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Cruel court decision makes it harder to prevent AIDS

Disease gets a boost from federal judge in Texas

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Just as the disease was on a glide path to extinction thanks to new drugs, HIV/AIDS got a boost from a federal court in Texas.

On Sept. 7, U.S. District Judge Reed O’Connor ruled that the government can’t require an employer-sponsored health care plan to cover a therapy that prevents the spread of a disease that has already killed more than 700,000 Americans. The decision in Braidwood Management Inc. v. Becerra is not just poorly argued; it is flat-out cruel.

Perhaps the best feature of the Affordable Care Act (ACA) of 2010, nicknamed Obamacare, was a requirement that insurance offer coverage of specified preventive care procedures and therapies, such as colon cancer screening and influenza immunizations.

In June 2019, the U.S. Preventive Services Task Force, an advisory panel of experts, issued a “Grade A” recommendation for pre-exposure prophylaxis, or PrEP, a medicine that is 99% effective in preventing HIV transmission during sex. The first PrEP drug, Truvada, had been approved seven years earlier by the Food & Drug Administration. On Jan. 1, 2021, the federal government required plans to cover PrEP with no copay, coinsurance, or deductible.

Even before the mandate, the Centers for Disease Control and Prevention (CDC) credited PrEP with helping reduce new HIV infections in the U.S. by 8% between 2015 and 2019 “after a period of general stability.” The CDC now calls PrEP “a key prevention strategy for ending the HIV epidemic in the U.S.,” a goal for 2030 set by both the Trump and Biden administrations.

The way to end AIDS once and for all is to get PrEP to those who need it most. Researchers are developing intravaginal rings, implants, antibodies, and long-lasting injectables. Although PrEP use has risen by a factor of eight in just five years, three-quarters of those most at risk are not using the therapy.

The success of the lawsuit by a group of self-described Christian business owners and employees will make access even more difficult. The plaintiffs argued that the preventive care mandate for PrEP violated their constitutional right to religious freedom. In the complaint, Dr. Steven Hotze said that he was unwilling to pay for a health plan covering PrEP “because these drugs facilitate or encourage homosexual behavior, which is contrary to [his] sincere religious beliefs.”

Hotze, whose vitamin company ran afoul of the FDA for COVID-19 claims, was indicted in April on aggravated assault charges involving a bizarre search for ballots after the 2020 election.

In the PrEP case, Hotze’s objection went beyond gay sex. He complained that providing coverage of the drugs facilitates and encourages “sexual activity outside of marriage between one man and one woman” as well as illegal drug use.

Judge O’Connor agreed. He went even further, ruling that members of the Preventive Services Task Force were “unconstitutionally appointed.”

In a previous case, O’Connor had ruled that the entire ACA was unconstitutional, but the Supreme Court reversed that decision last year. The current ruling draws on the Religious Freedom Restoration Act (RFRA) of 1993, which was enacted by Congress after the Supreme Court ruled in Employment Division v. Smith that the protection of the free exercise of religion in the First Amendment does not entitle anyone to a religion-based exception from a general law.

In recent years, writes Michael Dorf of the Cornell University Law School, “conservative Christians have increasingly relied on [RFRA] to obtain exceptions from laws involving insurance coverage for contraception and abortion.”

For example, in Burwell v. Hobby Lobby, a 2014 case, the Supreme Court held that a company owned by religious Christians could be excused from an obligation to pay for health insurance that covered “forms of contraception that the owners regarded as tantamount to abortion.”

But the ruling in the Braidwood case is far more sweeping. The Hobby Lobby plaintiffs considered abortion itself immoral. In this case, it’s not PrEP that Braidwood considers immoral; it’s certain kinds of sexual activities. By substantially lowering the risk of contracting HIV/AIDS, this twisted logic goes, PrEP is a facilitator of what Hotze considers immoral. And by offering insurance that covers PrEP, Braidwood says it becomes complicit.

There is a serious cost to this attenuated argument. By decreasing access to PrEP, people will needlessly become ill and, in some cases, die. The economy will also be burdened with the cost of treating a disease that can be prevented.

Modern science has developed therapies that are ending the spread of a dangerous, mortal virus. Easing access to these medicines is clearly a legitimate function of government — undoubtedly, a compelling interest. What can be more selfish and foolish than to erect needless obstacles for those who want to protect themselves and people around them?

James K. Glassman, a former Under Secretary of State in the George W. Bush administration, is an adviser to health care companies and non-profits.

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Hospitals are abusing this drug discount program

Congress must step in to help low-income patients

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Hospital chains are unfairly profiting off a program meant to help low-income patients afford their medicines. If policymakers don’t reform this system soon, I worry that many of the marginalized patients I’ve devoted my career to protecting won’t be able to access the care they need.

The program, known as 340B, gives drug discounts to hospitals in underprivileged areas so that they can better serve their communities. Yet, with little oversight, the hospitals can divert the savings to their own bottom lines.

A recent report from the Drug Channels Institute exposed just how big the problem is.

The analysis found that under 340B, hospitals took discounts worth $52.3 billion in 2022 with scant evidence that those savings went to help low-income patients. The report also found that the 340B program continued its exponential growth during the pandemic, swelling by 22% between 2021 to 2022. 

In short, money intended to help marginalized communities is instead being funneled into hospital profits in ever-greater amounts. Having spent much of my career helping Black men with HIV, I find this gravely concerning. But the impact of the exploitation extends far beyond my own work, to all communities grappling with chronic disease and unaffordable health care. The solution is for Congress to bring some much-needed oversight and regulation to the 340B program. 

It all started three decades ago when lawmakers launched a seemingly benevolent plan: In order to help non-profit “safety net” hospitals in poor communities, 340B required pharmaceutical companies to sell them drugs at big discounts. The idea was that this would lower drug prices for low-income patients and also help the hospitals, so that they could reinvest in facilities, equipment, and staff to serve disadvantaged patients. 

Unfortunately, the 1992 law failed to codify any rules about what hospitals should do with the savings, so no proof of reinvestment is required. Soon enough, even hospitals serving prosperous communities realized they could use the law’s loopholes to turn 340B into a profit center. 

Many hospitals have multiple locations. Under current regulations, a hospital can use its facility in an underserved community to qualify for the 340B Program, take millions of dollars in drug discounts, then resell the drugs in more affluent neighborhoods. 

Consider the Cleveland Clinic, known as one of the best hospitals in the country. It uses satellite “rural referral centers” to qualify for discounted drugs under 340B, then sells them at full price through its Cleveland-based flagship hospital. 

The profit from such maneuvers can be substantial. For instance, 340B hospitals sell top oncology drugs at a median of 4.9 times their discounted price, according to a report from the Community Oncology Alliance.

It’s no wonder that 44% of U.S. hospitals now report that the 340B program is a substantial revenue source. It may have also contributed to industry consolidation in recent years, encouraging hospitals to merge in order to acquire qualifying facilities.  

Despite the program’s rapid expansion, there’s little evidence that it’s benefiting marginalized patients. A study in the New England Journal of Medicine found that the “financial gains for hospitals have not been associated with clear evidence of expanded care or lower mortality among low-income patients.” Another study, in the journal Health Services Research, concluded that when new hospitals join 340B, it doesn’t lead to any change in the amount of uncompensated care they provide. 

In fact, 340B may actually increase healthcare costs for low-income patients. Because hospitals benefit from the difference between the discounted drug price and the sale price, they are incentivized to prescribe more expensive drugs, which yield higher profit margins than lower-cost generic alternatives.

This appears to be happening with the PrEP drugs that prevent transmission of HIV. A report from the American Action Forum, a think tank, found that 340B likely incentivizes hospitals to prescribe more expensive brand-name PrEP over generic versions. This means some patients are paying more than they should for this lifesaving medicine. 

Hospitals chains’ continued abuse of 340B also takes critical resources away from the healthcare facilities the program is meant to help. For instance, Ryan White HIV/AIDS providers help low-income people living with HIV access medications and support services. But letting hospitals exploit loopholes in 340B could leave fewer discounted drugs for Ryan White and similar safety net programs.

Congress needs to reform the bloated and unaccountable 340B program as soon as possible. Democrats and Republicans should be able to agree that eligibility standards must be tightened and reporting requirements improved. Hospitals must use 340B profits to help our most vulnerable patients.

Guy Anthony is president and CEO of Black, Gifted & Whole.

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Key West doesn’t need more, or bigger, cruise ships

Seeking a balance of ‘environmental protection and sustainable tourism’

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(Photo by Miami2you/Bigstock)

There is a fight today about whether they should let more, and bigger, cruise ships dock in Key West. The New York Times recently wrote about it. As someone who has spent many memorable vacations in Key West, I side with those who say “no” to more cruise ships. The organization Safer, Cleaner, Ships, is fighting to keep more, and larger, ships, out of Key West. They have the right idea. 

The question that should be asked is: “What kind of an island do the people living on Key West want?” And the answer should drive the decision of the Florida Legislature, and Governor DeSanctimonious. Unfortunately, it may be decided based on political donations the governor received. One resident of Key West, Christopher Massicotte, co-founder of Duval Street Media, said, “Key West voters overwhelmingly supported reducing cruise ship size, and the number of daily disembarkations. Then greedy Mark Walsh, who owns the dock, went straight to the governor and the legislature asking them to overturn the will of the people for his own financial gain, greased with a $1 million contribution to DeSantis’s campaign for president. The citizens of Key West aren’t trying to stop all cruise ship traffic, or bring the city back to ‘The good old days.’ We are trying to create a balance of environmental protection and sustainable tourism.”  

I cruise regularly and love it and have traveled to Alaska on a cruise and woke up one morning on the ship in Ketchikan, to step out on the balcony and see six massive ships, and hundreds of busses on the pier, ready to take passengers on tours. In Key West, that won’t happen. Instead, the thousands of passengers will not get on busses, rather throng the main street (Duval), from one end of town to the other, making it look more like Times Square, instead of a sleepy little island, which is what always attracted people to the idea of Key West. It is what attracted Hemmingway. It attracted President Truman to set up his winter White House. Everyone going to visit Key West heads to the Southernmost Point in the U.S. to snap their photo. One doesn’t need thousands more people heading there all at once. Just the thought of this would have Hemmingway and Truman turning over in their graves.

I always thought Key West did fine with an airport, and people coming to visit by car, then staying in a hotel, or guesthouse. I often stayed at one of the great little guesthouses, or some of the smaller hotels, on the island. I remember the larger ones being on both ends of Duval Street. There were great bars and restaurants, and you could amble down Duval slowly, enjoying the sound of the music coming out of the bars — think Jimmy Buffett.

I loved Key West when it was a gay Mecca, having the first openly gay mayor of a city. At the time there were lots of gay guesthouses and clubs. I remember dancing at the Copa, and there was the dock on the southern side of the island, next to the one tiny beach, which locals called ‘dick dock.’ It was a great spot for nude sunbathing, as was the pool at the Southernmost Motel. That period ended when the gay community moved to South Beach in Miami. Key West is still welcoming to the LGBTQ community. There is the iconic La Te Da hotel, on Duval Street, with its tea dance. Performing there is another Key West icon, Christopher Peterson, a female impersonator extraordinaire. Christopher said, “Unfortunately I don’t think we need to dredge again the beautiful coral reef we live on, just to have 10,000 more people here for six hours, adding nothing to the economy because they eat and drink on the ship for free.” He added, “Bigger is not always better unless it’s in the bedroom…. king-size bed…. dirty minds!”

Numbers can always be used in many ways, but the Times column reported “Before the pandemic, nearly a million people a year were visiting Key West aboard cruise ships. But when Covid-19 brought that to a halt, the city’s $2.4 billion tourism industry, responsible for 44 percent of its jobs, did not collapse. Instead, hotel tax revenue rose 15 percent, and with 1.4 million arrivals, the airport set a record in 2021.”

If that is enough revenue to keep Key West being the wonderful place it is to live and visit, it seems adding thousands of more day trippers out of cruise ships isn’t going to make the place better. Rather, it will hurt the environment, and make things worse.

Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist. He writes regularly for the Blade.

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Most of America opposes Speaker Johnson’s anti-LGBTQ hate

No one should have their identity politicized so GOP can score points with its base

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House Speaker Mike Johnson (R-La.) (Washington Blade file photo by Michael Key)

When I was a kid, I was afraid to come out to my religious family – at the time, gay marriage was still illegal. Fortunately, times have changed: My family is supportive of me for who I am and I now plan to marry my partner one day. But the newest speaker of the House jeopardizes that dream, making me fear the life I have planned with the person I love will soon fall out of reach.

Recently, after three weeks of chaos, the House of Representatives elected Mike Johnson (R-La.) as speaker. His extremist rhetoric and horrific record of discrimination toward the LGBTQ community doesn’t represent where most of America is – but it does clue us into the priorities of today’s Republicans.

The love that I and my partner have built over our three years together is the same as straight couples. Yet Johnson’s legislative record flies in the face of that as he’s argued to uphold bans on same-sex marriage, sought to ban inclusion of gay couples in employment benefits, and compared gay marriage to bestiality. It’s impossible to feel optimistic that, with a background like that, Johnson will protect my rights during his tenure.

The entirety of my community feels the same apprehension. My coworker, Mads Stirling, who came out as a nonbinary trans person in 2021, has the same fears that I do. They found that being empowered to live as their authentic self through hormone replacement therapy (HRT) and changing their driver’s license gender marker improved their mental health. 

“But even as I was transitioning with the crucial support of family, friends, coworkers, and the local government, I felt terrified as I watched Republican-led states roll back rights for trans people,” Mads said.

Johnson contributed to the dangerous climate that spurred these attacks, speaking in favor of banning gender-affirming care for transgender youth and joining a contingent of politicians who proposed more than 500 anti-LGBTQ bills in the U.S. in 2023. In his new role as speaker, Johnson could even help unravel important protections like federal nondiscrimination laws. 

It feels like our country is moving backward and that nowhere is safe for people with identities like mine. Having been there myself, my heart breaks for LGBTQ children who will hear the new speaker’s horrible homophobia and transphobia and feel unsafe being their authentic selves. No person, least of all children, should have their identity politicized so the Republican Party can score points with its members. 

It is appalling that while 70% of Americans support gay marriage, we have a speaker who opposes it. It is appalling that while gender-affirming care reduces suicidality in trans adults and children, we have a speaker that wants to deny life-saving care to them. It is appalling that, in 2023, a person in power can spread such hatred toward a group of people for simply existing.

The Speaker of the House should be a voice for all Americans, representing our interests and embodying the role of a leader. But as a gay Black man, it is impossible for me to feel that Johnson — and the Republican Party he answers to — can ever represent us when they work so actively against us.

The Republican Party and Mike Johnson have demonstrated over and over again that protecting and uplifting LGBTQ+ people is not a priority. We expect Johnson intends to serve only his own party’s extremist agenda by further isolating and oppressing LGBTQ people — after all, they maneuvered him into power. We fear the erasure of LGBTQ identities entirely by disappearing us from public life and making our private lives intolerable by criminalizing our families and our healthcare.

America deserves better than Mike Johnson. We can never tolerate nor normalize Johnson’s hateful rhetoric toward LGBTQ people, and now that he has a national platform, it’s more important than ever to speak out and vote against the GOP’s extremist policies. We must continue our work to elect representatives that will champion LGBTQ people and fearlessly defend their rights so that in the future, no one with views like these can assume a place in Congress. 

We deserve leadership reflective of the American people and that’s not Mike Johnson or the GOP’s anti-LGBTQ agenda.

Mike Griffin is senior electoral organizer for D.C.-based Community Change.

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