by Bob Roehr
The Ryan White CARE Act, which funds a large portion of HIV programs in the United States, did not expire on Sept. 30 but was extended for another 30 days as part of a continuing resolution to fund all federal government operations. The resolution was necessary because once again Congress has not passed funding bills for federal agencies prior to the start of the new fiscal year.
The Senate Health Committee canceled a scheduled Sept. 23 meeting on Ryan White, later rescheduling it for Sept. 30. Their goal is to craft legislation that can be approved by unanimous consent and avoid a formal vote on the floor of the Senate; then have that accepted by the House.
While Ryan White has enjoyed broad bipartisan support in the past, and still does, the rules of the Senate make it possible for a single member to prevent unanimous consent. That means negotiations with Senators such as conservative Oklahoma Republican Tom Coburn, who may be seeking to include certain provisions on HIV testing, as well as changes to the formula for distribution of funds to better serve areas such as the South where the epidemic has grown more rapidly in recent years.
As of early September, seven states had waiting lists for their AIDS Drug Assistance Programs and five more are expected to join them shortly. They are primarily states with smaller caseloads that were hit by the epidemic later than epicenters such as New York and California. Funding for ADAP is primarily through the Ryan White program.
If a consensus agreement cannot be achieved, then it is likely that the legislation will be extended for one year in its current form, according to AIDS Action. AIDS advocates say local organizations need the stability of longer legislation to better plan their operations.
Those advocates have emphasized several themes in congressional debate over broader health care reform. They seek expansion of Medicaid coverage to all low-income individuals, including childless adults; a strong national public insurance option; affordable private health insurance; and an increased investment in prevention and the public health infrastructure.
They were disappointed when an amendment to eliminate the so-called "donut hole" gap in Medicare Part D prescription drug coverage did not pass the Senate Finance Committee.
