The Early Treatment for HIV Act A Pathway to Success through Congress

1. The Early Treatment for HIV ActA Pathway to Success through Congress Gabriel Seth Koch Manager of Policy & Federal Affairs Community Access National Network gskoch@tiicann.org (202)588-1775

2. ETHA • What is ETHA legislatively? • What has already been done? • What still needs to be done?

3. What is ETHA? • The Early Treatment for HIV Act • First introduced 4/28/1999 • H.R.1591Title: To amend title XIX of the Social Security Act to permit States the option to provide Medicaid coverage for low-income individuals infected with HIV.

4. Pelosi, Gephardt • Rep. Nancy Pelosi: "Early treatment for HIV can extend and improve the lives of people with HIV disease, But, tragically, many people are going without this powerful and cost effective therapy. This legislation will extend access to the drug therapies and primary care that people with HIV should receive." • Rep. Dick Gephardt: "We must take this important step to address the Catch-22 faced by thousands of low-income HIV-positive Americans who don't have health insurance. Medicaid should be providing them with the therapies that help keep them healthy and live longer, more productive lives."

5. Senator Torricelli (NJ) • Sen. Robert Torricelli: "This bill is simple logic. It is a real step toward improving the quality of life for thousands of low-income people with HIV. This legislation eliminates a glaring flaw in the Medicaid program by allowing access to vital medical services." • Fifty-nine other members of the House joined Gephardt and Pelosi as original cosponsors of the bill. Earlier the same month, the Presidential Advisory Council on HIV/AIDS wrote the President urging his active support of the Early Treatment for HIV Act. (May 21, 1999) • What happened?

6. H.R. 2063 ETHAJune 5, 2001 • Rep. Pelosi makes changes to the bill based on the Breast and Cervical Cancer treatment Act of 2000 • Receives 152 cosponsors in a little over 1 year • Dies in the Energy and Commerce Health subcommittee

7. Why is it important to treat early?Quality of Life Improvements • Dr. Anthony Fauci, Director of NIAID: “Increasingly, scientific evidence indicates that beginning treatment for HIV as early as possible in the course of infection has advantages for infected individuals, their partners and their communities. Early treatment appears to improve the odds of staying healthier longer. In addition, treatment can dramatically reduce the amount of HIV in blood and other bodily fluids, decreasing the chances of virus transmission. This is particularly important during the first weeks after infection, when the amount of virus circulating in untreated individuals is extremely high.”

8. Life of HIV Dr. Anthony Fauci

9. Why is it important to treat early?Cost Savings and Efficiencies • Treatment costs are 2.6 times higher per year at later stages of HIV disease • Why? • Additional ailments due to poor health, hospitalizations, unemployment, housing, transportation

10. What does 2.6 times more look like in real terms?

11. What have we done so far? • Community coalescence • The House of Representatives • The Senate

12. HIV Healthcare Access Workgroupunder FAPP • ETHA Fact Sheet • Included in top 10 priorities for healthcare reform • Organized numerous Hill visits

13. House of Representatives • Reps. Eliot Engel and Ileana Ros-Lehtinen • H.R. 1616 – Early Treatment of HIV Act of 2009 • Speaker Pelosi, Chair Waxman, Reps. McCotter, Bono Mack lead the charge • 40 original cosponsors: 20 Dem 20 GOP • Dropped on March 19, 2009

14. House of RepresentativesTimeline • March 09: Previous cosponsors on Energy and Commerce • April 09: GOP Push • June 09: Hit 100 Cosponsors, Included in Tri-Committee Discussion Draft • July 09: Included in Tri-Committee Final

15. How are we doing?A comparison between Congresses at 4 months 2 days • H.R 2063, 2001: 6/5-10/7 = 158 Cosponsors • H.R. 3362, 2007: 8/2-12/4 = 83 Cosponsors • H.R. 1616, 2009: 3/19-7/21 = 126 Cosponsors

16. Side note on Nancy • The Speaker has only Cosponsored 3 serious bills: • H.R.1740 : To amend the Public Health Service Act to increase awareness of the risks of breast cancer in young women and provide support for young women diagnosed with breast cancer. • H.R.2920 : To reinstitute and update the Pay-As-You-Go requirement of budget neutrality on new tax and mandatory spending legislation, enforced by the threat of annual, automatic sequestration. • H.R.1616 : To amend title XIX of the Social Security Act to permit States the option to provide Medicaid coverage for low-income individuals infected with HIV. By comparison, Rep. Eliot Engel from NY has cosponsored 16 serious bills and Rep. Maurice Hinchey from NY has cosponsored over 300 bills.

17. SenateTimeline • Nov 08: Clinton/Smith – the search for new leaders • Jan 09: The Schumer/Snowe Connection • Apr 09: Meeting with the Finance Committee Members • Apr 20, 09: S. 833 ETHA is introduced • May 09: Push for Previous Cosponsors • June 09: New Members and Old House Members

18. How are we doing?A comparison between Congresses at 3 months 1 days • S. 987, 2001: 6/5-9/6 = 8 Cosponsors • S. 860, 2007: 3/13-6/14 = 14 Cosponsors • S. 833, 2009: 4/20-7/21 = 26 Cosponsors

19. What do we have left to do?The House of Representatives • Push for more cosponsors! • The Magic Number: 218 • Pass the House version of the health reform bill • Identify strong champions who may sit on the Conference Committee in case ETHA does not pass the Senate

20. What do we have left to do?The Senate • Push for more Cosponsors! • The Magic number is: 51… err sort of • Insert it as a provision of the Finance Committee during “markup” • Identify strong champions who may sit on the Conference Committee in case ETHA does not make it in the Finance bill

21. Feel free to contact me if you are interested in getting more involved with your Congressional members To do more… Gabriel Seth Koch Manager of Policy & Federal Affairs Community Access National Network gskoch@tiicann.org (202)588-1775