July 3, 2017

Update on Opposed/Opposed Unless Amended Legislation

Since the start of the 2017/18 Legislative Session, HOAC has taken oppose or oppose until amended positions on seven bills. So far, we have achieved our desired outcome on all but one of these bills – SB 384 (Wiener), which would allow localities to extend the hours of sale for alcohol by two hours, and is scheduled to be heard by the Assembly Committee on Governmental Organization this Wednesday.

HOAC’s legislative program has taken great strides this year in forming an internal Legislative Committee, which has allowed health officers to more expediently share expertise with our lawmakers. The committee has also allowed health officers to evaluate even more legislative items, resulting in HOAC taking about twice as many positions on legislative items than we did at this time in the 2016/17 Legislative Session.

President Trump Nominates Indiana Health Officer as U.S. Surgeon General

The White House announced on Thursday that President Trump has nominated Jerome Adams, MD, MPH to serve as Surgeon General of the Untates. Adams has served as Indiana’s health commissioner – a position equivalent to California’s health officer – since 2019 and is an Assistant Professor of Anesthesiology at the Indiana University School of Medicine. As Indiana’s top-doc, Adams worked under then-governor Mike Pence in 2015 to implement a needle-exchange program in response to an HIV outbreak among needle-sharing oxymorphone users in Scott County, a rural area in Southeast Indiana.

The 2015 outbreak, which left nearly 200 people HIV-positive, was unprecedented in Indiana and is considered a defining moment of Pence’s tenure as governor. In 2013, Scott County’s Planned Parenthood – the only HIV testing center available to the county’s 24,000 residents – was closed during Pence’s first year as governor. Opioid addiction and IV drug use has long been a critical challenge to Scott County, where about 20 percent of residents live below the poverty line, and the clinic’s closure greatly hindered the rural community’s access to HIV testing and prevention services. The lack of accessible resources coupled with the high rates of needle-sharing among drug users aided a community-wide HIV outbreak that, at its height, resulted in 20 new infections each week.

Health officials identified an HIV outbreak in Southeast Indiana by January 2015. At the time, both Adams and Pence, a steadfast evangelical conservative, shared moral concerns over initiating a needle-exchange program (in Indiana, it is illegal to possess a syringe without a prescription). However, by March 2015, the number of infections continued to rise, and Adams became a leading voice in encouraging Pence to authorize the exchange. In light of new information and mounting political pressure, Pence reversed his position and issued an executive order that allowed for the distribution of thousands of syringes. The exchange program, along with aggressive outreach, was successful in slowing HIV infection rates to a trickle.

As an anesthesiologist and academic, Adams has research interests in pain management and opioid addiction. Adams once revealed in his testimony during a House committee hearing that his brother is living with addiction, and has been an outspoken advocate for increasing the accessibility of naloxone, a lifesaving overdose reversal medication. If confirmed, Adams would replace Vivek Murthy, MD, MBA, who was asked by President Trump to resign his post as Surgeon General in April.

Better Care Reconciliation Act Would Eliminate Prevention and Public Health Fund in 2018

The Better Care Reconciliation Act (BCRA), the Senate Republican healthcare proposal to repeal and replace the Affordable Care Act, proposes eliminating the Prevention and Public Health Fund next year. The Fund makes up 12 percent ($900 million) of the CDC’s budget. Additionally, local and state health departments receive more than $620 million annually through the Fund for various programs.
Senate Republican leaders were hopeful they could pass BCRA before adjourning for Independence Day, however a handful of the Senate’s Republicans have indicated their opposition to the bill – interestingly, some think the proposal goes too far, and others think it doesn’t go far enough. Appearing to have fallen short of the 50 votes needed, Senate Republican leaders agreed to act on BCRA after the July 4 holiday.