San Francisco Chronicle - Thursday, September 21, 2006
Edward Epstein, Chronicle Washington Bureau

The vote in the House Energy and Commerce Committee reflected a dilemma for members faced with redistributing scarce federal dollars to parts of the country where the HIV caseload has grown in recent years, meaning that such longtime centers of the epidemic as San Francisco, New York, Boston and Chicago would find their funding hacked.

San Francisco, which has about 15,000 HIV-positive residents, receives about $28 million a year under the federal Ryan White AIDS program, which has a budget of about $2 billion a year.

The city also spends $15 million of its own money to fight the disease.

If the committee-passed bill becomes law, losses to the city's funding would be phased in, with the biggest hit coming in the fourth year of the proposed new five-year program, when $10.4 million in federal funds would be lost. The city's share under other funding formulas and competitive grants would also fall, perhaps by millions of dollars more.

"It would be dramatic," said Ernest Hopkins, director of federal affairs for the San Francisco AIDS Foundation.

"Nothing will be untouched by this loss, if it happens," said James Loyce, director of AIDS programs at the San Francisco Department of Public Health.

He said cuts would be made across the board -- in medical and dental visits, drugs, hospice care and home health services for a population that is living longer but still requires expensive care.

And almost all of the city's 15,000 HIV-positive residents would be hurt, he said, because Loyce estimated that only about 1,000 are covered by private insurance.

With time running out on the current Congress, the success of the bill that has been in the works for a year is far from certain.

Sen Hillary Clinton, D-N.Y., has said she'll try to block it if New York City's funding isn't protected. And senators from other affected states, including California Democrats Barbara Boxer and Dianne Feinstein, also want to protect funding for San Francisco, Los Angeles and other cities.

San Francisco Mayor Gavin Newsom also is lobbying against the House bill. "Passage of the bill in its current form would be disastrous for HIV/AIDS patients in San Francisco," he wrote in a letter to Congress.

House Democratic leader Nancy Pelosi of San Francisco wrote the heads of the House Energy and Commerce Committee urging them to maintain the current law's "hold harmless" provision that guarantees cities won't see their federal grants slashed during the life of the authorized program. The committee's bill approved Wednesday would phase out that provision, and San Francisco officials estimate that step alone would cost the city $10.4 million in the fourth year of the renewed program.

"The hold harmless (provision) was adopted to protect the epicenters of this disease from experiencing drastic reductions in funding from year to year that would disrupt the systems of care in place, and eliminating it now would cause this very consequence," Pelosi wrote.

The other side in the debate points out that the HIV caseload has changed over the years. Once an epidemic in urban, gay populations, the disease has spread across the country, to suburban and rural areas and has hit some minority groups especially hard.

Proponents of the new bill point out that "hold harmless" rules mean San Francisco would continue collecting federal money for AIDS patients who have died.

Representatives of areas where the disease arrived later than in big cities say it's time to change the funding formula and the way the number of HIV and AIDS cases are counted to help spread the federal money in a more equitable way.

"Geography should not be a death sentence," Sen. Jeff Sessions, R-Ala., said last week.

"It is time for Ryan White funds to be distributed more evenly so all patients, not just those living in New York, San Francisco and Boston, can receive the care they need," added Sen. Richard Burr, R-N.C.

The Ryan White program is named for a Kokomo, Ind., teenager who died of AIDS in 1990 after receiving infected blood in a transfusion.

Pelosi said Congress is being forced into a painful choice of cutting some areas' funding to give money to other places because Ryan White funding per patient has declined in constant dollars about 25 percent since 2000.

"The priority of this Republican Congress has been to cut taxes for the wealthy. The epidemic has spread, yet we can't increase funds for new areas of the epidemic without taking funds from California, New York and Illinois," said Rep. Henry Waxman, D-Los Angeles.

"We can't be self-congratulatory if we take from one area and give to another," said Rep. Anna Eshoo, D-Atherton, who co-sponsored an amendment that would protect San Francisco's funds and authorize more money overall to fight AIDS.

Eshoo's proposal lost 22-21 in the committee, although Republican leaders said they had even more votes to defeat it if necessary.

The committee voted 38-10 in favor of the overall bill.

Eshoo predicted the proposed House bill will be blocked in the Senate, or changed sharply. "Unless we're heeded, this thing is headed for trouble," Eshoo said.

But Rep. Mary Bono, R-Palm Springs, said it's only fair to redistribute the money. "No one wants to reduce AIDS funding in any jurisdiction, but I ask you to consider the disparities in current funding," she said.
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