Southern Ohio sits at the center of America’s ground zero where the opioid crisis is concerned.
Few people from the Cincinnati area are likely to forget anytime soon the 2017 Cincinnati Enquirer feature “Seven Days of Heroin: This is what an epidemic looks like.” Depending on who you ask, things may have improved since then.
But one problem Ohio continues to grapple with is too-high rates of HIV transmission– especially in suburban and rural areas. According to the CDC:
[I]n the South, 23% of new HIV diagnoses are in suburban and rural areas, and in the Midwest 21% are suburban or rural—higher proportions than in the Northeast and West.
Indeed, Ohio’s HIV transmission rate sits at 8.8 per 100,000 people, compared to 4.3 per 100,000 in neighboring, opioid-ravaged West Virginia.
So, stopping HIV transmission is a live issue in the Buckeye State in the 2020 presidential election, which explains a lot why President Trump devoted special attention to the topic in this year’s State of the Union and why his administration is already working on combating HIV using existing tools in the political and governmental arsenal.
One of those is of course the bully pulpit, which Trump frequently seizes to make drugmakers look like rapacious thugs jeopardizing Americans’ health to bank higher profits. The bully pulpit and strong position of the federal government to generate bad press for pharmaceutical companies is de facto being used by Health and Human Services Secretary Alex Azar to negotiate with Gilead– the maker of anti-HIV drug Truvada– to force down its cost.
But the Trump administration is also leaning in, using an existing no-cost-to-taxpayers program to get HIV-related medications into the hands of poorer, especially rural, Americans like a lot of the Ohio-based opioid addicts at higher risk of contracting HIV.
That program is called 340B and it’s been around since former President George H W Bush signed it into law. Basically, it says that in exchange for Big Pharma companies getting access to entitlement money, which they use as a foundation for their very solid financial bottom lines, drug companies have to offer discounts on a bunch of their products for the benefit of poorer Americans. The program doesn’t just benefit individual, less-well-off consumers. It also helps keep open rural health care providers like those that poor, rural HIV-susceptible patients visit. And it’s what the Trump administration is relying on to get moving on combating HIV in places like Ohio.
Department of Health and Human Services Assistant Secretary for Health Brett Giroir said at a Kaiser Family Foundation event on April 22 that “Community health centers leveraging the 340B program, where we get highly competitive prices, are really the way to go” where distributing HIV-prevention drugs like Truvada is concerned. Jen Kates, vice president and director of global health and HIV policy at the Kaiser Family Foundation validated that plan stating that community health centers within 340B could become “front-line provider[s]” for getting Truvada “to a wider group of people and to communities.” This matters because Truvada can retail for $1,600-1,700 for a 30-day supply– a price tag that puts it well outside the realm of the affordable for most Ohioans, including those most at risk. 340B makes it more accessible and/or cheaper to a bunch of target patients.
Trump won in 2016 because in states like Ohio, he brought out often-disinclined-to-vote rural and suburban voters who ranked high on the misery index. That meant people hit very hard by the opioid crisis, including its knock-on effects like too-high HIV transmission rates. These people and their family members have become core Republican voters, when before, perhaps they voted Democratic or just didn’t vote because they felt ignored by the political system and marginalized socially, economically, and democratically.
Democrats are bound to make a play for these voters in 2020, too, but in the short term, Trump is putting them in something of a jam because he has prioritized issues key to combating opioid-related aspects of misery in Trump country– drug-smuggling and cartels, reforming the criminal justice system so it’s less punitive to those who fell afoul of criminal laws thanks to their drug consumption or side-dealing, and yes, bringing HIV transmission rates down.
There are a lot of reasons Ohio doesn’t look today like the swing state it was in 2008 or 2012, but this is probably one of them. Trump may not be popular nationwide or overall with voters, but for a lot of Ohioans who previously felt totally ignored by politicians, Trump is delivering.