Washington Blade - December 30, 2005
Lou Chibbaro, Jr.

Medicaid serves as the main health care provider for low-income people with AIDS. Health care advocates warn that the lives of thousands of AIDS patients could be in jeopardy if the cuts are put in place.

Senate Democratic leaders on Dec. 21 forced Republicans to accept three technical changes in a $39.7 billion budget reconciliation bill that includes the Medicaid cuts. The changes require that the bill return to the House for final approval.

The House voted 215-213 to approve an earlier version on Dec. 19 before adjourning for the year. The Senate passed the same bill - except for the changes prompted by the Democrats' points of order - on Dec. 21 by a rare 51-50 vote. The vote came after Vice President Dick Chaney rushed back to Washington from an overseas trip to break a 50-50 tie.

"We hope to defeat it in the House and send it back to conference," said Carl Schmid, director of federal affairs for the AIDS Institute, a national advocacy group.

Schmid was referring to a House-Senate conference committee that would be assigned to rewrite provisions of the bill if the House defeats it in January. AIDS groups want the revised bill to eliminate or greatly reduce the Medicaid cuts.

With the House expected to remain out of Washington until the end of January, the action by Senate Democrats could give opponents of the Medicaid cuts a month or more to apply pressure on House members - especially moderate Republicans - to vote against the bill.

The budget reconciliation measure, aimed at curtailing the nation's ballooning deficit, includes the first proposed cuts since 1997 in so-called entitlement programs such as Medicaid, Medicare, welfare and student loans.

Proponents of the Medicaid cuts say the reductions are needed to forestall what they predict will be staggering budget deficits among the states, which share the costs of Medicaid. The cost of Medicaid has risen dramatically in recent years.

AIDS groups said Medicaid is the single largest provider of health care for people with AIDS in the United States, where low-income people who don't have private health insurance have few options for receiving life-sustaining medical care.

"It is unacceptable to pull the rug out from under hundreds of thousands of our neighbors living with HIV/AIDS and simply say your government is not there for you," said Joe Solmonese, head of the Human Rights Campaign. "We should be focusing on ways to improve these programs, not shoving them not the cutting room floor."

Ryan White also cut

The Dec. 21 Senate vote came two weeks after Congress approved a separate, fiscal year 2006 appropriations bill for the Department of Health & Human Services that cuts funding for AIDS prevention programs. The appropriations bill provides for a $10-million increase in the Ryan White CARE Act program, but AIDS groups call that amount marginal and inadequate.

For more than a decade, the CARE Act has helped cities and states provide social services and medical care for low-income people with HIV and AIDS who don't qualify for Medicaid.

The 2006 appropriations bill provides $2.1 billion for the Ryan White program. The figure includes a $10-million increase in funding for the AIDS Drug Assistance Program, known as ADAP, which is one component of the Ryan White CARE Act. The funding for all other components of the CARE Act - including patient care - is the same as what Congress approved for the current fiscal year.

However, in yet another budget-related measure, Congress this month approved a 1-percent, across-the-board cut in most domestic spending programs. That cut would decrease the $10-million "increase" for ADAP and lower the remaining 2006 Ryan White appropriations from a "flat funding" proposal to an outright reduction in funds, AIDS activists said.

AIDS advocacy groups have argued that an increase in Ryan White funding is needed to offset the projected 40,000 new HIV infections each year plus the growing number of people with HIV who live longer because of antiretroviral drugs.

"We are going to see more and more low-income people across the country, particularly in minority communities, being denied life-saving health care and drug treatment," said Marylin Merida, president of the AIDS Institute.

Abstinence funding increased

The DOH appropriations bill, meanwhile, calls for cuts in the fiscal year 2006 budget for the Centers for Disease Control & Prevention's HIV prevention programs. While approving the prevention cuts, Congress also approved an $11-million increase in funding for President Bush's "abstinence-only-until marriage" AIDS education program.

AIDS activists charge that abstinence-only programs are ineffective in curtailing the spread of AIDS among at-risk populations, especially young people - both gay and straight.

"With most new HIV infections occurring in youth and women, particularly in communities of color, ignoring the effectiveness of prevention programs while allowing abstinence-only programs to promote ideology over science is negligent and puts young lives on the line," said David Harvey, executive director of the AIDS Alliance for Children, Youth & Families.

The Senate action on the budget reconciliation bill follows an announcement by House Republican leaders that the House would likely extend its holiday recess until the end of January.

This would give AIDS advocacy organizations and other groups opposed to the Medicaid cuts - including the politically influential American Association of Retired Persons - nearly a month to put pressure on moderate GOP House members as well as some Democrats to vote against the reconciliation bill.

If the House votes against the bill, Congressional leaders would be forced to go back to the drawing board to devise a new version acceptable to opponents. AIDS groups are hoping the new version would eliminate or significantly reduce the Medicaid cuts.

"There is an effort to reduce the Medicaid cuts to the beneficiaries," Schmid said, referring to a proposal for reducing Medicaid expenses by trimming administrative costs.

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