Bay Area Reporter - October 5, 2006
Bob Roehr

California's two Democratic senators - Dianne Feinstein and Barbara Boxer - 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 325-98, late on September 28.

During 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He pointed out that "one city in particular [San Francisco] is greatly advantaged by an outdated, hold-harmless formula, one that may allow even for deceased persons counted for current funding purposes.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."

Ernest Hopkins, a lobbyist with the San Francisco AIDS Foundation, said that Barton and other members of Congress from the South "have every reason to highlight false statements."

SFAF said in a statement that the bill under consideration would cut funding to California by as much as $50 million by the fifth year of the authorization. San Francisco stands to lose more than $13 million over the next four years, a one-third cut in CARE Act funding. An estimated 11,000 San Franciscans rely on CARE funding for their care and treatment.

Hopkins told the Bay Area Reporter Tuesday, October 3 that while the current bill is "vastly improved" for California and San Francisco as well as other areas of the country, changes in the funding structure would still result in cuts to the city. San Francisco is expected to experience a decrease in supplemental funding.

He added that the foundation is continuing to work with Feinstein and Boxer to make some adjustments in the bill, which could be taken up in the Senate during an expected lame-duck session after the midterm elections.

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.

Representative Frank Pallone (D-New Jersey) 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, urban centers against rural communities. This is not how you treat a public health emergency," 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 Representative Henry Waxman (D-California).

House 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 health care 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 percent to 4 percent in what it receives.

"Healthcare and treatment access for one low-income, uninsured group should not be provided at the expense of another," SFAF Executive Mark Cloutier said.

Jennifer Kates, an HIV policy analyst with the Kaiser Family Foundation, said AIDS organizations would 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, she noted.

"Ryan White is the safety net, it alone cannot fix the problems," said Kates.

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