The United States is currently at an inflection point in Hepatitis C virus (HCV) response. We have the tools for rapid and accurate diagnosis, safe and effective cure, and prevention. These tools are only as useful as access to them can be, which is why the Cure Hepatitis C Act (S.1941) holds so much promise. This bill would implement a wide-scale national test-and-treat program that could bring us closer to HCV elimination in the U.S. by making treatment more accessible. A nationwide subscription model would allow public and private insurers to pay one flat fee for unlimited amounts of medication, thereby incentivizing greater uptake. Medicare beneficiaries would have no cost sharing for treatment and all costs would be waived for those on Medicaid, without insurance, or incarcerated. [1]
This bill’s potential, however, is limited by its exclusions. Section 10 specifies that certain immigrant populations are not eligible for increased access to any prevention, testing, and linkage-to-care services [2], but no disease elimination strategy can succeed without including everyone at greatest risk. Immigrants, like any other community, cannot simply be exempt from communicable disease transmission because a piece of legislation separates them from the rest of the population. This exclusion is not grounded in the reality of HCV epidemiology; as a result, all Americans — regardless of immigration status — will bear the consequences of this politically-motivated decision. Section 10 is also nonsensical from a fiscal standpoint: if additional courses of treatment would not incur any additional cost to the government under the subscription model, but would still save money long-term by preventing hospitalization and liver cancer treatment, how can lawmakers possibly justify this exclusion?
Further problems lie in what the bill does not say. There is barely any mention of substance use disorder or injection drug use, the leading cause of HCV infection in the U.S. [3] It also lacks any comprehensive plan for access in jails, prisons, or detention centers, and does not address care transition between carceral facilities and release. Without a plan to engage correctional health systems, the cost waiver will be virtually useless for increasing access, and the transition back to community is where many people with HCV fall through the cracks. [4] Furthermore, the bill lacks recognition of stigma as a main driver of the HCV epidemic by preventing people from getting diagnosed in the first place. Lastly, it does nothing to change the ban on federal funding for syringes, despite the fact that the CDC’s own website lists used syringes as a locus of transmission. [5]
All of these exclusions and omissions defeat the overall purpose of the bill: to bring the U.S. closer to HCV elimination. They will also lead to higher long-term costs for both public and private payors, as delayed diagnosis worsens liver damage, increases healthcare spending, and enables onward transmission. Prevention and cure are far less expensive than advanced disease management; untreated HCV can cause cirrhosis and liver cancer, and can eventually require transplantation. [6] Because this care often takes place in public hospitals and emergency rooms, these costs are borne by taxpayers. Most importantly, any exclusions in care raise significant ethical issues for physicians — who have taken the Hippocratic oath — and human rights concerns for the public at-large.
Luckily, these problems can be solved if there is sufficient political will to do so. The Cure Hepatitis C Act’s sponsors can still ensure that the bill can reach committee and be amended in time for passage this session, but they must act quickly. In order to gain the necessary community support to advocate for more cosponsors and get the bill passed, it must align with national and global elimination principles. The immigration-based exclusions in Section 10 must be removed to avoid setting a dangerous precedent for the future, and to enable all residents to access screening, prevention, and linkage-to-care. Amendments must be added to address stigma, harm reduction, and the correctional health system. If public health and fiscal responsibility are prioritized over politics, S.1941 can be a great success that eliminates HCV in the U.S. in our lifetimes.
References
[1] https://www.congress.gov/bill/119th-congress/senate-bill/1941/text
[2] Ibid
[3] https://www.cdc.gov/hepatitis/hcp/populations-settings/pwid.html
[4] https://www.sciencedirect.com/science/article/pii/S0955395925004219
[5] https://www.cdc.gov/hepatitis-c/prevention/index.html
[6] https://link.springer.com/article/10.1186/s12913-026-14360-1
