By Bob Roehr
WASHINGTON – Congress may not be able to reauthorize the Ryan White CARE Act by Sept. 30, the start of the new fiscal year. The major problem is that some states will lose funding under proposed formula changes that are the result of bipartisan congressional negotiations led by Sen. Ted Kennedy, D-Mass. Under the new formula, funding would be cut from states that have been dealing with the epidemic longest and shifted to southern states.
The House Energy and Commerce Committee resolved some of the contentious issues in the bill that it passed 38-10 on Sept. 20. The measure now goes to the full House, where passage is likely but not a foregone conclusion.
Some AIDS advocacy organizations support the bill that emerged. The AIDS Foundation of Chicago's David Munar called it "a vast improvement over the proposal submitted last year by the Bush Administration."
He singled out modifications to how coded data of HIV cases are counted towards the distribution of funds as a significant change. He also saw insufficient funds as the root of most of the problems and called for increased spending.
Other advocates continue to oppose the bill. San Francisco currently receives about $28 million a year under the current Ryan White structure. If the new language becomes law, the city would face immediate cuts but the big hit, and estimated $10.4 million cut, would come in four years, according to Ernest Hopkins, a lobbyist for the San Francisco AIDS Foundation.
New York will lose $17.8 million in Title I funding in the first years, and $78 million over four years in Title II funding, according to estimates by the New York Department of Health and Mental Hygiene.
The bill passed by Energy and Commerce would also require that 75% of Ryan White funds be spent on "core medical services," which could result in drastic cuts in funding to community based organizations that provide services ranging from food pantries to transportation. (See "Senate proposal could gut Ryan White AIDS funding for CBOs," online at www.pridesource.com)
Maneuvering has now switched to the Senate where the strategy for passage is to substitute the House versions for language that already has gone through committee in that chamber. Approving the House version would eliminate the need for a conference to work out differences and allow the bill to be signed into law immediately.
However, a single Senator can place a "hold" on a bill and delay its consideration. There are reports that several Senators have done so, though holds remain secret. An alternative would be to attach the legislation to an appropriations bill.
Senator Hillary Clinton, D-New York, has indicated her dissatisfaction with the measure as it currently stands. And on Sept. 22, California's Democratic Senators Dianne Feinstein and Barbara Boxer, announced their opposition.
"California HIV/AIDS projects take a big financial hit under the current version of the Ryan White reauthorization bill. Without the opportunity to offer amendments, there is a serious risk that established programs in San Francisco and across the state will be unable to preserve the quality of care they provide to HIV/AIDS patients," Feinstein said.
Boxer added, "If the Bush administration would put adequate resources into the fight against HIV/AIDS, we wouldn't be having this argument about a formula. It's unacceptable that California, and therefore our HIV/AIDS patients, will suffer if we don't go along with every detail of this bill."
The California Senators wish to offer amendments to keep jurisdictions hardest hit by the epidemic–including San Francisco, Chicago, and New York–from being adversely affected under the bill. They also want to ease transitions provisions to names-based HIV reporting.
One little-reported aspect of the bicameral, bipartisan approach that has moved the reauthorization forward to this point is that it has shunned anti-gay provisions in HIV prevention and other activities. Allowing amendments on the floor of the Senate might open the door to such amendments by social conservatives hoping to score political points just before the election.
