April 26, 2005

THE MYSTERIOUS LETTER

What's it all about, Enzi?

Due for reauthorization this year, the Ryan White CARE Act—which provides last-resort treatment and care for hundreds of thousands of PLWHAs—is under intense scrutiny from the Bush administration and Congress. Advocates fear that powerful people in both bodies may weaken the Act by trying, for example, to "medicalize" it—moving more funding to care and treatment while draining money for such crucial supportive services as transportation to and from doctor appointments.

So Ryan White advocates were already a bit on edge when they heard recently of a letter dated April 13 from the Committee on Health, Education, Labor and Pensions (HELP), which oversees Ryan White and numerous other health-related bills, signed by its chair, Senator Mike Enzi (R-WY) and sent to the point persons for several Eligible Metropolitan Areas (EMAs), which are the 51 areas—such as New York, Chicago and Los Angeles—that receive funding under Title I of Ryan White.

Download the Enzi letter

[The HELP Committee also sent just a few EMAs a second letter asking for additional, related information, AIDS Issues Update learned this weekend.]

The letter—a copy of which was obtained by AIDS Issues Update—said its purpose was to "request information" on the various Planning Councils (the boards of community advocates that decide how and where each EMA's Ryan White money should be used) and to "gain a better understanding of the relationship that exists between the Planning Council members and the grantees [meaning the clinics and other organizations who contract within an EMA to receive Ryan White money]." It then went on to ask each EMA to:

• submit to the HELP Committee, going back five years, the names, affiliations and contact information of its Planning Council members and its grantees
• list any Planning Council members "who also worked with a grantee who received grants during the past five years"
• in such cases, to "provide a copy of the minutes of the Planning Council meeting wherein the grant was approved," plus "an explanation of how any potential conflicts of interest...were addressed"
• provide "a copy of the policy of the Planning Council that addresses potential conflicts of interest"
• see that this extensive and detailed information was received by April 20

As news of the letter rocketed through the Ryan White community, advocates wondered what was behind Enzi's obvious attempt to unearth conflicts of interest between those who decide where Ryan White money goes and those who get it. Was it a way for the senator—an accountant by profession who likes to keep strict tabs on things but is also perceived as a friend of the CARE Act—to signal that Ryan White faced a grueling reauthorization process?

"We're not trying to be evil," insists an Enzi staffer. But advocates are still leery.

"What evidence [of conflict of interest] does the [HELP] committee have which prompted this rather large effort?" asked Matthew McClain, the Philadelphia representative of the CAEAR (Communities Advocating Emergency AIDS Relief) Coalition, which advocates for the CARE Act. He submitted that query in a written analysis of the Enzi letter that also asserted that the letter demonstrated a lack of "basic understanding" of the mechanisms of CARE Act funding—by calling subcontractors (such as care clinics) "grantees," for example, or assuming they received direct grants rather than reimbursement for services provided.

"We were informed there were some technical errors in the letter," Kori Foster, an Enzi staffer, told AIDS Issues Update, explaining the letter's purpose: "We wanted to help the senator so he had a complete picture of what goes on within Ryan White...We want to be sure that [RWCA] is used to the best of its ability...and that the money is not being given to people who are sitting on the board. That's the entire purpose. We're not out to get anyone or trying to be evil."

Foster also said that the letter had only gone to "randomly selected" EMAs, not all 51, and that while she didn't have everyone's response in hand by the deadline of April 20, that was likely because the letters were being examined by Senate security. "People's initiative reaction was negative," she admitted, but since then, "we've gotten a very positive feedback." She also said that among responses she had scanned so far, she saw no sign of conflict of interest.

For now, it seems as though CARE Act advocates have relaxed a bit about the initially disturbing inquiry, apparently one of many efforts by a new "investigative arm" of the HELP Committee that Enzi has established to scrutinize the practices of the more than two dozen health bills that HELP oversees. Only time will tell if the spirit of the letter was Enzi's accounting-as-usual or something that bodes more darkly for Ryan White's reauthorization. Still, advocates continue to feel its initial sting: "Ideally, the investigative arm [of HELP] would have reached out to...HRSA, or to the CAEAR Coalition, prior to sending this letter," says McClain, adding that either body "could have explained the strict firewall between the Title 1 grantees and Planning Councils regarding the actual grant-making to HIV service providers."

The Housing Works AIDS Issues Update is reported, written and edited by Diana Scholl, David Thorpe, Phil Fox Rose, Christine Campbell, terri smith-caronia and Housing Works staff. Send your feedback, leads and story ideas to d.scholl@housingworks.org.

You can reach us by phone at 212-967-1500 x168, by fax at 212-868-4222, and by email at d.scholl@housingworks.org. Housing Works provides housing, advocacy and services to homeless people living with AIDS and HIV. Housing Works is the nation's largest community-based AIDS organization and the nation's largest minority-controlled AIDS organization.

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