On July 25, the House, by voice vote, approved a bill (H.R. 4807) that would reauthorize the Ryan White CARE Act (P.L. 101-381). During debate on the measure, Members applauded the success of the CARE Act, with some Members touting the improvements under H.R. 4807 and others expressing concern over the new funding formula (see The Source, 7/14/00).
Rep. Tom Coburn (R-OK), one of the bill sponsors, urged Members to put their funding concerns aside: “We cannot forget about what this epidemic is about. There should not be 40,000 new infections this year for this disease….For every one person who gets this disease, it is a minimum of $10,000 in health care. If we prevent 1,000 from getting it, we save $10 million in health care that year, the next year, and every year.”
Rep. Henry Waxman (D-CA), who sponsored the original CARE Act in 1990, pointed out the continuing need for the program. “Since we last authorized the CARE Act in 1996, there has been dramatic progress in treating AIDS, but there is still much more to be done. There are new treatments, but there still is no cure. There are fewer deaths, but …new HIV infections and dangerous complacency are on the rise, and the treatment gap grows wider every day for the poor and communities of color. This is why the CARE Act is so important. Its reauthorization is crucial to the lives and health of hundreds of thousands of Americans, and it is essential that we refine and expand the CARE Act to respond to the epidemic’s growing impact on women and adolescents.”
H.R. 4807 would reauthorize CARE programs through FY2005. The legislation would make several changes in current law in an effort to provide services to a greater number of individuals and to better aid communities with the greatest need.
Under H.R. 4807, which represents a bipartisan compromise between bill sponsors Reps. Coburn and Waxman, the number of HIV infections would be added to the criteria for determining grant assistance; however, the bill would not implement this change until 2005. Currently, cities receive funding based solely on the number of reported AIDS cases, not on the number of HIV infections. Many states began reporting HIV infections in 1985, but according to the Centers for Disease Control and Prevention (CDC), only 33 states have CDC-approved reporting systems in place.
The bill would authorize $30 million in additional grants to states that have enacted laws requiring mandatory newborn testing. The additional funding would be made available to these states to implement that testing. The Institute of Medicine (IOM) also would be required to study the number of infants born with HIV and the barriers that may prevent an obstetrician from routinely screening pregnant women and infants for HIV. The study also would make recommendations for states to reduce the cases of perinatal transmission of HIV.
H.R. 4807 would provide additional grants for states that have implemented partner notification programs. The funding would be used by states to aid in the implementation of those programs.
The bill would expand the Title I and Title II set-aside for infants, children, and women to include adolescents. Additionally, the bill would remove the current requirement that clinical research on drug therapies for infants, children, and pregnant women ensure “significant enrollment” of clients. The bill also would authorize training on prenatal and gynecological care for women with HIV/AIDS through AIDS Education and Training Centers.
H.R. 4807 also would change the funding formula in an effort to ensure a more equitable distribution of funding. Under the original 1990 Act, funding was distributed to eligible metropolitan areas (EMAs) based on the number of cumulative AIDS cases, which included individuals living with AIDS as well as those who had died from AIDS. However, the 1996 reauthorization changed the funding distribution so that it was based on the estimated number of living AIDS cases. Noting that this shift would cause a burden on certain EMAs, authorizers included a hold harmless provision that gradually implemented the funding change over a five-year period. Under the 1996 hold harmless provision, EMAs were guaranteed to receive at least 95 percent of the funds they received in the previous fiscal year (FY1999).
H.R. 4807 would phase-in another change to the hold harmless provision. EMAs would be guaranteed to receive 98 percent of funds the first year, 95.7 percent the second year, 91.1 percent the third year, 84.2 percent the fourth year, and 75 percent the fifth year. During committee action, an amendment was adopted to retain the 1996 hold harmless provision for Title II grants.
As amended by the House Commerce Committee, the bill also includes language to ensure that the membership of the HIV Health Services Planning Councils reflects the demographics of the population of individuals infected with HIV.
