This weekend marks the third anniversary of the passage of the Patient Protection and Affordable Care Act (ACA). The ACA improves access to care and preventive services through expansion of public and private insurance, reforms that eliminate discriminatory insurance practices and make insurance coverage more affordable, and significant investments in prevention, care coordination, and health workforce and infrastructure. In the case of viral hepatitis, the ACA provides an opportunity to not only improve access to essential care and treatment for people living with viral hepatitis, but to diagnose viral hepatitis earlier and prevent new infections. In light of the ACA’s anniversary, NASTAD released a primer today on viral hepatitis and the ACA, The Affordable Care Act and the Silent Epidemic: Increasing the Viral Hepatitis Response through Health Reform. The primer provides an overview of how health reform impacts viral hepatitis prevention, screening, linkage and retention to care, and treatment.
Quick Facts about Viral Hepatitis
- Hepatitis is an inflammation of the liver commonly caused by a virus, most often hepatitis A (HAV), hepatitis B (HBV) and hepatitis C (HCV)
- 5.3 million people are living with HBV and/or HCV in the U.S.
- Up to 75% of chronic viral hepatitis cases are undiagnosed
- Viral hepatitis can be asymptomatic for decades, leading to late-testing and late diagnoses
- Viral hepatitis can lead to liver disease, cirrhosis, liver failure or liver cancer
- Viral hepatitis claims the lives of 15,000 people annually
- “Baby boomers” (those born 1945-1965) have the highest rates of HCV-related deaths
- Recent epidemiologic reports indicate a rise in HCV infection among young people (15-29) throughout the country
- HAV and HBV are vaccine-preventable and appropriate treatment can lead to an effective cure of HCV
In 2010 alone, the Centers for Disease Control and Prevention (CDC) estimated that 38,000 Americans were newly infected with HBV and 17,000 with HCV. Unfortunately, these estimates are likely only the tip of the iceberg due to the lack of an adequate surveillance system. In fact, there is currently no categorical federal funding dedicated specifically to national programs for viral hepatitis surveillance, screening, care or treatment.
Additionally, viral hepatitis disproportionately impacts several communities, particularly:
- Persons who inject drugs (PWID)
- Men who have sex with men (MSM)
- African Americans
- Asian Americans
- Residents of rural and remote areas
- People living with HIV (PLWH)
Government and Community Response to Viral Hepatitis
Thanks to government and community leadership and initiative, the Action Plan for the Prevention, Care and Treatment of Viral Hepatitis, provides a road map for improving viral hepatitis surveillance, testing, care, and treatment, in line with the goals of Healthy People 2020. The ACA, in turn, provides necessary tools to assist with implementation of this action plan. Perhaps the most significant opportunity presented by the ACA is the potential to integrate viral hepatitis services into broader health systems, particularly important given that there is no separate health infrastructure for those infected with viral hepatitis, unlike for people living with HIV (PLWH) through the Ryan White Program. Innovative thinking to ensure that these broader systems are responsive to viral hepatitis needs is paramount and will take commitment from health departments, state and federal government stakeholders, providers, advocates, industry and consumers alike.
Health Reform and Viral Hepatitis
Here are some highlights of our newly released primer on how health reform impacts viral hepatitis prevention, screening, linkage and retention to care, and treatment:
- The implications of Medicaid expansion for low-income populations at risk for or living with viral hepatitis
- What Essential Health Benefits (EHB) are and how they will affect HAV and HBV vaccinations and screening for viral hepatitis
- What the U.S. Preventive Services (USPSTF) recommendations mean for HBV and HCV screening
- The Medicaid cost-sharing associated with HAV and HBV vaccinations
- An example of a State Medicaid Health Home Program that covers individuals living with HCV
- What Medicare reform can mean for baby boomers at risk of HCV
- What “exchanges” and “marketplaces” are and what it means for viral hepatitis
- How private insurance reforms will increase affordability of viral hepatitis treatments
- The importance of transitioning people living with viral hepatitis from Pre-Existing Condition Plans (PCIPs) to other insurance sources
- How community health center investments can benefit people living with and at risk for viral hepatitis
- The remaining challenges and opportunities during and after implementation of the ACA
Clearly, the ACA offers an unprecedented opportunity to improve early identification and linkage to comprehensive care and treatment for people living with viral hepatitis. However, realizing this opportunity will require leadership and vision from providers, advocates and federal, state, and local government. Viral hepatitis advocates and providers – and particularly state health departments – have a role to play to ensure that health reform responds to these needs.
This article was originally posted on March 21 on the National Alliance of State & Territorial AIDS Directors (NASTAD) web site. It is reprinted with permission from NASTAD. The author, Oscar Mairena, is the manager of Viral Hepatitis and Policy and Legislative Affairs at NASTAD.