Trump this week met with Dr. Jerome Adams, the health commissioner in Indiana, who was appointed to that post by Vice President-elect Mike Pence, and who helped oversee a response to a major HIV outbreak that later drew criticism from national health experts.
According to Trump’s transition team, the pair talked about improving the doctor-patient relationship, the “challenges Americans face each day” with the Affordable Care Act, and health policy issues.
Adams tweeted Tuesday that he had a great meeting and discussed community health and disease prevention with Trump.
Gr8t meeting w @realdonaldtrump yesterday. Shared thoughts on health vs healthcare, community health/prevention as cheaper than treatment.
— Jerome Adams (@JeromeAdamsMD) November 22, 2016
— Jerome Adams (@JeromeAdamsMD) November 22, 2016
An Indiana State Department of Health spokeswoman said Adams was not available for an interview and that she didn’t have any more details about the meeting. But if Trump made time to meet with Adams at this early stage, that could mean we could be seeing him or his ideas again.
Here are some things to know about Adams:
Trial by fire
Trained as an anesthesiologist, Adams has been outspoken about the risks of prescription opioid painkillers and the need to address the opioid epidemic. And as health commissioner, he was thrown into the deep end of the response.
Adams took the helm at the health department in October 2014. The next month, the first cases of what would later be recognized as a full-blown HIV outbreak were detected in the community of Austin in Scott County.
Within a year, health officials diagnosed 181 HIV cases among the fewer than 5,000 people in the town.
The Pence administration was criticized by some public health experts for its slow response to the crisis.
The virus was being spread primarily by intravenous drug users sharing needles to inject the prescription opioid oxymorphone (known as Opana). But for months, Pence remained opposed to authorizing a needle exchange on moral grounds. Pence was slowly convinced that exchanges were the best way to prevent new cases, and told other officials at the time that he was praying about what to do, the New York Times reported in August.
Adams told the Times that he initially shared the “real moral and ethical concerns about passing out needles to people with substance abuse problems,” but that he came around to starting a needle exchange and worked to persuade the governor.
In March 2015, Pence authorized an emergency needle exchange for 30 days. Within a few months, the state ended its ban overall.
What’s happened since then?
Since state law was changed to allow needle exchanges, a small number of other counties in Indiana have been permitted to start needle exchanges. But some counties have run into roadblocks.
As of July, five counties had opened needle exchange, but that month, the Courier-Journal reported that Clark County had been waiting almost a year for the state to approve its request, in part because of concerns the state had about the county’s deal with a nonprofit to fund the exchange. It took other counties from one day to two months to get cleared, the newspaper reported.
A month after the report, the Clark County exchange was approved.
What’s more, researchers who studied the Austin outbreak found that in many ways, it could have been anticipated. Like many places, Scott County had high rates of poverty, hepatitis C, unemployment, and drug users — all key risk factors for the spread of HIV.
In a report published in July in the New England Journal of Medicine, public health officials suggested that states should launch more preventive measures, including expanding HIV testing, identifying networks of drug users, and improving access to treatment. The Austin area hadn’t had any free HIV testing available since 2013, when a Planned Parenthood clinic shut down.
“Although the magnitude of the outbreak was alarming, the introduction of HIV into a rural community in the United States was not unexpected when considered in the context of increasing trends in injection use of prescription opioid analgesics,” the officials wrote.
The paper’s authors included several state health department officials; Adams was not one of them.
“We don’t have all the answers, but we are learning as we go,” Adams wrote in May 2015. “We are building a model for prevention and response should this type of outbreak happen in other communities in the US. I would like nothing better than to tell you this unprecedented HIV epidemic will never happen anywhere else. But I can’t do that.”
How else has he tackled the opioid crisis?
In July, Indiana joined the list of states with standing orders for naloxone, the antidote that can revive people who overdose on opioids. Standing orders are blanket prescriptions that cover an entire city or state, so now in Indiana, residents can go to registered pharmacies, nonprofit organizations, and health centers and get naloxone without needing their own prescription from a doctor.
“When you’re riding in a car, you can protect yourself by wearing a seatbelt,” Adams said at the time. “By getting naloxone into the hands of people across the state, we can save lives and help those struggling with addiction.”
Do his views jibe with Trump’s?
During the Ebola crisis in West Africa, Adams tried to correct myths about the disease. He stated clearly and correctly, for example, that the outbreak was only occurring in three West African countries.
Trump, not so much. In a series of tweets, he bashed President Obama for the response and accused health officials of covering up information. He also falsely said the disease was spreading all over the continent:
Ebola is much easier to transmit than the CDC and government representatives are admitting. Spreading all over Africa-and fast. Stop flights
— Donald J. Trump (@realDonaldTrump) October 2, 2014
Perhaps more importantly, it appears Trump and Adams might take differing views on parts of the Affordable Care Act. Trump has vowed to repeal President Obama’s health law, including the Medicaid expansion. (At the same time, he has said he would provide Medicaid to people who wanted it without explaining what that would look like.)
Under Pence, Indiana expanded Medicaid through the ACA, although with some requirements that beneficiaries in other, more liberal states did not have to meet. After Pence announced the expansion in January 2015, Adams praised the agreement for expanding coverage and including provisions that made many beneficiaries pay premiums.
“I could not be more excited about this happening,” he said, according to the Northwest Indiana Times. “I’m convinced it’s going to give people access, it’s going to provide better health care, and it’s going to transition our citizens … to be able to work and better themselves as opposed to trapping them in an income-based entitlement program.”
Still, if the ACA is repealed without a replacement being offered, many of the people who gained coverage through Indiana’s Medicaid expansion could lose their benefits.
Those could include people in Austin. The authors of the New England Journal report noted that the expansion occurred “fortuitously” in January 2015, so people who contracted HIV were able to obtain treatments.