it would cause “serious public harm,” pushing forward a legal battle that cost taxpayers nearly half a million dollars. She also asked the Florida Supreme Court to overturn a lower court ruling that found the state’s same-sex marriage ban unconstitutional.
More recently, Bondi established a “Title IX Special Investigations Team” within the Justice Department focused on restricting transgender women and girls from participating in women’s and girls’ sports teams and accessing facilities aligned with their gender identity. She also told Children’s Hospital of Philadelphia to turn over the medical records of anyone under 19 who received gender-affirming care.
Her removal follows Trump’s decision last month to oust another controversial female Cabinet figure, Kristi Noem.
The White House
VIDEO: Gay journalist detained for booing Trumps at ‘Chicago’ opening night
Eugene Ramirez booed first family at Kennedy Center
President Donald Trump and first lady Melania Trump attended the opening night of “Chicago” at the John F. Kennedy Center for the Performing Arts on Tuesday. They were greeted by a mix of cheers, applause, and some audible boos.
Among them was Eugene Ramirez, a gay Washington resident, who later shared his account of the night after being briefly detained by security for booing the president and giving a thumbs-down gesture — an expression of what many would call a textbook definition of constitutionally protected speech to criticize the government.
Ramirez attended the opening night performance with a group of friends, hoping to catch a final show before the center undergoes two years of major changes under Trump oversight. The musical, based on a 1926 play of the same name, has become synonymous with Broadway success.
With music by John Kander, lyrics by Fred Ebb, and a book by Ebb and Bob Fosse, “Chicago” has cemented itself as a cultural staple — known for its signature Fosse choreography, stripped-down staging, and sleek, campy aesthetic. The story follows Roxie Hart and Velma Kelly, women who murder their husbands but — with the help of the manipulative, charismatic, and narcissistic attorney Billy Flynn — walk away scot-free.
It remains the longest-running American musical in Broadway history, and its 2002 film adaptation famously won the Academy Award for Best Picture. On this night, however, the production also became the backdrop for a very modern moment of political protest.
“I accompanied five friends to opening night of ‘Chicago’, as a way to enjoy a final performance in the Kennedy Center as we know it,” Ramirez began to recount to the Washington Blade, describing the moment his group settled into their seats inside the ornate Opera House theater.
Just before the performance began, the twice impeached president and first lady appeared in the balcony box, drawing immediate attention from the audience below. Theatergoers stood, cheered, clapped, and waved, while Ramirez made a different choice.
While accounts of the crowd’s reaction have varied, Ramirez said his response was intentional, immediate, and within his rights. Moments after booing and giving a thumbs-down while recording on his iPhone, security intervened.
The video of Ramirez booing the Trump’s is here:
“Within moments, the director [of security] and another guard approached and escorted me to a side area where several other security guards were waiting,” he said. “I was detained until everyone was seated and the lights dimmed.”
As he was escorted away, Ramirez said his instincts as a journalist kicked in. A former lead anchor for Sinclair’s national evening news broadcast, he said the situation immediately felt off — or more aptly put — as if he could see the strings being pulled from someone attempting to control the narrative.
“Journalism is a vocation, not just a job. I immediately knew there wasn’t just an uncomfortable interaction with security,” he said. “The Kennedy Center is a federally funded cultural institution, and being questioned about speech related to the president in that setting felt like something the public should know about.”
Ramirez explained the difference between a standard visit by a public official and this performance: the president’s appearance wasn’t just ceremonial; it was very clearly a media moment.
“The White House press pool was there, and it was clear this was an effort to manage the president’s image in the media,” Ramirez continued. “The irony was not lost on me that this was happening on opening night of ‘Chicago’, a musical about manipulating the press to shape public perception.”
According to Ramirez, the explanation he received from Kennedy Center Director of Safety and Security Karles C. Jackson Sr., was brief, but illuminating.
“He said, ‘they don’t want booing,’ and even called out my thumbs-down gesture. He never clarified who ‘they’ were, but whether it was the administration or the Kennedy Center, the distinction felt meaningless,” he explained. “Mr. Jackson ultimately told me he was just trying to do his job, shook my hand, and allowed me to return to my seat once the lights dimmed and the overture started playing.”
Ramirez said he didn’t blame the guard individually, noting the broader context of the Kennedy Center’s uncertain future and the pressures staff were under.
“With the center closing in the coming months, some of these security guards being pressured to restrict our freedom of speech may only have a few weeks of work left.”
He believes the decision to remove him was driven less by disruption than optics, particularly given the presence of the press.
“It was very clearly about protection — whether protecting the president from visible dissent, or his image before the media present. There was no disruption as almost everyone was standing and reacting loudly to the arrival of the president and first lady, with cheers, applause, and hand gestures. The difference was that my reaction, unlike most, was negative.”
Drawing on his experience covering public officials, Ramirez said the incident felt more about controlling perception than security.
“Usually, law enforcement may monitor or intervene if there’s a disruption, but here there was no disruption at all. Simply expressing dissent in a public, cultural space drew the attention of security. It made it feel less like a matter of decorum and more like an effort to control the narrative around the president,” he said. “It’s about what happens when dissent is treated as disruption rather than a right.”
“The show hadn’t started. I threatened no one. Billy Flynn would have approved of the optics. The rest of us should be paying attention.”
Ramirez framed the incident as part of a broader constitutional concern, one that is plaguing the Trump-Vance administration as they continue to reject rules and normalcy set forth by other reserved presidents.
“Being singled out by security at a federally funded institution for expressing dissent shouldn’t be brushed off; it undermines the First Amendment,” he said, looking at it slightly distanced from it now. “Being of Cuban heritage, and a journalist, it’s a right I’m not willing to give up readily.”
“Publicly funded cultural institutions should allow visible dissent, even in politically charged moments,” he added. “Of course, I understand the need to manage disruptions during a performance, but that was not the case here.”
The themes of “Chicago”, a long-running satire about media manipulation and public perception, added another layer of irony to the experience, Ramirez explained.
“The satire truly leapt off the stage! A show about controlling the narrative, manipulating the press, and covering up truths by leaning on showmanship and distractions. The show is decades old, but could’ve been written today. We’re being razzle-dazzled daily and it’s getting harder to tell fact from fiction, no matter where you get your news.”
He, being gay, also acknowledged how hard it must have been for the performers on stage, assuming that at least some in the cast were also members of the LGBTQ community — and artists — two things Trump doesn’t always get along with.
“It was not lost on me that many of the actors on that stage, that the president and first lady presumably applauded, are members of the LGBTQ community which this administration has rolled back protections for under the guise of religious liberty and free speech, resulting in blatant discrimination.”
He pointed to a particular number that felt surreal given the circumstances.
“Its ‘Razzle Dazzle’ number celebrates keeping audiences off balance; at its climax, a massive American flag descends as the song celebrates blinding audiences to what is real. Watching that scene after being detained for a thumbs-down was surreal.”
Ramirez said the show’s closing lines were especially sharp given the presidential audience and what he just experienced.
“At the end of the show,
Velma says: ‘You know, a lot of people have lost faith in America.’
Roxie replies: ‘And for what America stands for.’
Velma: ‘But we are the living examples of what a wonderful country this is.’
Roxie: ‘So we’d just like to say thank you and God bless you.’
They had both just gotten away with murder!”
His closing lines, however, were a bit more pointed than “scintillating sinners” Roxie Hart and Velma Kelly’s were in the show.
“Democracy only works when citizens are allowed to boo,” he said. “Tuesday night at the Kennedy Center, ‘Chicago’ made that point better than I ever could.”
The Blade reached out to the Kennedy Center but did not receive a comment back.
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