Washington Blade - June 2, 2006
Lou Chibbaro Jr.

The complexities of the multi-billion dollar Ryan White program have confounded patients benefiting from its provisions and have drawn derision from critics who say it would be unnecessary if the U.S. had a universal health care system.

But given the current realities, most gay and AIDS advocacy groups have praised both Republicans and Democrats in the House and Senate for working together to craft a proposal that seeks to change the program to conform to the changes in AIDS that have occurred since the bill was last revised 10 years ago.

Initial predictions that a Ryan White reauthorization bill approved earlier this month by a Senate committee would drastically reduce federal AIDS funds for New York, Texas and Florida have since been disputed by lawmakers working on the legislation.

Members of the Senate Committee on Health, Education, Labor & Pensions, which approved the bill, said calculations made by the Government Accountability Office, an arm of Congress - which first reported the possibility of cuts - were incomplete and could not be relied upon.

Reports of the possible cuts drew attention to the impact the new bill is likely to have on states and cities that have come to rely on the Ryan White program to provide care for millions of uninsured Americans with HIV and AIDS, activist have said.

The bill approved by the committee, the Ryan White HIV/AIDS Treatment Modernization Act of 2006, retains the program's overriding aim of providing federal funds to states and cities hit hardest by AIDS.

Among other provisions, the bill calls for increasing the number of cities eligible for federal AIDS funds and establishes a formula for basing the amount of funds allocated to cities and states on the number of people who have HIV rather than just the number with full-blown AIDS. The bill would also prevent cities from retaining funds they don't spend within two fiscal years.

Sen. Michael Enzi (R-Wyo.), chair of the Senate Committee on Health, Education, Labor & Pensions, and Sen. Edward Kennedy (D-Mass.), the committee's ranking minority member, are the lead sponsors of the bill.

Move to HIV names reporting

The funding formula change was first proposed 10 years ago, but it could not be fully implemented because federal rules did not require states to count the number of HIV cases through a names reporting system approved by the Centers for Disease Control & Prevention.

Ernest Hopkins, director of government affairs for the Communities Advocating Emergency AIDS Relief Coalition, said one of the bill's most contentious provisions calls for a special "proxy" system for phasing in the new system of allocating funding based on HIV cases.

For states just beginning names reporting, the system calls for assuming there are 0.9 HIV cases for every AIDS case. Officials in New York say the system could result in an undercounting - and under funding - during the phase-in period.

"For states that have a longer, more mature sytstem of counting HIV cases, they have a ratio of 1.6 HIV cases for every AIDS case," said Ronald Johnson, an official with the New York City-based Gay Men's Health Crisis, which provides AIDS services.

Several states, such as Maryland, and the District of Columbia, had been using a coded system for identifying those testing positive for HIV rather than a names reporting system.

With the names reporting issue all but resolved, the Ryan White reauthorization bill approved by the Senate panel establishes a phase-in systems for states that are just beginning to put in place an HIV names reporting system.

The major concern of advocacy groups is that the bill doesn't call for enough money for each of the program's provisions, especially the AIDS Drug Assistance Program which has been praised for covering the cost of life-saving AIDS drugs for people who could not afford to pay for them.

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