Inaction on Federal AIDS Programs Could Financially Hurt 17 States and D.C.
By Alex Wayne
CQ TODAY – HEALTH
December 1, 2006
Congressional inaction on a bill to renew federal AIDS programs could have real-world consequences — unlike many failed reauthorizations — leaving some states with reduced funding for treatment programs.
Seventeen states and the District of Columbia are scheduled to lose about $87 million in grants for their AIDS and HIV programs if Michael B. Enzi, R-Wyo. — chairman of the Health, Education, Labor and Pensions Committee — cannot persuade senators from New York and New Jersey to support his bill (HR 6143).
New York and New Jersey stand to lose money for their AIDS and HIV programs if Enzi’s bill becomes law.
It looks like that won’t happen.
In a Nov. 29 meeting, aides to Enzi and the ranking Democrat on the HELP panel, Edward M. Kennedy of Massachusetts, told advocates for AIDS patients and state AIDS programs, among others, that a compromise in this Congress was unlikely.
“I would like to think there would be a reauthorization, but I think a lot of things would have to happen exactly right,” said Damon Dozier, director of government relations and public policy for the National Minority AIDS Council. Dozier was among those who attended last week’s meeting.
This week’s inaction will be the denouement of a frustrating yearlong effort to reauthorize the Ryan White CARE Act (PL 101-381), which governs about $2 billion a year for treatment and support services for low-income AIDS and HIV patients. Debate over renewing the law — named after a teenage hemophiliac who went public with his battle against AIDS and died in 1990, the year it was enacted — has illuminated disparities between federally funded AIDS programs in different cities and states, leading to a split between lawmakers along geographic lines.
“Unfortunately, time is running out,” Enzi said in a Nov. 30 statement. “I hope we can still agree to a compromise that reflects the changes we are seeing in the HIV/AIDS epidemic spreading across the country — and that meets the needs of states facing the heaviest burdens fighting this epidemic.”
Under current law, about 36 percent of grant funding for state and local Ryan White programs goes to five states with large cities that have established populations of AIDS patients — New York, California, Florida, Texas and New Jersey, the Government Accountability Office said. Those are the five states with the largest populations of AIDS patients, according to the Centers for Disease Control and Prevention.
But the number of HIV cases in every state is unknown, complicating the debate. States with low populations of AIDS patients but growing numbers of HIV cases argue they should get a larger share of <Ryan> <White> funding.
Bill Blockers
New York and New Jersey’s four Democratic senators — Hillary Rodham Clinton and Charles E. Schumer of New York, and Frank R. Lautenberg and Robert Menendez from New Jersey — have blocked consideration of Enzi’s bill, aides said, because the measure would shift money from AIDS programs in big cities in their states to states with growing populations of people with HIV. Enzi has tried to bring the bill to the floor four times without success.
Two weeks ago, Senate aides said, Enzi offered the four senators a compromise: a three-year renewal of the law, rather than the five-year reauthorization the senators have blocked. New York and New Jersey would have seen their steepest financial loses in years four and five under the reauthorization, so Enzi reasoned that a three-year renewal — essentially lopping off the last two years of the original bill — might be acceptable.
The four senators rejected it, aides said, because New York and New Jersey would still lose some funding under the bill. “We are going to stand in opposition to this until a real compromise is worked out on this, one that doesn’t shut out those who are most in need of care and medical intervention,” said Allyn Brooks-LaSure, a spokesman for Menendez.
“Nobody should suffer under the reauthorization of this law,” another Senate Democratic aide said. “Part of the problem is that there just isn’t enough money in this bill.”
But another problem is what happens if the law isn’t reauthorized. Many government programs continue apace just fine without regular reauthorization, because Congress can appropriate money for the programs even after they have expired.
But the last reauthorization of the Ryan White law, in 2000 (PL 106-345), dictated that starting in fiscal 2007, grants to state and city AIDS programs would be based on counts of people with HIV as well as those with AIDS.
Seventeen states and the District of Columbia have not adopted systems to report the names of HIV-infected people to the government, or have only recently adopted such systems and so have incomplete counts, according to Enzi’s office. Five states and D.C. instead report HIV infections as anonymous codes — a less accurate count that the CDC does not accept and that cannot be used as a basis for funding. Hence, without congressional action, those states expect to see grant cuts.
Under Enzi’s bill, states that still report HIV infections to the government anonymously would have until April 2008 to begin reporting the names of infected people, instead of codes.
Lautenberg, along with Clinton, Schumer and Menendez, has offered his own compromise (S 3944): a one-year extension of current law, along with provisions that would avert the scheduled funding cuts for the 17 states and the District of Columbia.
Enzi rejects that bill as a solution to the impasse, said spokesman Craig Orfield.
Even if the reauthorization fails, as seems likely, the scheduled cuts might still be averted through appropriations, said Murray Penner, deputy executive director for the National Association of State and Territorial AIDS Directors.
The proposed fiscal 2007 spending bills for the departments of Labor, Health and Human Services, and Education (HR 5647, S 3708) each would increase spending for Ryan White programs by $70 million or more from fiscal 2006, and some of that money, Penner said, could be earmarked for states scheduled for funding cuts.
Neither bill is expected to become law before Congress adjourns for the year.
