Doing Better: Making Improvements to

Shared from HHS


Sunday, October 20, 2013

Over the past two and a half weeks, millions of Americans visited to look at their new health care options under the Affordable Care Act. In that time, nearly half a million applications for coverage have been submitted from across the nation. This tremendous interest – with over 19 million unique visits to date to– confirms that the American people are looking for quality, affordable health coverage, and want to find it online.

Unfortunately, the experience on has been frustrating for many Americans.  Some have had trouble creating accounts and logging in to the site, while others have received confusing error messages, or had to wait for slow page loads or forms that failed to respond in a timely fashion. The initial consumer experience of has not lived up to the expectations of the American people. We are committed to doing better.

Aside from the difficulties since launching the site, there are parts of the overall system that have proved up to the task.  The “Data Hub,” component, which provides with information that aids in determining eligibility for qualified health plans, is working.  Individuals have been able to verify their eligibility for credits, enabling them to shop for and enroll in low or even no-cost health plans.


Since launch, when we first recognized these issues, we have been working around the clock to make improvements.  We have updated the site several times with new code that includes bug fixes that have greatly improved the experience. The initial wave of interest stressed the account service, resulting in many consumers experiencing trouble signing up, while those that were able to sign up sometimes had problems logging in.

In response, we have made a number of improvements to the account service.  Initially, we implemented a virtual “waiting room,” but many found this experience to be confusing.  We continued to add more capacity in order to meet demand and execute software fixes to address the sign up and log in issues, stabilizing those parts of the service and allowing us to remove the virtual “waiting room.”  Today, more and more individuals are successfully creating accounts, logging in, and moving on to apply for coverage and shop for plans.  We’re proud of these quick improvements, but we know there’s still more work to be done. We will continue to conduct regular maintenance nearly every night to improve the experience.


To ensure that we make swift progress, and that the consumer experience continues to improve, our team has called in additional help to solve some of the more complex technical issues we are encountering.

Our team is bringing in some of the best and brightest from both inside and outside government to scrub in with the team and help improve  We’re also putting in place tools and processes to aggressively monitor and identify parts of where individuals are encountering errors or having difficulty using the site, so we can prioritize and fix them.  We are also defining new test processes to prevent new issues from cropping up as we improve the overall service and deploying fixes to the site during off-peak hours on a regular basis.

Most importantly, we want to hear from you, and make sure that your experience with is a positive one.  If you have any comments, either complimentary or critical, please let us know by sharing your feedback at  We’ve already heard so many stories of individuals getting health insurance for the first time, and we are dedicated to making that possible for all Americans.

LGBT Health and Obamacare

Shared from The Huffington Post


Throughout the administration, we operate on the fundamental belief that every American deserves equal opportunity, equal protection, and equal rights under the law. That’s why the Affordable Care Act is so important for lesbian, gay, bisexual, and transgender (LGBT) Americans.

The health care law prevents health insurance companies from charging anyone a higher premium just because they happen to be lesbian, gay, bisexual or transgender. It also prevents insurers from raising rates or denying coverage because of a pre-existing condition like HIV/AIDS, cancer, or mental health concerns.

Thanks to the law, insurance companies can no longer impose a lifetime limit on your coverage. This is particularly important to HIV/AIDS patients, and anyone who has a chronic condition.

The Affordable Care Act also includes critically important, non-discrimination provisions. For example, starting in January 2014, it will be illegal for any of the insurance companies who offer coverage through the Marketplace to discriminate on the basis of sexual orientation or gender identity. We’ve also taken action to strengthen the civil rights provision in the law, by clarifying that the new law’s prohibition on sex discrimination includes discrimination based on sex stereotyping, and on gender identity.

All of this is good news for the LGBT community, particularly when we consider that one in three lower income LGBT adults in our country do not have health insurance. Starting October 1, they are going to have the opportunity to sign-up for quality, affordable coverage through the new Health Insurance Marketplace for coverage beginning as early as January 1, 2014.

But here’s the thing: most of these Americans are not yet aware of their new options.

You don’t have to be an expert to figure out what we need to do to get the word out. It’s outreach. It’s education. It’s communication.

That’s why, last week at the White House, I joined Valerie Jarrett, Senior Advisor to President Obama, and nearly 200 LGBT community leaders and allies from across the country for a briefing on Obamacare and the LGBT community. The purpose of this briefing was to equip community leaders with the tools, information, and resources they need to get involved and help local LGBT communities get access to quality, affordable health care.

And that’s why we are excited to work with organizations like Out2Enroll, a new initiative to educate the LGBT community about the Affordable Care Act. Rooting for more of our neighbors to sign up for health care is not enough. It’s going to take work at the grassroots. And so Out2Enroll has a very important mission.

Dr. King taught us, “Human progress never rolls in on the wheels of inevitability. It comes through the tireless effort and the persistent work of dedicated individuals.”

So in the weeks and months ahead, we look forward to working with a diverse range of partners – national advocates, LGBT community centers, HIV/AIDS service providers, Pride organizations, PFLAG chapters – to ensure that members of the LGBT community have the information, resources, and tools they need to sign up for quality, affordable health care.

I hope you will join us in this important work.

In case you missed it:
Video of Secretary Sebelius’s keynote remarks
Improving Health for LGBT Americans
On the Road in Philadelphia: Focus on LGBT Health

Day 1 Highlights from USCA

Shared from


The annual U.S. Conference on AIDS (USCA) opened yesterday, Sunday, September 8, 2013 in New Orleans. Organized by the National Minority AIDS Council Exit Disclaimer (NMAC), the conference has drawn more than 1,700 stakeholders from all fronts of the HIV/AIDS epidemic—from case managers and physicians, to public health workers and advocates, people living with HIV/AIDS, and policymakers – for four days of information sharing. Among the highlights of the first day of the conference were two plenary sessions.

Federal Perspectives on the Affordable Care Act coordinated a plenary that focused specifically on how implementation of theAffordable Care Act is supporting efforts to improve HIV prevention, care, and treatment and achieve the goals of the National HIV/AIDS Strategy. Introducing the session, NMAC’s Executive Director, Mr. Paul Kawata, observed that “when we join the Affordable Care Act with the science of ‘treatment as prevention’ and the National HIV/AIDS Strategy, we have a combination that can begin to end this epidemic.”

The session featured HIV leaders from several federal agencies. During their presentations, each shared observations about aspects of Affordable Care Act that are making a critical difference in their work on behalf of people at risk for or living with HIV. These included:

  • Dr. Grant Colfax, Director of the White House Office of National AIDS Policy (ONAP), pointed to the vital role that the Affordable Care Act has in national efforts to achieve the goals of the National HIV/AIDS Strategy and, in particular, improve outcomes all along theHIV care continuum which the President has recently called federal agencies and other stakeholders to focus on more intently as they continue to implement the Strategy.
  • The health care law’s provisions requiring coverage by most private health insurance plans without co-pays or deductibles for many preventive services—especially HIV testingand behavioral counseling to reduce risk for sexually transmitted infections and HIV—were cited as particularly significant by Dr. Johnathan Mermin, Director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.
  • Dr. Laura Cheever, Associate Administrator of the Health Resources and Services Administration for the HIV/AIDS Bureau, pointed to two provisions of the health care law that will substantially aid in delivering care to people living with HIV/AIDS (PLWH/A). First, the law’s provisions that give states the option to expand Medicaid to PLWH without having to qualify as ‘disabled’ as currently required. Given the relatively low income of the majority of uninsured PLWH who currently receive services under the Ryan White HIV/AIDS Program, they would be eligible for Medicaid coverage under the law if their state chooses to expand it, she explained. This would provide them with access to a broader array of health care services than the Ryan White program can cover. Second, Dr. Cheever pointed to the fact that the health care law prohibits insurers from denying coverage to people with pre-existing conditions, including HIV/AIDS. This will expand the availability of health coverage for people with HIV.
  • Observing that the Centers for Medicare and Medicaid Services (CMS) is collaborating more closely than ever before with its federal partners for a unified vision and approach to HIV issues, Dr. Stephen Cha, the Chief Medical Officer for CMS, observed that the Affordable Care Act is much more than about getting more people health coverage. He emphasized that its true promise lies in leveraging the foundation of that coverage and combining it with the successes of the Ryan White HIV/AIDS Program and others to fundamentally improve way we are providing care to change course of the HIV epidemic in the United States. He shared that, toward this end, CMS is exercising various authorities to foster healthcare delivery reform and offer states new flexibilities.
Spotlight on HIV/AIDS in the Southern U.S.

The conference’s opening session put a spotlight on the disproportionate impact of HIV/AIDS across the Southern states. In the U.S., the HIV/AIDS epidemic is not evenly distributed across states and regions. According to CDC data, states in the South report many of the highest rates of persons living with a diagnosis of HIV infection. In addition, by region, both the number of people diagnosed with AIDS and the rate of AIDS diagnoses (number of diagnoses per 100,000 people) is highest in the South (15,855 diagnoses or 13.7 per 100,000 people).

A panel comprised of a provider, state AIDS director, person living with HIV, and advocates and program staff working with most affected populations shared perspectives on the challenges and opportunities in working to combat HIV/AIDS in the region. Discussing the reasons for HIV’s disproportionate impact in the region, one panelist pointed to social determinants of health that drive HIV in all regions of the country including poverty, lack of education, and lack of access to health care; but she also observed that there are additional factors exacerbating the HIV epidemic in the South including institutionalized racism, homophobia, and a general lack of sex education in schools. Rather than becoming dispirited in the face of the region’s HIV disparities, one of the panelists observed that these disparities challenge and motivate those working to address HIV/AIDS in the region to do more and find new, effective approaches to reach those at risk for and living with HIV. As one step toward better addressing the epidemic in the South, a panelist who is living with HIV urged more open dialogue about HIV by and among those living with or at risk for HIV. This is a vital step, she observed, to breaking down the stigma that still surrounds HIV in the region. Another panelist observed that the implementation of the Affordable Care Act is providing improved opportunities to link those who test positive for HIV and STDs to culturally competent care, pointing especially to the benefits for young, Black, gay men, a population that is particularly impacted both in the South and nationally.

These sessions provided participants with much to consider as they continue to engage with each other in the days ahead. Check back tomorrow for highlights from the second day of the conference. And, next week, we will provide you video interviews from the federal panelist.

For more information on the conference, visit Exit Disclaimer and follow #USCA2013 Exit Disclaimeron Twitter.

Addressing the Intersection of HIV/AIDS, Violence against Women and Girls, and Gender-Related Health Disparities

Shared from Office of National AIDS Policy Blog


Today we are proud to announce the release of the report by the President’s Working Group on the Intersection of HIV/AIDS, Violence against Women and Girls, and Gender-Related Health Disparities. We have had the honor of serving as co-chairs of the interagency Federal Working Group since March 2012, when President Obama issued a Presidential Memorandum to address two overlapping challenges to the health and wellbeing of communities across the United States: the effects of HIV/AIDS, and the alarming rate at which women and girls experience violence.

More than 1 in 3 women in the United States has experienced rape, physical violence, or stalking by an intimate partner in her lifetime; of these women, 69% report experiencing intimate partner violence at age 25 or younger, and 22% experience IPV for the first time as girls between the ages of 11 and 17 years.  Furthermore, approximately 280,000 women in the United States were living with HIV in 2009, with an estimated 15% unaware of their status.  Women account for 20% of new HIV infections in the United States, with over three-quarters of these new infections occurring among black and Latina women.

By themselves, these statistics represent a compelling call to action, but the particular prevalence of intimate partner violence among women living with HIV further reinforces the need to address the intersection of HIV/AIDS and violence against women and girls: 56% of women living with HIV, compared to the national prevalence of 36%, have experienced violence by an intimate partner.

Given these data, the Working Group established by the Presidential Memorandum was tasked with developing actions for evidence-based, culturally relevant steps for Federal agencies to address the barriers to care and prevention for both HIV and violence. The culminating report charts a path forward to improve collaboration among agencies by leveraging federal resources in support of the health and wellbeing of women and girls, particularly those living with or at high-risk for HIV/AIDS and violence. The report’s action steps include: a focus on research and data collection to evaluate existing programs; ideas to develop new strategies for intervention; and expanded efforts to empower women and girls, as well as engage men and boys, in the prevention of violence and HIV risk.

The release of this report comes at a particularly exciting time for women’s health, with open enrollment into the health insurance marketplace beginning October 1 under the Affordable Care Act. Built into the report are action steps to improve screening rates for both intimate partner violence and HIV for women; already as a result of the Affordable Care Act, new health plans provide coverage with no cost sharing for these services. Each of the report’s action steps will help meet the goals of the National HIV/AIDS Strategy and are synergistic with the Administration’s additional efforts to promote health and wellness among women and girls.

On Sunday, September 8, we will present the report at the United States Conference on HIV/AIDS, in New Orleans. We look forward to sharing the report with stakeholders, because a coordinated response to this complex issue is necessary to maximize impact. While the report identifies specific federal actions, its long-term success will depend on collaboration with partners in the private sector, faith communities, academia, and advocacy organizations. Our collective efforts will help us reach the goals of the National HIV/AIDS Strategy and reduce violence against women and girls.

Read the full report here.

Dr. Grant Colfax is the Director of the Office of National AIDS Policy. Lynn Rosenthal is the White House Advisor on Violence Against Women.

NIH Observes 20th Anniversary of Women’s Interagency HIV Study

Shared from NIAID News Releases


The largest and longest-running study to investigate the impact of HIV on women in the United States marks its 20th anniversary this month. Findings from the Women’s Interagency HIV Study (WIHS) have helped define how best to treat HIV-infected women in the United States and globally.

The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, established the WIHS in 1993 in response to a dramatic increase in AIDS cases among women in the United States. Since then, the WIHS has enrolled a total of 4,137 women who were HIV-infected or at risk for acquiring HIV, and has published more than 550 scientific papersExternal Web Site Policy. In so doing, the study has charted the course of HIV disease in treated and untreated women across the United States through detailed clinical, biological, neurocognitive, and behavioral assessments; comparisons of HIV-infected and uninfected women; and studies of HIV-infected women receiving treatment.

The scientific accomplishments of the WIHS include assessing how genetic, metabolic, behavioral and other factors influence HIV disease progression. The study also has generated information on the health effects of other viruses in HIV-infected women, including herpes, hepatitis C and human papilloma viruses. These data have helped clarify how such co-infections impact the course not only of HIV disease, but also of cardiovascular, liver, and kidney disease; cervical cancer; diabetes; lipodystrophy (the redistribution of fat) and neurocognitive disorders. And the study has demonstrated that economically and socially disadvantaged women will volunteer to participate in intensive, long-term clinical studies and make important contributions to medical research.

Today, nearly 2,120 women participate in the WIHS. More than 1,100 volunteers died from AIDS or other causes and 917 dropped out of the study. About 70 percent of the current participants are infected with HIV, and nearly 90 percent of those infected have taken antiretroviral therapy. The women are largely from minority groups, with 58 percent black, 28 percent Hispanic and 14 percent white. Roughly half of the participants live in poverty. These demographics of the WIHS volunteers reflect those of the HIV epidemic among women in the United States.

Every six months since 1993, WIHS volunteers have made study visits to sites in Chicago, Los Angeles, New York City, San Francisco and Washington, D.C. New study sites were established this year in Atlanta; Birmingham, Ala.; Jackson, Miss.; Chapel Hill, N.C.; and Miami, while the Los Angeles site was closed. WIHS staff interview women about their health and behavior and conduct clinical and laboratory tests, and the data and specimens gathered during these visits are confidentially stored and managed in a central database in Baltimore and a repository in Frederick, Md.

Since 1993 NIAID has continuously funded the WIHS in partnership with the National Cancer Institute, the Eunice Kennedy ShriverNational Institute of Child Health and Human Development, and the National Institute on Drug Abuse, all part of NIH. The National Institute of Mental Health recently became a funding partner.

NIH thanks the WIHS staff, scientists, and most importantly the volunteers, whose commitment and dedication over the past two decades have made the accomplishments of the WIHS possible.

NIAID conducts and supports research—at NIH, throughout the United States, and worldwide—to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit

NIH…Turning Discovery Into Health ®

The Affordable Care Act and American Indians and Alaska Natives

Shared from HHS


By Dr. Yvette Roubideaux, Acting Director, Indian Health Service
Posted August 22, 2013

I get questions all the time from American Indians and Alaska Natives (including my own relatives!) wondering why they should care about the Affordable Care Act since they already are eligible for the Indian Health Service (IHS).  My response is that while the IHS is here to stay and will be available as their healthcare system, the Affordable Care Act brings new options for health coverage.  It is another way that the federal government meets its responsibility to provide health care for American Indians and Alaska Natives.

The purpose of the Affordable Care Act is to increase access to quality health coverage for all Americans, including our First Americans.  The benefits of the health care law for American Indians and Alaska Natives are significant whether they have insurance now, want to purchase affordable insurance through the Health Insurance Marketplace or take advantage of the States expanding Medicaid starting in 2014.  Indian elders will benefit from a stronger Medicare with more affordable prescriptions and free preventive services no matter what provider they see.  And of course, we’re thrilled that the Indian Health Care Improvement Act (IHCIA), our authorizing legislation, was made permanent by the Affordable Care Act.

These new benefits mean potentially more services for individuals and the communities we serve.  So we are encouraging every American Indian and Alaska Native to enroll in the Marketplaces starting October 1, 2013 to see what benefits are available to them.

To learn more about how the law is benefiting our community visit:

To learn more about the Health Insurance Marketplace visit

Ryan White HIV/AIDS Program and Essential Health Benefits Webcast

Shared from


The Affordable Care Act (ACA) ensures that health plans offered in the individual and small group markets, both inside and outside of the Health Insurance Marketplace, offer a comprehensive package of items and services, known as essential health benefits.

The Health Resources and Services Administration’s (HRSA)HIV/AIDS Bureau and the Centers for Medicare and Medicaid Services (CMS) are hosting a webcast titled “The Intersection of the Ryan White HIV/AIDS Program with the Essential Health Benefits in Private Health Insurance and Medicaid” on Wednesday, August 28th at 2:30pm ET.

Speakers from the CMS Center for Consumer Information and Insurance Oversight (CCIIO) will review individual and small group commercial plan coverage of essential health benefits inside and outside of the Health Insurance Marketplace.  Speakers from the Center for Medicaid and CHIP Services (CMCS) will review Medicaid coverage of essential health benefits.  The HIV/AIDS Bureau will end the presentation with a brief discussion of the intersection of the essential health benefits with the Ryan White HIV/AIDS Program.  There will also be time for questions and answers.

Click here to join the webcast Exit Disclaimer. No registration is required.

FDA approves first rapid diagnostic test to detect both HIV-1 antigen and HIV-1/2 antibodies

Shared from FDA News Release


The U.S. Food and Drug Administration today approved the first rapid Human Immunodeficiency Virus (HIV) test for the simultaneous detection of HIV-1 p24 antigen as well as antibodies to both HIV-1 and HIV-2 in human serum, plasma, and venous or fingerstick whole blood specimens. Approved for use as an aid in the diagnosis of HIV-1 and HIV-2 infection, the Alere Determine HIV-1/2 Ag/Ab Combo test is also the first FDA-approved test that independently distinguishes results for HIV-1 p24 antigen and HIV antibodies in a single test.
The test can be used by trained professionals in outreach settings to identify HIV-infected individuals who might not be able to be tested in traditional health care settings. The test does not distinguish between antibodies to HIV-1 and HIV-2, and is not intended to be used for screening of blood donors.
Detection of HIV-1 antigen permits earlier detection of HIV-1 infection than is possible by testing for HIV-1 antibodies alone. The test, can distinguish acute HIV-1 infection from established HIV-1 infection when the blood specimen is positive for HIV-1 p24 antigen but is negative for HIV-1 and HIV-2 antibodies.
“This test helps diagnose HIV infection at an earlier time in outreach settings, allowing individuals to seek medical care sooner,” said Karen Midthun, M.D., director of the FDA’s Center for Biologics Evaluation and Research. “Earlier diagnosis may also help to reduce additional HIV transmission.”
HIV infection can result in the development of Acquired Immune Deficiency Syndrome, or AIDS. HIV damages the body’s defense mechanisms by destroying specific blood cells, called CD4+ T cells, which are crucial to helping the body fight diseases. Two types of HIV have been identified, HIV-1 and HIV-2. HIV-1 is responsible for most HIV infections throughout the world. HIV-2 is found primarily in West Africa; however, cases of HIV-2 infection have been reported in North America and Europe.
The Centers for Disease Control and Prevention estimates that each year approximately 50,000 people are infected with HIV in the United States. Of the more than 1 million people living with HIV in the United States, approximately 20 percent of those people have not been diagnosed.
The Alere Determine HIV-1/2 Ag/Ab Combo test is manufactured by Orgenics, Ltd. (an Alere, Inc. company) of Yavne, Israel.
For more information:
The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

Coming This Month: Health Insurance Marketplace Trainings

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Two months from today – on October 1, 2013 the online Health Insurance Marketplace will open in every state and the District of Columbia. No matter what state you live in, you’ll be able to use the Marketplace to apply for coverage, compare your options, and enroll. As we get closer to the opening of the Marketplace, growing numbers of people – maybe even you – want to know more about this new way to find health coverage that fits your budget and meets your needs.

To help you learn more the Health Insurance Marketplaces, this month and next month, the Centers for Medicare & Medicaid Services (CMS) are offering a series of online webinars.  Read the descriptions, review the schedules below, and select the free online session that best meets your information needs. (Note: Webinar audio will be delivered over the Internet (VOIP) and will play through your computer speakers or you can stream audio from a mobile device such as a smart phone or tablet.)

Health Insurance Marketplace 101

This webinar is for people who want to better understand the basics of the Health Insurance Marketplace. It includes an overview of the accomplishments of the Affordable Care Act, and a basic introduction to the Marketplace (Exchanges) highlighting who is eligible and how the Marketplace will work.

Date Time Webinar Link
August 8, 2013 1:00 – 2:00 pm ET Exit Disclaimer
August 28, 2013 1:00 – 2:00 pm ET Exit Disclaimer
September 5, 2013 1:00 – 2:00 pm ET Exit Disclaimer
September 25, 2013 1:00 – 2:00 pm ET Exit Disclaimer
Understanding the Health Insurance Marketplace

This webinar is designed for those who help people make informed health coverage decisionsThis detailed review of the Marketplace (Exchanges) includes eligibility, enrollment, plan structure, Medicaid expansion, and the streamlined application. This session covers many of the same topics as the Health Insurance Marketplace 101 session, but it is provided in more depth.  The organizers suggest you take this or Marketplace 101, not both.

Date Time Webinar Link
August 14, 2013 1:00 – 2:30 pm ET Exit Disclaimer
September 11, 2013 1:00 – 2:30 pm ET Exit Disclaimer

Be sure to visit to get more of your questions answered about health care reform and the opening of the Health Insurance Marketplaces.

Watch this preview of a new message from Secretary of Health and Human Services Kathleen Sebelius about the Affordable Care Act and HIV.