San Francisco Chronicle - September 30, 2006
Edward Epstein, eepstein@sfchronicle.com.

With the 325-98 vote late Thursday to renew the 16-year-old Ryan White AIDS care program, the focus shifts to the Senate, where a handful of senators from New York and New Jersey were making a last-ditch stand to try to change a proposed new funding formula to preserve money for states that were the early epicenter of cases.

California's two Democratic senators, Barbara Boxer and Dianne Feinstein, dropped their objections, according to the bill's Senate sponsor, Sen. Mike Enzi, R-Wyo., after getting assurances that the state would not be penalized unduly as it switches to operating under new funding formulas. Boxer had been among those who had put a formal hold on the bill.

The chief remaining objector is Sen. Hillary Rodham Clinton, D-N.Y., who has attracted a lot of attention for her stand. Her position shows the tension between her two constituencies -- New Yorkers and those across the country she'll need if she runs for president in 2008.

"I am committed to reauthorization of a good bill," Clinton said on the Senate floor Friday afternoon as Congress prepared to leave town until after the Nov. 7 election. "A bill that devastates the ability of high-prevalence communities to deal with cases is unacceptable."

If there is no deal today and Congress leaves, the legislation would wait until a post-election lame-duck session. Sponsors, however, warn that cuts in the program could begin as early as today because money for the continuing program federal money runs out in parts of the country.

San Francisco receives $28 million a year under the current Ryan White program. The House-passed bill would cut $11 million of the amount by the fourth and fifth years of the renewed five-year program.

The city Department of Public Health says such cuts would devastate programs for most of the city's 15,000 HIV-positive residents who are helped under the federal plan.

San Francisco's representatives say the House-passed bill is unfair because it will cut funds for cities that have dealt with the disease since it first surfaced in the 1980s. They also argued that it pits one group of needy patients against others with HIV and AIDS. All the Bay Area's Democratic House members voted against the bill, while Rep. Richard Pombo, R-Tracy, voted for it.

Proponents pointed out that the epidemic has changed over the years, spreading across the country and ethnic groups, moving even into rural areas that might not be getting any federal dollars under the current funding formula. They also point out that the existing program provides money for people diagnosed with AIDS, not just those who are HIV-positive, and that patients are living far longer than they did when the program was created.

"Address the epidemic of today, not yesterday," Enzi told the Senate.

"The House bill is a good approach that takes a little from New York, takes a little from San Francisco, and gives lifesaving drugs to those who don't have them today. We ought to be about doing that today," Sen. Tom Coburn, R-Okla., said on the floor of the Senate.

Clinton and others seeking a revised bill have proposed a one-year extension of the current program to allow time for more negotiations; providing 3.7 percent more than the $12.2 billion authorized for the five-year program; and offering grants for unmet needs in rural areas.

But so far, the talks haven't produced a compromise. Rep. Joe Barton, R-Texas, whose House Energy and Commerce Committee originated the legislation, said the existing House bill already is bipartisan and "makes sure that money is spread more equitably across the country."

Barton warned that many states would face immediate cuts in programs if the Ryan White bill isn't passed by the time Congress leaves for its recess.

But Ernest Hopkins, director of federal affairs for the San Francisco AIDS Foundation, said that isn't true.

"This is all a scare tactic that Sen. Clinton is too smart to fall for. It's a bad bill for her state and others," Hopkins said.

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