By Bob Roehr
The U.S. House of Representatives has adjourned until after Labor Day with reauthorization of the Ryan White CARE Act still in limbo, and the Senate will follow them at the end of this week.
Five-year authorization of the bill that provides most federal funding for AIDS in the United States, technically expired last September. By late spring congressional leaders involved in the process said agreement had been reached and the Senate would vote on it in May, with the House to follow in June.
It hasn't happened that way.
The impasse is a common one – money. Under the proposed legislation the formula for distributing funds would change to a names-based reporting of the number of persons who have tested positive for HIV within the jurisdiction.
The Centers for Disease Control and Prevention (CDC) has pushed names reporting for years and most states have such a system in place. But others allow for anonymous testing, which experts agree allows for some duplication in reporting.
Several states, particularly New York, are likely to see a decrease in funding under the new formula. However, projections of who will get what have not been forthcoming from the Government Accountability Office (GAO) and the Department of Health and Human Services.
The traditional way such impasses are resolved is by increasing the total pot of funding so that no jurisdiction suffers actual losses. However, given the current funding and political climates in Washington, that does not seem to be a viable option.
On July 20, the Senate Appropriations Committee approved a budget of $2.139 billion for the CARE Act for fiscal year 2007, which begins Oct. 1. In most cases it even fell short of funding levels requested by the Bush administration.
The President had requested a $70 million increase in AIDS Drug Assistance Program (ADAP), but the Senate OK'd an additional $55 million.
Earlier, on June 13, the House had supported the President's full $70 increase for ADAP, but it also voted no increase for any other section of the CARE Act, despite Bush's proposed modest increase.
Given the rate of inflation, the rising cost of new drugs, and the increasing case load because of the success of these programs and patients living longer, the net effect is a decrease in dollars spent per person living with AIDS.
Some Capitol Hill observers have speculated that the appropriations bill that includes the Department of Health and Human Services, second in size only to the military, may be delayed until after the November elections. AIDS advocates are beginning to think that might be their best hope to secure additional funding.
