Trump’s Big Ugly Bill is a healthcare ‘catastrophe,’ says AHF’s Michael Weinstein
This is a “wakeup call” to jumpstart AIDS activism!
Welcome to flawed businessman/President Donald Trump’s Gilded Age 2.0 where “The Apprentice” Reality TV theme song “For the Love of Money” drowns out any hint at humanity or truth-telling.
Trump repeatedly admonished House Republicans, for instance, “to love and cherish” and “don’t fuck around with Medicaid” – then cravenly caved in to ambition to sign his “One Big Beautiful Bill” on Independence Day.
“More than 71 million people rely on Medicaid, which expanded under Obama’s Affordable Care Act, and 40 million use the Supplemental Nutrition Assistance Program [SNAP]. Most already work, according to analysts,” the Associated Press reports. “The Congressional Budget Office estimates that 11.8 million more Americans would become uninsured by 2034 if the bill became law and 3 million more would not qualify for food stamps, also known as SNAP benefits.”
Meanwhile, two in three Americans say they know little to nothing about the bill – and may not believe the truth when they hear it.
With Trump’s enforcement of Project 2025 erasing anything related to DEI, sexual orientation and gender identity and the dearth of reliable sources, I asked global AIDS Healthcare Foundation co-founder and President Michael Weinstein for reaction and information.
The following are edited excerpts from our conversation on healthcare. Please view the video for the full interview on this topic.
Karen Ocamb: What is your reaction to Trump’s Big Ugly Bill?
Michael Weinstein: “Well, it's a catastrophe from the point of view of access to healthcare. The estimates are that more than 11 million people who are currently eligible for Medicaid, which is called MediCal in California, will lose that eligibility through a variety of means. It's going to have a major budget impact in California.
It was a wealth transfer. It gave trillions of dollars to the ultra-wealthy and it took it from the people who are poor.
It's very interesting to me because a lot of times when we're lobbying for human needs, we're told that there's too much of a deficit and we don't have the money. And yet, this - by Congressional Budget Office’ s own calculations - is going to increase the deficit by $3 trillion.
On the other hand, this is what Trump ran on, it's what he promised to do. And so, it's not shocking in terms of the politics.”
KO: So we hear about these massive cuts to Medicaid. How is this going to work?
Michael: “In two major ways. One is that fewer people will be eligible for Medicaid, which is Medi-Cal in California. So that means that their access to primary care will be extremely limited. And they'll go back to the system we had before they relied on emergency rooms for their care, which is time consuming expensive, et cetera, right? And it hurts their health.
The other aspect of this bill is that it's going to remove, reduce federal government support to the states for the Medicaid program.
This is essentially a rollback of a lot of what the Affordable Care Act - known as Obamacare – did. And that was a pledge made by the Republicans and by Trump. So, they're not actually technically repealing or rolling back Obamacare, but part of Obamacare and Affordable Care Act was this expansion of Medicaid. And now that's being reversed.”
KO: How does this impact AIDS Healthcare Foundation?
Michael: “Well, we don't precisely know.”
KO: Are you preparing for this in any way?
Michael: “In the normal course of our service to clients, we have case managers and benefits counselors who handle these types of questions. So that mechanism is in place.
We accept patients without regard to ability to pay. So, we're not going to stop doing that.
I think the question is: what's going to happen to smaller agencies that serve [specific] populations? Those agencies are extremely important because they have a cultural relatability and a knowledge of its communities and trust in those communities.
We don't want to see that happen. But we are sort of the underlying safety net. We care for about 10% of all HIV patients in the nation and we're in 40 jurisdictions so we can pick up a portion of that load, if it becomes necessary.”
KO: How can you do that?
Michael: “Because we have a different model. You know, we're what's called a “social enterprise,” which is that we get some grant funding, but our primary funding comes from the businesses we operate and therefore we're not as sensitive to these types of changes as other organizations. We were a tiny organization and so we feel they're pain.
A.H.F. distributes about $20 million a year in grants and funds to other organizations. Here locally, we've been a long-time sponsor of In The Meantime, Bienestar and other organizations. We recognize their value and importance and that's why we're supporting them. We are the largest [HIV/AIDS organization] in the nation, largest in the world. We have a budget of $3 billion. We have 8,000 employees. So, we're buffered to a degree about these types of changes that are happening.
One of the tools that we have at our disposal, which came out of COVID, is telehealth, which is widely available and is becoming more and more accepted. So, we offer that to every patient, including the undocumented patients. I'm not counting on this - but so far, there's been little intrusion into healthcare space in terms of ICE. But that's no guarantee whatsoever.
And we also have a project program where we have mobile phlebotomy where we can actually send blood drawers at someone's home.
So those are alternatives that the person can utilize.
When it comes to PrEP, there was a Supreme Court decision in the last few days that said that the advisory board to HHS on preventative medicine, it upheld that. And that body had already stated that insurers needed to make PrEP available without a charge. So that will at least temporarily remain in effect.
The downside of that Supreme Court decision was it also said that the members of that committee could be removed by the head of Health and Human Services, Robert F. Kennedy Jr. or that they were not bound to, and he, as the secretary, was not bound by that decision.
We have not heard anything to the effect that they intend to cut that off, but that's the current status. It is available through private insurance. In California, it's on the formulary for Medicaid or Medi-Cal, California and likewise, for Medicare.
The other question, though, is in the grants that California gets. LA gets, for instance, with PrEP - those come from the Centers for Disease Control. And there is an ambiguity about whether that support will continue.”
KO: What does that mean?
Michael: Well, a person who wants to go on PrEP - very often they need assistance with insurance. There are other services, lab services, et cetera, right? So, the medication may be covered, but there are other aspects of it, right?
Also, they require to have quarterly testing for STDs and HIV and bone density and kidney function. So, these auxiliary things are covered by federal and state and local funds. And whether those funds will be available in the long run is unclear.
The landscape is about to change for PrEP because of this new six month injectable, which has some complicating factors. But, of course, it'll have the big advantage that people will not have to take a medication daily or go to the doctor for the other injectable that's available for every two months or six times a year.
KO: Right, could you explain a little bit more about that?
Michael: “The normal procedure is that there's an advisory committee of the FDA that says whether something should be approved and normally that recommendation is followed.
So, Gilead has developed this drug. It is a long- acting antiretroviral. It requires an injection every six months. There's also an oral loading dose that goes along with it when you start. And that's replacing either an oral medication or it's replacing current injectable aptitude that's every two months.
As far as we've seen, there are a lot of things that come under the discretion of these departments or come under the discretion of the president. And then there are others which do not normally and which they have been defying.
I think that their [the Trump administration’s] attitude is: ‘make us stop,’ right? I don't think that we can be assured about this. In the global realm, they have drastically cut back on the support for PrEP globally. That's their attitude, which is may be an economic decision to cut funding. I'm not certain about that. But, obviously, AIDS denialism is something we wish was in the rear view mirror. And it's scary that the head of HHS entertains those ideas. We haven't seen any direct impact from that, as yet.
Honestly, this is a wakeup call. I think that we've taken a lot for granted over the number of years as to what government would provide. And so, HIV advocacy and other forms of advocacy have kind of dwindled. I think it's time to reorganize around those things.
I want to reassure our clients that we're there. And I want everyone else to know that we're growing.
Now is not a time to shut down or turn back. I mean, I know there are obstacles, but it's especially important to double down in times like this and not give in to the pessimism.”