On September 28, the House approved, 325-98, the Ryan White HIV/AIDS Treatment Modernization Act (H.R. 6143) to reauthorize the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act (P.L. 101-381). The House Energy and Commerce committee approved the bill on September 20 (see The Source, 9/22/06). The CARE Act was last reauthorized in 2000 (P.L. 106-345). The bill would authorize $604 million for FY2007, $626.3 million for FY2008, $649.5 million for FY2009, $673.6 million for FY2010, and $698.5 million for FY2011 for grants for eligible metropolitan areas. CARE grants would be authorized at $1.195 billion for FY2007, $1.239 billion for FY2008, $1.285 billion for FY2009, $1.333 billion for FY2010, and $1.382 billion for FY2011. Grants for coordinated services and access to research for women, infants, children, and youth would be authorized at $71.8 million for FY2007-2011.
The reauthorizing legislation, sponsored by Rep. Mary Bono (R-CA) would, among other provisions: define an “eligible metropolitan area” as any area with 3,000 or more persons living with AIDS and a population of 50,000 or more; distribute funds to states based on the number of actual, name-based cases of persons living with HIV and AIDS; provide a three-year “hold harmless” period during which time states’ grants would not be reduced more than five percent from FY2006; allow the secretary of Health and Human Services to make additional grants to areas with demonstrated severe need based on an increasing number of HIV/AIDS cases; and require that 75 percent of the CARE Act allocation be spent on core medical services, such as drug assistance, early intervention, and oral health services.
The comptroller general of the Government Accountability Office also would be required to biennially submit a report to Congress describing barriers to HIV program participation, particularly for racial and ethnic minorities, recommendations for enhancing the continuity of care and building stronger community linkages to address HIV prevention, and how funds are used to help identify HIV-positive pregnant women and their children who are exposed to HIV and connect them with care that can improve their health and prevent perinatal transmission.
Rep. Bono said, “HIV/AIDS is a disease that has virtually touched all of us in all parts of our great nation…As we discuss the specifics of this legislation, and the more technical aspects of the funding formulas, it is my hope that each of us will bear in mind the true purpose of this legislation. It is critical that we recognize the significant steps that have been made towards ensuring that the funding we are providing here today is going to real people to meet very real and very imminent needs. In bringing together systems of care from across the nation, significant compromises have been made, and I assure you that they have been made in the interest of providing care to the individuals who need it the most. Every attempt has been made to ensure that funds are directed to areas of greatest need and are balanced by provisions that limit the loss of funds for jurisdictions. I believe that none of us want to reduce funding for HIV services in any jurisdictions, but I ask you to consider carefully the existing disparities in funding and services, to bear in mind our solemn duty to serve people with HIV regardless of where they live and to support the effort of the Modernization Act to address those disparities.”
Speaking in opposition to the bill, Rep. Hilda Solis (D-CA) called attention to the rising rate of HIV among some minority communities, saying, “We see an increase [in HIV] in communities like East Los Angeles, the hub of the Hispanic community in the San Gabriel Valley, that fought over 20 years to combat this disease, yet it continues to be on the rise. Yet you want to take away very important funding and reappropriate it to other parts of the country. We need to expand the pie. We need to make sure people are covered everywhere. And I am glad to hear from my colleagues that while we know that this is not a good solution, but we are really working toward a deadline of October 1, we should hold off, make some rational decisions, and when we come back in November do the right thing for those afflicted by this disease. I am very concerned, because a large number of Latinas, almost 20 to 25 percent, are now faced with this disease, and it is through heterosexual relationships. We have yet to understand the cultural dichotomies that exist in our communities. We have to understand that, get information tools out there, a campaign to combat this disease, and put all the resources that are necessary there.”
Rep. Joe Barton (R-TX) said, “We know that HIV/AIDS disproportionately affects people in poverty and racial/ethnic populations who are underserved by health care and prevention systems. We know that the most likely users of Ryan White services are persons with no or limited sources of health care. We know that Ryan White services keep these people out of hospitals, increases their access to health care and improves their quality of life. Here is what we also know about the current Ryan White program. We know that due to outdated, hold-harmless and double-counting provisions in the current law persons are not treated similarly across this country. We know that, under the current formula, there is reportedly a 50 percent increase in funding per AIDS case for some areas of the country over other areas of the country who get no increase or little increase at all. We know that sometimes this huge inequity occurs within the same state. We know that one city in particular is greatly advantaged by an outdated, hold-harmless formula, one that may allow even for deceased persons, someone who is no longer living, counted for current funding purposes. I do not think anyone would think that is right. In fact, I would say that is not right…The bill before us would begin to right those wrongs. The bill before us would begin to treat people across the country in a fair and equitable fashion so that, no matter where you live, if you are eligible for Ryan White assistance, you will get access to health care, you will get access to treatment, you will get access to drugs.”
“Nineteen years ago, I came to Congress to fight AIDS, a disease that has taken nearly 18,000 lives in my city of San Francisco alone,” said Rep. Nancy Pelosi (D-CA). “There are a number of good provisions in this bill, including the recognition of emerging communities and the use of actual living AIDS counts rather than estimated living AIDS cases…” Rep. Pelosi said she could not support the bill because “under this reauthorization, San Francisco, with the highest per capita caseload of people living with AIDS in the country, stands to lose almost $30 million over the next 5 years…The problem is not that one part of the country gets too much money and some other parts of the country are left behind. Instead, people suffering from this disease–and those caring for them–are being forced to compete for pieces of an ever-shrinking pie. The reported bill would rely exclusively on names-based HIV and AIDS cases in making funding allocations starting in FY2011. In order to meet this deadline, and have all of their names-based HIV cases counted for funding purposes, code-based jurisdictions will be required to have completely converted to names-based systems in less than 3 years…I cannot support legislation that would disadvantage my state and city and take large amounts of dollars away simply because the data system is incomplete. The number of persons with HIV and with need for services remains. They should not lose needed services because of an unrealistic data requirement.”
