San Francisco Examiner - July 12, 2000
Judy Holland, examiner Washington Bureau

Rep. Tom Coburn, R-Okla., said Tuesday that research by the General Accounting Office showed San Francisco receives $5,958 in federal Ryan White program money for each AIDS case, while 50 other cities hard hit by the epidemic receive an average of $3,000. Coburn called for slashing The City's share by 25 percent over five years.

"What we need to do is make sure that the black teenager with HIV in my district has access to the same funding as someone living in the middle of San Francisco," Coburn told the House subcommittee on health and environment, which is drafting the House version of the five-year Ryan White program.

The Ryan White program provides federal aid for medication and health care for people who don't have private insurance, but who aren't poor enough to qualify for Medicaid.

Legislation sponsored by Coburn and Rep. Henry Waxman, D-Los Angeles, would cut San Francisco's share by $4.5 million over five years, from $35 million a year to $31.5 million, according to congressional staffers, unless Congress dramatically increases total funding for the program.

'A lot of inequities'

After the full House passes a bill being written by the subcommittee, it must be melded into a compromise with the Senate-passed version before actual funds for San Francisco are determined.

Janet Heinrich, associate director of the GAO - the investigative arm of Congress - told the panel Tuesday that the HIV/AIDS epidemic is spreading to women and children and that the geographic focus of the disease is becoming more diffuse. Dr. Claude Earl Fox, administrator of the federal Health Resources and Services Administration, which runs the program, agreed there is a need to re-examine how the funds are doled out.

But, he added, "We do believe that communities should be protected from these funding shifts. We do not want to see huge disruptions in funding." Rep. Anna Eshoo, D-Atherton, said a 25 percent cut in San Francisco's Ryan White funds would be "potentially devastating."

Changes in funding formula

Eshoo complained that the distribution formula undercounts the number of people with AIDS because it assumes that people with the disease will die within 10 years of being diagnosed. But, as a result of new drug therapies, AIDS patients are living longer.

When the Ryan White program began in 1991, payments to communities were based on a formula that took into account a city's total number of AIDS cases, both living and dead. San Francisco's share of the money was relatively large because the epidemic had hit hard there a decade earlier.

Fred Dillon, public policy director for the San Francisco AIDS Foundation, who attended the hearing, said afterward that The City's per-patient cost is higher than other places because the cost of living in the Bay Area is so inflated.

Dillon also said San Francisco needs more federal funding because of the high concentration of people with AIDS in the city - 51 cases per 100,000, the fourth highest in the country behind New York City, Fort Lauderdale, Fla., and Miami.

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