Holds placed on the Ryan White CARE Act by the Democratic senators from New York and New Jersey have prevented the Senate from voting on reauthorization of that legislation. Its future is uncertain.
California's senators withdrew their holds when they were assured that the state would not be unduly penalized as the new funding formula was implemented.
The House had approved the bill by a vote of 325 to 98 late on Sept. 28.
During the debate on the House floor, Energy and Commerce Committee chairman Joe Barton, R-Texas, said the measure 'reflects over a year of intense negotiations by all of the stakeholder groups and the Bush administration … I know that the bill is not perfect. I know that there have been significant compromises made by all parties at the table.'
He pointed out that 'one city in particular [ San Francisco ] is greatly advantaged by an outdated, hold-harmless formula, one that may allow even for deceased persons counted for current funding purposes … I would say that is not right.'
The revised CARE Act would shift funds to parts of the country that have experienced more rapid and more recent growth in the number of persons living with HIV.
Rep. Frank Pallone, D-N.J., said, 'This bill will punish states like New Jersey for keeping people alive and preventing new infections. It sets up a very perverse disincentive. It says to states: you will be penalized for doing a good job.'
'This bill pits AIDS against HIV [ and ] urban centers against rural communities,' he added.
'We find ourselves in a tragic situation today because the basis of the problem is that the population of those needing services has grown, but the funds for the Ryan White program have not grown with it,' said Rep. Henry Waxman, D-Calif.
Democrat Minority Leader Nancy Pelosi, who represents San Francisco, said the bill 'means a loss in services for patients receiving primary medical care, a lack of access to counseling, support, outreach services, transitional and emergency housing and emergency payments for healthcare costs' in her city.
The final vote in the House was a bipartisan one that broke down along the lines of who would lose and who would gain money. The New York and New Jersey delegations, and more than half of the California delegation, supplied most of the 98 votes against the bill.
'Within an often-hostile political environment, we believe this bill is as good as it's going to get,' said Mark Ishaug, executive director of the AIDS Foundation of Chicago. 'Hard-fought provisions will benefit Illinois and other communities with emerging HIV/AIDS epidemics.' Still, because of inadequate levels of funding, the state is likely to see a reduction of 3-4% in what it receives.
Jennifer Kates, an HIV policy analyst with the Kaiser Family Foundation, said AIDS organizations will see no immediate impact from the failure to pass reauthorization as most federal programs continue to operate under a continuing resolution. Planning in this uncertain environment is the bigger challenge.
'Ryan White is the safety net; it alone cannot fix the problems,' said Kates. A comprehensive approach must involve strengthening Medicaid coverage and state contributions.
