September 21, 2006
RYAN WHITE REAUTHORIZATION REACHING THE FINISH LINE
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Jessica Mardis and Valencia Robinson of AIDS Action in Mississippi met with Representative Benni Thompson (D-MI) last week during the last stakeholders meeting for Ryan White reauthorization. |
On Wednesday, September 20, the House Energy and Commerce committee approved the Ryan White HIV Treatment Modernization Act, and now the legislation may be insulated from amendments or debate in the Senate. In the preceding weeks, advocates representing organizations across the country worked to come to common ground and to press Congress to forge policy that would most benefit all people living with HIV and AIDS in America. In the final hours, however, time and politics compelled organizations to stand for or against a bill that falls far short of our needs. Though the community succeeded in facilitating some changes, several components of this version of the Ryan White CARE Act spell trouble for people living with HIV/AIDS.
"We regret that the House version of the legislation did not authorize adequate funding levels for all areas of the country," said Robert Cordero, Vice President for Development and Government Relations for Housing Works.
All People Living With AIDS Need Services
Twenty-five years into the epidemic, AIDS prevention, treatment and care still stagger along grossly under-funded, so new formulas allocating funds geographically created the most contention among the AIDS community. For a city to qualify as an Eligible Metropolitan Area (EMA) (Title I funding), it must have a certain number of living AIDS cases diagnosed in the past 5 years. This formula shifts funding to rural and suburban areas experiencing increase in HIV infections, many in the South where problems include lack of healthcare providers: money for drugs but not enough doctors to write the scripts. Without an influx of new funding, however, the formula drains money from localities with critical and complex systems of services that people living with HIV/AIDS rely on every day.
The CAER coalition made successful recommendations that prevalence also be considered in determining funding to protect Title I funding for areas such as Cleveland, Ohio and Austin, Texas. Specifically, they proposed that if a locality documents more than 3,000 cases of AIDS, it stays in Tier 1 funding.
The bill provides "hold harmless" clause that buffers a city's funding from fluctuations in reporting but only for a term of 3 years. Many groups have been advocating for extending the term for up to 5 years, but it is likely the hold harmless will remain too short. Representative Ed Towns (D-NY) did offer an amendment that would have extended the hold harmless provisions in the bill from 3 to 5 years and increased the authorization levels in Title I and Title II by 3.7%. The Towns amendment, however, failed by a vote of 21 to 22.
(Want to know what all this math means for New York? See The View from New York below.)
Programs Need More Money
The current House version of Ryan White provides for an additional $70 million for the base funding for Title II. The promises made to people living with HIV/AIDS in that same bill can only be made good if fully funded for fiscal year 2007. On September 18, seven leading AIDS organizations, including Housing Works, laid out the case for desperately needed increases in funding in a letter to Senators Thad Cochran (R-MI) and Robert Byrd (D-WV) and Representatives Jerry Lewis (R-CA) and David Obey (D-WI).
"The $70 million increase for Title II means more care and treatment for people with HIV around the country, particularly in southern and rural states," said Ryan Cleary with San Francisco-based Project Inform. "Everyone should call their members of Congress and urge them to fight for this badly needed funding."
Most of the new funding would go to all the states to pay for care services. Advocates have pushed to allow states the flexibility to put these dollars into primary care, support services, and/or their ADAP. The group also urged legislators to use any funds added to the $70 million to top-up ADAP. ADAP needs an additional $197 million to meet projected need for AIDS-related medications in 2007 (that's about 16,000 people needing life-saving medication). As Bill Arnold with TII CANN - Title II Community AIDS National Network explained, "Whether the bill passes or whether the bill fails, we have a national ADAP crisis on our hands with a zero increase in ADAP funding. In the separate appropriations process for FY 07 there is no signal yet that any congressional action will provide significant relief to the current ADAP crisis."
People Need More Services
The current bills in the Senate and the House requires States to spend 75% of their Ryan White funds for "core medical services," limiting the bulk of money for a narrow list of services. Food, transportation costs, and translation services are not permissible expenditures. The poorest PLWHAs need food and nutritional support for treatment to work, and services are meaningless if they cannot afford to travel to them. AIDS in immigrant populations is under-addressed, and for those who do not speak English, translation and linguistic services are essential to medical care. Many advocates have called for an expansive definition- in report language if not in the legislation- that would grant communities the flexibility to meet the real needs of PLWHAs.
Now What for Ryan White?
The bill now goes to the Senate - possibly within the week- for reconciliation prior to consideration on the House floor. If the bill stands alone, it faces a full floor vote, and concerned Senators could offer amendments. Insiders worry it will be attached to another appropriations bill, prevent a full floor vote and forcing all amendments to be cleared through Frist. Moreover, the most likely vehicles are the Department of Defense or Department of Homeland Security appropriations bills, setting up any Senator who holds up the process vulnerable to accusations of holding up funding for the Administration's war.
THE VIEW FROM NY
In the ever more shallow funding pool, New York stands to lose, and Fossella flip-flopped on hold harmless...
With millions of dollars on the line for HIV-positive New Yorkers, most of our elected officials took to the defensive. Back home, people living with HIV/AIDS and AIDS advocates met Thursday afternoon at Gay Men's Health Crisis to get the real-world translation of Ryan White reauthorizatiion, which came out sounding more like Ryan White "politicization."
Through Ryan White's labyrinthine funding tiers and formulas, New York state stands to lose $78 million in Title II funding over the next four years, and the City estimates it will lose $17.8 million in Title I funding in the first year alone, according NY Department of Health and Mental Hygiene. We're not alone: California, Illinois, New Jersey, and Florida also stand to lose money they rely on to maintain stable systems of care.
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Rep. Fossella (R-NY) said he opposed the inadequate funding, but...actions speak louder than words. |
Advocates tried to buffer the blow by extending the "hold harmless" clause. Representative Ed Towns (D-NY) did Brooklyn proud, by offering an amendment cosponsored by Rep. Lois Capps (D-CA), Eliot Engel (D-NY) and Anna Eshoo (D-CA) that would have extended the hold harmless provisions in the bill from 3 to 5 years and increased the authorization levels in Title I and Title II by 3.7%. The Towns amendment failed by a vote of 21 to 22.
Representative Vito Fossella (R-NY) was among those who voted against the Towns Amendment, the only available vehicle for immediately protecting New Yorkers relying on Ryan White-funded programs. Fossella did join his colleagues from our state to broadly oppose the harmful funding formulas in the draft bill.
Standing with the Governor's office, Mayor's office, New York's Representatives in the House and in the Senate asked "the four corners" not to cut medications and services for New Yorkers living with HIV/AIDS, while explicitly supporting necessary funding where Ryan White funding is insufficient.
The under-funding across the country is unacceptable, and the New Yorkers from across the state and the city gathered at GMHC vowed to hold their representatives accountable, turning up the heat this process and the up-coming election cycle. Patrick McGovern, Harlem United Community AIDS Center, Inc., urged the community to reinvigorate our advocacy: "We need to recognize the process is political. We need to get political. We need to get political now. And we need to stay political."