Most Americans say they are concerned that there will be a major outbreak of the coronavirus in the U.S. (55%) and that it will negatively affect the U.S. economy (57%), the latest KFF tracking poll finds. A substantial share (43%) also say they are concerned that they or a family member will contract the virus.

Fielded prior to Monday’s steep U.S. stock market declines, the poll finds most Americans (83%) have read or heard at least some about the coronavirus outbreak that started in December in Wuhan province in China and has since spread to other countries, with dozens of confirmed cases so far in the U.S. A similar majority (87%) are aware there have been cases diagnosed in the U.S.

So far, nearly seven in 10 Americans (69%) say that U.S. government officials are “doing enough” to prevent the spread of coronavirus. This includes majorities of Republicans (80%), independents (70%) and Democrats (60%).

“The public largely seems comfortable with the government’s response so far, but those perceptions could change if we see more U.S. cases and deaths,” KFF Senior Vice President Jen Kates said.

Designed and analyzed by public opinion researchers at KFF, the poll was conducted February 13-18, 2020 among a nationally representative random digit dial telephone sample of 1,207. Interviews were conducted in English and Spanish by landline (302) and cell phone (905). The margin of sampling error is plus or minus 3 percentage points for the full sample. For results based on subgroups, the margin of sampling error may be higher.

KFF also has an interactive map, updated regularly, that captures the number of confirmed coronavirus cases and deaths by country across the globe.

With lowering prescription drug costs a top priority for Americans, the Trump Administration, presidential candidates, members of Congress, and several states are proposing to allow the importation of drugs from abroad, chiefly Canada. The idea of allowing drugs to be imported from Canada and other countries is popular with Americans across the political spectrum, but has yet to be implemented due to concerns about safety, and strong opposition from the drug industry.

A new KFF resource, 10 FAQs on Prescription Drug Importation, provides answers to questions, such as:

• How does current U.S. law regulate the importation of prescription drugs from other countries?
• What are the safety concerns related to importation of prescription drugs?
• What has the Trump Administration proposed regarding importation?
• What are states currently doing regarding importation?

Importing drugs from abroad is just one of many proposals on the table for tackling rising drug costs. The House of Representatives recently passed a bill (H.R. 3) that would authorize the Secretary of HHS to negotiate prescription drug prices for Medicare, and curb annual increases in drug prices. The Senate Finance Committee has also passed legislation to address drug costs. (Neither H.R.3 nor the Senate bill, S.2543, includes a proposal to allow importation from other countries.) For more KFF resources on prescription drugs and the debate over how best to lower drug costs, visit kff.org.

With the Supreme Court today considering whether to take up a case that seeks to overturn the entire Affordable Care Act, the latest KFF tracking poll finds that a clear majority (55%) of the public now views the law favorably – its highest rating in more than 100 KFF polls since it became law nearly 10 years ago. In comparison, slightly more than a third (37%) hold unfavorable views.

The recent uptick reflects strong support among Democrats, 85% of whom now express favorable views. A narrow majority (53%) of independents also view the law favorably.

While most Republicans (77%) still hold unfavorable views towards the ACA, the poll suggests that Republican voters have largely moved on from efforts to repeal the Affordable Care Act and now rank opposition to a single-payer government health plan like Medicare-for-all among their top health priorities. When asked what about health care is important to their vote, few Republican voters (3%) say repealing the Affordable Care Act, while much larger shares say health care costs (24%) or opposition to Medicare-for-all (19%).

Repealing The ACA Is No Longer The Top Health Care Issue For Republican Voters

“Republicans seem to be shifting their ire from the ACA to Medicare-for-all,” KFF President and CEO Drew Altman said. “The gulf between Republicans and Democrats on health has never been wider.”

Health care ranks lower in a list of important issues in the 2020 election for Republican voters, compared to Democratic voters, independent voters, and the crucial group of voters who haven’t made up their minds yet – swing voters. More than one-third of Democratic voters (36%) say health care is the “most important” issue in their 2020 vote choice as do three in ten independent voters and 28% of swing voters. The economy is the top issue for Republican voters (34%).

Issues are not the only factor in the election. When asked what is the one thing that will motivate them to vote in 2020, a larger share of voters offer responses related to defeating President Trump and electing a Democrat (20%) than any issue, including health care (8%) or the economy (8%).

As the Democratic primary season heats up, the poll finds about two thirds (66%) of the public favor a government-run public insurance option that would compete with private insurance plans and be available to all Americans, while about half (52%) favor Medicare-for-all, in which all Americans would be insured through a single government plan. Four in 10 (43%) favor both a public option and Medicare-for-all

With both of these proposals garnering majority support and being front-and-center in the 2020 presidential campaign, the poll pushed voters who support both approaches to choose the one they prefer. The results show voters prefer the public option (44%) over Medicare-for-all (26%).

The public option retains this clear edge among Democratic, Republican and independent voters. Among the potentially crucial group of swing voters twice as many prefer a public option (49%) as Medicare-for-all (25%).

Additional findings from the poll will be released next week.

Designed and analyzed by public opinion researchers at KFF, the poll was conducted February 13-18, 2020 among a nationally representative random digit dial telephone sample of 1,207 adults including 998 self-reported registered voters. Interviews were conducted in English and Spanish by landline (302) and cell phone (905). The margin of sampling error is plus or minus 3 percentage points for the full sample and 4 percentage points for voters. For results based on subgroups, the margin of sampling error may be higher.

When the Affordable Care Act (ACA) became law in 2010, public opinion of it was narrowly divided and deeply partisan. This Health Affairs article reviews 102 nationally representative public opinion polls in the period 2010–19 and finds public opinion has shifted in a sustained way at only two points in time: in a negative direction following technical problems in the first enrollment period, and in a positive direction after President Donald Trump’s election and subsequent Republican repeal efforts.

In late 2019 the ACA was more popular than ever, yet partisan divisions have gotten larger rather than smaller. Many core elements of the law remain popular across partisan groups, even as fewer people recognize the ACA as the source of some of these provisions. While Republicans may never embrace the law that is seen as President Barack Obama’s legacy, the public’s reluctance to see certain benefits taken away will continue to be a roadblock for people who would seek to repeal or dismantle it.

Read the article in Health Affairs.

Source

The Past, Present, And Possible Future Of Public Opinion On The Affordable Care Act

KFF Health Tracking Poll – September 2019: Health Care Policy In Congress And On The Campaign Trail

KFF Health Tracking Poll: June 2016

A new KFF poll examines the public’s knowledge and attitudes about sexually transmitted infections (STIs) and finds that while knowledge about how STIs are transmitted is high, large majorities are unaware of how common STIs are among adults in the U.S.

About one-third of adults (36%) know that STIs have become “more common” over the past ten years — similar to the share who say they “don’t know enough to say” (38%). In addition, few (13%) know that over half of the people in the U.S. will get an STI sometime during their lifetime.

Slightly more than half (54%) of the public say they or someone they know has had an STI. Nearly six in 10 (58%) women say they know someone who has ever had an STI, as do half of men. Older adults are less likely to know someone compared to younger age groups (18-29 year olds: 54%; 30-49 year olds: 63%; 50-64 year olds: 57%; 65 and older: 36%).

Only a fraction of the public (8%) is worried about contracting an STI in the next year, but larger shares of younger people, ages 18-29, express concern (20%). About one in ten Black adults (13%) and Hispanic adults (13%) and 5% of White adults say they are worried they may personally contract an STI in the next year.

Knowledge about treatment is mixed, but knowledge about transmission is high. About half of the public know certain common STIs are curable with medications. Slightly more than half of adults know gonorrhea and chlamydia are curable (56% and 54%, respectively), and genital herpes is not curable (59%). Fewer are aware that syphilis is curable (45%).  In contrast, a large share of the public is aware that STIs are often asymptomatic, yet transmissible.

In addition to these poll findings, KFF has an updated fact sheet about STIs that includes an overview of STIs and reviews how STI prevention and treatment services are financed in the United States.

Designed and analyzed by public opinion researchers at KFF, the poll was conducted December 20-30, 2019 among a nationally representative probability-based sample of 1,215 adults including an oversample of 351 women, 18-49 years old. Interviews were conducted in English and Spanish online (1,100) and on the phone (115). The margin of sampling error is plus or minus 3 percentage points for the full sample and 6 percentage points for women, 18-49. See topline for margin of sampling error for other subgroups.

Key Findings:

There are an estimated 20 million new sexually transmitted infections (STIs) every year in the United States with rates of reported STIs continuing to rise, reaching record-breaking levels in 2018. This poll provides new data on the public’s knowledge and attitudes about STIs.

• Large majorities of the public are unaware of how common STIs are among adults in the U.S. About one-third (36%) are aware that STIs have become more common over the past decade and few (13%) know that over half of people in the U.S. will get an STI sometime during the lifetime.
• Slightly more than half (54%) say they know someone who has had an STI, including those who say they have personally had an STI. There are some differences by key demographic groups with larger shares of women and younger adults saying they personally know someone who has had an STI.
• Small shares of the public (8%) are worried about contracting an STI in the next year, with larger shares of younger people, ages 18-29, expressing concern (20%). About one in ten Black adults (13%) and Hispanic adults (13%) and 5% of White adults say they are worried they may personally contract an STI in the next year.
• Overall, the public is aware that STIs are often asymptomatic, yet transmissible. Large majorities know that STIs can be transmitted even when that person is not showing any symptoms (96%) as well as during pregnancy and childbirth (87%). Equally large shares are aware some people who have an STI might not even know it (96%) and symptoms may not display in some people with an STI for years (90%).
• About half know chlamydia (54%), gonorrhea (56%), and syphilis (45%) are curable. More than half (59%) know that genital herpes is not curable.

Sexually Transmitted Infections

Slightly more than half (54%) of adults say they personally know someone, including themselves, who has had an STI such as gonorrhea, chlamydia, genital herpes, syphilis, or human papillomavirus (HPV).  Nearly six in ten women (58%) say they know someone who has ever had an STI, as do half of men. Older adults are less likely to know someone compared to younger age groups (18-29 year olds: 54%; 30-49 year olds: 63%; 50-64 year olds: 57%; 65 and older: 36%).

Despite this, few know how common STIs are in the U.S. today and that STIs are on the rise. One-third of adults (36%) are aware that STIs have become “more common” over the past ten years, but this is similar to the share who say they “don’t know enough to say” (38%) and only ten percentage points higher than the share (26%) who either say STIs have become “less common” or “stayed about the same.” About one-third of men (32%) are aware that STIs have become more common over the past decade and about four in ten women are aware (39%). Awareness is also higher among Black adults (48%) compared to White adults (33%). Four in ten Hispanic adults are also aware STIs have become more common.

Additionally, a small percentage (13%) know that “over half of the people in the U.S.” will have an STI, other than HIV, at some point in their lifetime.

About one in ten (8%) are worried that they personally will contract a new STI over the next year, yet there are some groups who worry more about contracting an STI. Larger shares (20%) of younger adults (18-29) report being worried which is consistent with data from the CDC which states that this age group is the group at the highest risk for STIs. Additionally, STI rates are higher among Black adults and Hispanic adults compared to White adults. At least one in ten Hispanic adults (13%) and Black adults (13%) say they were worried about contracting an STI, compared to 5% of White adults.

About one in eight say they are uncomfortable discussing STIs with a sexual partner (12%) and one in seven (15%) are uncomfortable talking about STIs with a doctor. In fact, large majorities of the public say they are “very comfortable” or “somewhat comfortable” talking about STIs with their doctor or health care provider (84%) or sexual partners (75%). Smaller majorities are comfortable talking about STIs with their close friends (67%) or family (61%). Similar shares also report feeling comfortable talking about their sexual health with these different groups. In a survey conducted more than two decades ago, KFF found that more than one-third of the public were uncomfortable discussing STIs with a sexual partner (37%) and three in ten (31%) were uncomfortable talking with a doctor about getting an STI test (compared to 12% and 15% in the most recent survey).

There are some differences by age and gender in how comfortable people are talking about the topic. A higher share of women than men said they were comfortable talking with their close friends about STIs (71% vs. 61%, respectively) and their sexual health (62% vs. 52%).

While most new STIs are among young adults, older adults are also at risk. A smaller share of those 65 and older say they are comfortable talking about STIs and their sexual health with a variety of audiences, compared to younger adults.

Understanding of STI Transmission and Treatment Options

The vast majority of adults are aware that STIs are often asymptomatic, yet transmissible. More than nine in ten adults are aware that a person with an STI can spread it to a sexual partner even if they do not have any symptoms (96%) as well as during pregnancy and childbirth (87%). Equally large shares are aware some people who have an STI might not even know it (96%) and that some people with an STI may not display symptoms for years after contracting the STI (90%).

Large shares of the public are unsure about whether many STIs are curable with medication or not. Slightly more than half of adults know gonorrhea and chlamydia are curable with medication (56% and 54%, respectively), and genital herpes is not curable with medication (59%). Fewer are aware that syphilis is curable with medication (45%). About half (51%) of the public say they are unsure if HPV is curable with medication or not. HPV is a common STI that has more than 150 different strains (including some associated with cervical and other cancers and others that cause genital warts). There is no medical treatment for HPV, however, most people who acquire HPV (specifically those not associated with cancer or warts) will clear the infection on their own and without health problems. There is a vaccine available to protect against some of the more serious types of HPV.

In 1998, less than half of the public knew gonorrhea and chlamydia could be cured with medications (48% and 32%, respectively), while now more than half are aware of this (56% and 54%, respectively). Awareness that both genital herpes and HPV are not curable with medications has not changed over the past two decades.

Knowledge around treatment of STIs is generally higher among those who are under the age of 65. Majorities of younger adults are aware that chlamydia and gonorrhea are curable and that genital herpes is not curable with medication, compared to less than half of adults 65 and older who are aware of this. For each STI assessed, individuals aged 65+ were significantly less likely to correctly identify whether they are curable or not, compared to adults younger than 65 years old.

There were also some differences by gender and race. A larger share of women than men correctly reported that chlamydia is curable and that HPV is not curable (even though most people who acquire HPV will clear the infection on their own and there is a vaccine for HPV prevention), while awareness about other infections was similar between women and men. A higher share of Black adults know that chlamydia, gonorrhea and syphilis are curable, compared to other races. A previous 2017 KFF survey showed a higher share of Black and Latina women compared to White women said their physician discussed STIs with them.

Sexually transmitted infections encompass many different types of viral and bacterial infections.  Every year, an estimated 20 million new sexually transmitted infections (STIs) are reported to the Centers for Disease Control and Prevention (CDC) in the United States. The rates of reported STIs reached record-breaking levels in 2018, continuing their recent rise. Despite these high rates, a 2019 KFF poll found that a large share of the public is unaware of how common STIs are, with less than half (36%) aware that STIs rates are increasing.

While all sexually active individuals are potentially at risk, rates are highest among 15-24 year olds, as well as gay and bisexual men. Black and Hispanic populations are also disproportionately affected relative to non-Hispanic White populations. Increasing rates of STIs highlight the importance of prevention, testing, treatment, as well as information and education, in curbing the transmission of these infections. This fact sheet examines trends and disparities in STI prevalence, reviews the STI screening and preventive care coverage policies for private insurance and public programs (including coverage gaps), and describes confidentiality in the provision of these services.

What are Sexually Transmitted Infections?

STIs are generally defined to include chlamydia, genital herpes, gonorrhea, hepatitis B, HIV, Human Papillomavirus (HPV), syphilis, and trichomoniasis . All STIs, including HIV, are preventable, and there are treatments to cure many, though not all, of them. Because some STIs often show no symptoms, at least initially, some people with an STI may not find out until more serious health concerns present. For this reason, preventive measures and routine screenings are important for the early identification of these infections in order to engage in treatment and to prevent further transmission and more serious complications.

Untreated STIs, particularly chlamydia and gonorrhea, can result in pelvic inflammatory disease (PID) in women and infertility. It is estimated that HPV, the most common STI in the United States, will be contracted at some point during the lifespan of nearly every sexually active individual. Most cases of HPV resolve on their own, but certain strains of HPV are linked to cervical, throat, penile, and anal cancers. The HPV vaccine protects against nine strains of this virus, including several that are associated with cancer.

Pregnant women with an untreated STI face increased risk of complications as do their infants. Exposure to an STI during pregnancy can result in preterm labor, low birth weight, premature rupture of membranes, and transmission to the infant during delivery. HIV and syphilis are particularly serious if transmitted to newborn infants. So long as a mother with HIV is engaged in consistent antiretroviral (ARV) treatment, it would be highly unlikely to transmit HIV to a baby. Up to 40% of babies born to women with untreated syphilis may be stillborn or die from the infection. Late or limited prenatal care has been associated with congenital syphilis (when the infection is present in utero or childbirth). Congenital syphilis is preventable in most cases, if women are screened for syphilis and treated early during prenatal care.

Prevalence of Sexually Transmitted Infections

While women still account for the highest reported cases of STIs (driven mainly by high numbers of chlamydia in women), men, in particular gay and bisexual men, saw greater increases in rates of syphilis, chlamydia, and gonorrhea in recent years. Syphilis infection rates nearly doubled among men from 2014 to 2018 (Figure 1).

Congenital syphilis rates increased 173% between 2014 and 2018, with the number of cases the highest they have been since 1995. The highest rates of congenital syphilis were in the South, West, and Southwest (Figure 2).

STIs also have a disproportionate impact on young people, ages 15-24, who acquire half of all new STIs, despite only representing 25% of the sexually active population (Figure 3). Young people, ages 15-24, account for 60% of all reported cases of gonorrhea and chlamydia.

Due to a combination of social, structural, and economic inequities, HIV and other STIs disproportionately affect certain groups (Figure 4). In 2018, Blacks accounted for 38% of reported gonorrhea cases and 33% of primary and secondary syphilis cases, despite comprising just 13% of the population. Blacks also accounted for 42% of new HIV diagnoses in the U.S in 2018. Hispanics are also disproportionately affected, accounting for 27% of persons newly diagnosed with HIV and representing 18% of the population in 2018.

Gay and bisexual men of all races have also been disproportionately affected since the start of the HIV/AIDS epidemic. In 2018, men who have sex with men (MSM) accounted for more than two thirds (69%) of all HIV diagnoses in the U.S., representing 86% of cases among males. MSM also accounted for 78% of male primary and secondary syphilis cases in 2018.

The higher prevalence of HIV and other STIs in certain communities can mean risk of exposure is also greater in these communities, particularly when sexual networks are close-knit. When used correctly, condoms are effective at preventing the transmission of HIV and other STIs. However, condom use in the U.S. remains low (Figure 5. Pre-exposure prophylaxis (PrEP), a daily pill approved by the FDA in 2012, reduces the risk of sexually contracting HIV by up to 99% among people at high risk.

Expedited Partner Therapy

Many states have laws allowing expedited partner therapy (EPT), which permits the treatment of partners of patients diagnosed with an STI without examination. The CDC has recommended this practice since 2006 in certain circumstances due to its success in reducing gonorrhea reinfection rates. Currently 39 states and DC allow physicians to provide at least some treatment to the partner of a patient diagnosed with a STI. Among publicly funded clinics, 79% provided expedited therapy for the patient’s partner at the same visit in 2015. However, even in states where EPT has been legalized, many do not allow the patient’s insurance coverage to be billed for the partner’s treatment, which can create a financial barrier to care.

Paying for STI Prevention and Treatment Services

Access to prevention, screening, testing and treatment services for STIs is facilitated by private insurance, public coverage such as Medicaid and Medicare, as well as publicly-supported health programs. The CDC estimates that in 2008 (the most recent estimate available), the annual direct medical costs in the US associated with STIs (including HIV) were nearly $16 billion.

Private Insurance

The Affordable Care Act (ACA) requires most private health insurance plans to cover recommended preventive services, including HIV and other STI screening, with no cost sharing. For adults, this includes US Preventive Services Taskforce (USPSTF) recommendations receiving an A or B grade, which include vaccines recommended by the CDC’s Advisory Committee for Immunization Practices, and services for women recommended by the Health Resources and Services Administration (HRSA). STI-related services that must be covered without cost-sharing by most plans are presented in Table 2.

In June 2019, the USPSTF Task Force added an A grade recommendation for PrEP for the prevention of HIV in high-risk populations, which means that most insurance plans must begin covering the full cost of the drug in the plan year that starts after June 2020. CDC guidelines on PrEP advise that individuals on PrEP have follow up visits and lab work, including being re-tested for HIV four times a year, but it is unclear whether these follow-up visits and lab work must be covered without cost-sharing by most insurance plans.

Plans are also required to cover prescription contraceptives for women, so coverage for female condoms would be required if an enrollee has a prescription but not when purchased over the counter. Twelve states (CA, CT, DE, IL, MD, MA, NJ (will apply to insurance plans in April 2020), NM, NV, NY, OR, WA) and DC currently require insurance coverage for over-the-counter contraceptive methods – of these however– 8 states (CA, DE, IL, MD, MA, NJ, NV, OR) exclude male condoms.

Medicaid

Medicaid, the national health coverage program for low-income individuals, is financed and operated jointly by the federal and state governments. For the 37 states and DC that have expanded Medicaid, STI counseling, screenings, preventive vaccinations, and PrEP must be covered at no cost for the newly eligible populations under the ACA just as they are for enrollees in private insurance plans (Table 2). However, this requirement does not apply to populations covered by Medicaid through other pathways, where coverage for specific STI screenings and treatments is determined by the state.

Some states extend access to STI services through limited-scope Medicaid family planning programs that provide Medicaid coverage solely for family planning services to women and men who do not qualify for full Medicaid benefits. Most of these programs cover STI screenings, but not all cover treatment if diagnosed. While all state Medicaid programs must cover medically necessary HIV testing, state coverage of routine HIV screening varies because it is an optional benefit under Medicaid. While several states cover condoms, they require prescriptions for this over-the-counter product. Medicaid is the largest public funder of HIV treatment and care, and all state Medicaid programs should cover PrEP.

Medicare

Medicare plays a key role in providing health coverage to 60 million people 65 and older as well as younger people with long-term disabilities. The ACA also requires Medicare to cover preventive services that are rated “A” or “B” by the USPSTF without cost-sharing. Medicare Part B (Medical Insurance) covers STI screenings for chlamydia, gonorrhea, syphilis, and/or Hepatitis B once every 12 months for individuals at increased risk for an STI or at certain times during pregnancy for pregnant individuals. Medicare also covers up to two individual 20-30 minute, face-to-face, high-intensity behavioral counseling sessions once each year for sexually active individuals at increased risk for STIs. Additionally, Medicare covers an HIV screening once per year for individuals age 15-65 without regard to perceived risk or for individuals outside of this age range who are at an increased risk for HIV. Medicare Part D is required to cover all approved antiretrovirals (one of “six protected” drug classes), which includes PrEP, but unlike most preventive services covered under Part B, plans are allowed to charge cost sharing for these drugs.

Services and Programs for Uninsured Individuals

Roughly 28 million people, 9% of the population, were uninsured in 2018. A patchwork of public-supported clinics and program make STI services available to uninsured individuals. STI programs funded by federal, state, and local governments, such as those that receive funding from various federal agencies such as HRSA, the CDC, or the Office of Population Affairs (OPA), are important sites of care for STI prevention and treatment, especially, those who are under- or uninsured. As part of the safety-net healthcare network, health centers and health departments provide low-income individuals with free or low-cost care, including counseling, testing, diagnosis and treatment. Research suggests that clinicians at these clinics are also more likely to provide routine STI care and discuss the use of condoms with patients than private providers.

The federal Title X family planning grant program, administered by OPA, also provides support to clinics to serve low-income and uninsured individuals in need of STI screening and treatment. In the past year, however, the network of clinics participating in the program has shrunk significantly. About one in four Title X funded sites have withdrawn from the program in response to the Trump Administration’s new regulations that block Title X support to clinics that provide abortion services and referrals in addition to family planning and STI services. The organizations that no longer participate in the program have not only lost funding available to provide low-income individuals with contraceptive services, but also may have had an impact on the availability of STI testing and treatment services in many communities.

For people living with HIV, the Ryan White HIV/AIDS Program works with health departments and local community-based organizations to provide HIV medical care and other support services for people living with HIV who have no insurance or are underinsured.

The AIDS Drug Assistance Program or ADAP is part of the Ryan White HIV/AIDS Program. It helps covers the cost of HIV-related prescription medications for low- to moderate- income people who have limited or no prescription drug coverage. Each state operates its own ADAP, so eligibility and program elements can vary state to state.

Gilead, the manufacturer of Truvada and Descivy, the PrEP medications, offers a Medication Assistance Program for PrEP that may provide the medication at no cost based on income, but does not cover the cost of the medical visits or the recommended lab testing. The program may also be available to those on Medicare who do not have Part D prescription drug coverage. In addition, some city and state health departments, and foundations offer navigation and other support services, as well as financial assistance to make PrEP free or low cost. In December 2019, the U.S. Department of Health and Human Services launched the Ready, Set, PrEP program, which makes PrEP prescriptions available at no cost to 200,000 at-risk, uninsured individuals each year for up to 11 years. The program does not support required labs and medical services, which can be expensive. This new program is still in early implementation stages.

Confidentiality

Confidentiality is a crucial factor in the provision of STI screening and treatment services. For minors in particular, it can be a challenge. Although all 50 states and DC allow minors to consent to STI services, 18 states allow physicians to inform a parent or guardian that the minor is seeking these services (Figure 6).

Confidentiality has long been a fundamental principle of the Federal Title X family planning program; however, the Trump Administration’s new final regulations for the Title X program also have broadened its requirements to encourage family participation, require documentation of the specific actions taken to encourage family participation (or the specific reason why family participation was not encouraged) in minor’s records, and to document the age of the minor’s sexual partner. While the impact of this regulation on minors’ willingness to seek care at a Title X clinic has not yet been evaluated, there is concern that this new requirement will deter minors from seeking services because of their concerns about confidentiality.

Another confidentiality concern resulted from the ACA provision that allows dependents to remain covered under their parent’s plan up to the age of 26. In 2018, approximately 11.1 million young adults aged 19-25 were covered as dependents in an employer-sponsored insurance policy.¹  Although this policy has expanded coverage for young adults, it has raised concerns about privacy and confidentiality in the use of sensitive health services such as STI screening and treatment for young adults covered as dependents. According to a 2013 Kaiser Family Foundation survey, 71% of women ages 18 to 25 rated confidentiality as important to them, but only 37% understood that an Explanation of Benefits (EOB) summary is sent to the primary policyholder (typically the parent) when health services are used.

However, seven states (CA, CO, HI, MD, ME, OR, and WA) have implemented broad laws to ensure confidentiality for minors seeking sensitive services such as STI screenings. Some states (CA, MD, and OR) require insurers to provide confidential communications upon the written request of the covered dependent, including minors. Other states (HI and ME) offer broader protections from disclosure of health information without the consent of the minor. Some states (CT, DE, and FL) have laws focusing specifically on the disclosure of STI treatment without a minor’s consent, including in the billing process.

Conclusion

High rates of STIs continue to be a public health concern. Women, people of color, and youth experience the highest rates of reported infections. Gay and bisexual men account for the majority of the increase between 2000 and 2018. The general public, however, appears to be unaware of the how commonly STIs occur and that their incidence is on the rise.

Publicly funded clinics, many funded by the CDC, OPA’s Title X program, and HRSA’s Ryan White program, including health centers, state and local health departments, STI clinics, and Planned Parenthood clinics, provide confidential STI and HIV care to at-risk and uninsured populations. With the passage of the ACA, most private health insurance plans and Medicaid expansion programs are now required to cover HIV and STI counseling and screening without cost sharing. In addition to coverage, access to and the availability of STI/HIV care will likely depend on a number of factors, including public funding for safety-net providers, adoption of practices aimed at the reduction of transmission such as patient education, expedited partner therapy, consistent routine screenings and treatment, as well as proximity to providers.

1. Kaiser Family Foundation estimates based on the Census Bureau’s American Community Survey, 2018. ↩︎