Washington Blade - September 22, 2006
Lou Chibbaro Jr

One faction of AIDS advocacy groups has joined members of Congress from mostly Midwestern and Southern states to warn that a failure by Congress to reauthorize the Ryan White Act by Sept. 30, the end of the current fiscal year, could lead to confusion and "chaos" among AIDS service providers by causing large cuts in federal AIDS funds for many of the nation's cities and states.

Another faction of advocacy groups has called these warnings scare tactics intended to frighten Congress into passing a version of the bill they claim would deprive New York, New Jersey and California, among other high-population states, of millions of dollars in AIDS funds over the next five years.

"The losses for New York and New Jersey alone prevent us from endorsing this bill in its current form," said Ernest Hopkins, government affairs director for the Communities Advocating Emergency AIDS Relief, or CAEAR Coalition, which represents AIDS groups in more than a dozen cities and states.

Disagreements over the funding formulas in the pending bill, the Ryan White HIV/AIDS Treatment Modernization Act of 2006, center on proposed rules for allocating funds based on the number of people who have both HIV and AIDS. The existing formula for allocating funds is based on the total number of full blown AIDS cases.

Federal health officials and most AIDS experts agree that linking the funding allocation to the number of HIV and as well as AIDS cases is needed to ensure that medical treatment and prevention programs reflect the changes in the epidemic. Over the past decade, AIDS researchers have said, it has become clear that far more people have HIV than AIDS and that those with HIV needed treatment to help prevent them from developing AIDS.

Officials with public health departments in states and cities have said they need sufficient time to transition their HIV testing programs and epidemiologic studies to properly count the number of people with HIV.

The bill provides a five-year phase-in period that includes "hold harmless" provisions that provide more funds to states and cities that have yet to complete the transition from counting people with AIDS to tracking HIV cases. But many state and city health officials say the current bill does not go far enough in providing carry over funds for this transition period.

The current version of the bill would result in a loss, over a five-year period, of $78 million for New York State and $17.8 million for New York City, New York officials have said. California could lose $50 million during the five-year period, officials there have said.

The potential losses for New York prompted New York Senators Hillary Clinton and Charles Schumer, both Democrats, to threaten to block the bill in the Senate if the formulas aren't changed.

On the other side of the coin, states like Illinois, Alabama and North Carolina are expected to gain millions more in federal Ryan White funds over the same period under the pending bill.

While disagreeing over the allocation formulas, Hopkins and representatives of the faction that supports the bill agree that any funding shortfall could be prevented if Congress appropriates more money for the Ryan White program as a whole.

"There are major cities that will take a hit whether this passes or not," said Jeff Graham, spokesperson for the AIDS Survival Project of Georgia. "It's all because of a lack of sufficient funds."

"The bottom line is the total level of funding is not high enough," said Hopkins. "It's clear to anyone who looks that the epidemic continues to grow, and the administration and the Congress are not appropriating the money we need to address it."

D.C. received $26.9 million

Pat Hawkins, deputy director of the Whitman-Walker Clinic, D.C.'s largest private AIDS service provider, said D.C. could gain as much as $3.3 million next year if the reauthorization bill passes before Sept. 30.

If Congress remains deadlocked and does not pass the bill by Sept. 30, Hawkins said D.C. could lose about $1.4 million from its Ryan White funding allocation.

She said the city received about $26.9 million in Ryan White funds for the current fiscal year.

"We really won't know the exact amount until the bill is passed and the numbers are calculated," Hawkins said.

She said the bill includes a provision that could subject D.C. to further cuts in funds by requiring cities and states to spend all of their Ryan White funds in a given fiscal year before they become eligible for a percentage of new funds the following year. In the past, D.C. often has failed to spend large portions of its federal AIDS funds in the year the funds were disbursed to the city due to problems in the city's AIDS office.

Hawkins said that under the current version of the pending Ryan White reauthorization bill, if D.C. and other jurisdictions don't "obligate" at least 98 percent of their Ryan White funds by the end of the fiscal year, they would be eligible for only about half of the Ryan White funds it received the previous year. She said it was unclear whether federal officials would interpret "obligated" funds as funds that were spent or funds earmarked for specific programs or community groups that carry out the city's AIDS programs.

In either case, Hawkins said, the District stands to lose millions of dollars if it doesn't "get its act together" in disbursing federal AIDS funds in a timely fashion.

Gay D.C. Councilmember David Catania, who chairs the Council's Committee on Health, has criticized the city's procurement and AIDS office leaders for not moving quickly enough to disburse federal AIDS funds.

Carl Schmid, federal affairs director of the AIDS Institute, and Jim Driscoll, an official with AIDS Health Care Foundation, said their groups support the current bill as the best possible compromise likely to clear Congress.

"It's the product of a series of compromises between different groups and different interests," said Schmid.

"Everybody has acted in good faith," said Driscol, in referring to the bipartisan coalition of senators and House members who drafted the bill and who, according to Driscoll made numerous changes at the suggestion of AIDS groups.

"Most of the parties are taking a loss and most of the parties are making gains in at least when you consider the overall bill," he said.

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