Gay Men's Health Crisis: Treatment Issues - Volume 8 no. 6
Derek Hodel

Cut in President's AIDS Research Budget

The battle for AIDS dollars began in February with President Clinton's budget, which requested substantially more money than anyone had to spend. For AIDS, Clinton's package included two investments: a $78 million increase (six percent) for AIDS research at NIH and a $93 million increase (sixteen percent) for the Ryan White CARE Act. For AIDS prevention programs at the Centers for Disease Control and Prevention, the President apparently decided that the investment was not worth it, and requested no increase in spending at all.

President Clinton's proposed six percent increase in AIDS research - tiny compared to last year's big $227 million (21 percent) increase - was set against a backdrop of flat funding for virtually every other program at NIH, save breast cancer and certain high-performance computing projects. Though less so than last year, it was another budget that, by virtue of inadequate support for other critical programs, pitted AIDS against other diseases. (The American Heart Association took the opportunity to exploit the numbers to their fullest advantage, pointing out that vastly more research dollars per death are spent for AIDS than for heart disease, while failing to examine the average age at which people die or the horrific worldwide AIDS projections over the next decade.)

To make matters worse, during the debate the Administration surreptitiously shopped around some alternate numbers, suggesting to House subcommittee members that the President could live with a little less than he had requested publicly. The silently spoken numbers included reductions in spending for NIH ($189 million, distributed across all programs, including AIDS), Ryan White ($12 million) and AIDS prevention ($11 million - amounting to a 2 percent reduction in current spending).

The tactic, saying one thing publicly while presenting a different picture behind closed doors, is a Washington standard but ultimately went nowhere. The subcommittee declared that they would have nothing to do with the revised request and would interpret the President's original request as planned. And interpret they did. For both AIDS research and Ryan White programs, the subcommittee recommended increases amounting to only half of what the President requested: research received a $40.5 million (3.1 percent) increase and Ryan White a $46.6 million (eight percent) increase.

The subcommittee made clear its intention to treat the AIDS program as it would any of the individual institutes at the NIH. The three percent boost meted out to AIDS research was applied across the board to all the NIH institutes. In spite of the disappointing AIDS research and Ryan White numbers, Nancy Pelosi (D-CA), a staunch community ally, pulled off a brilliant organizing campaign among friendly subcommittee members that led to a veritable bonanza for AIDS prevention funding. Pelosi scored by assembling a $163 million Public Health Service prevention package that featured a substantial addition for HIV prevention (a $63 million, or 11.6 percent, increase), as well as enough other pet programs to consolidate the support of six subcommittee members - enough to convince the new appropriations subcommittee chair, Neal Smith, to adopt the proposal as his own.

The fate of AIDS appropriations for FY95 now lies in the hands of the Senate. At this writing, the Senate Labor, Health and Human Service and Education Subcommittee is scheduled to report on the budget as early as July 14, although this date strikes many Capitol Hill veterans as a decidedly optimistic schedule. Congress is supposed to wrap up the entire budget by the end of this fiscal year, September 30. We'll see.

Consolidated OAR Budget Saved

The news about the rather bleak numbers for AIDS research was offset by the President's request for a consolidated appropriation for all AIDS research at NIH, consistent with the NIH Revitalization Act. The single line account would be the first time in years that the entire AIDS research portfolio was appropriated in a unified fashion ($1.378 billion with the President's increase). AIDS advocates believe such a mechanism is critical to the ability of OAR to reshape the overall AIDS research program.

Some subcommittee members opposed the President's request following substantial agitation from subcommittee staff director Mike Stephens, who declared the consolidation was not "required by law." Stephens' objections to the consolidated appropriation surprised and infuriated AIDS advocates, who had been under the impression that the long fight was over when the President signed the Revitalization Act in June of 1993.

The AIDS advocates were not the only ones who were surprised. The congresspeople responsible for writing the legislation were also under the impression that the consolidated appropriation was a done deal, and said so in a letter to subcommittee chair Neal Smith. John Dingell (D-MI) and Henry Waxman (D-CA), chairs of the House Energy and Commerce Committee and the Subcommittee on Health and the Environment, respectively, notified Smith that they would oppose any effort to reconsider the consolidated budget question via an appropriations bill, and urged the subcommittee to appropriate the money as requested.

Meanwhile, Stephens maintained that the consolidation would set an undesirable precedent (a "that's not the way we do things around here" approach), would make AIDS research funding more vulnerable to attack ("years from now, you'll thank me," a variation on the it's-for-your-own-good theme), and would open the floodgates for a variety of disease-lobbyists from Alzheimer's Disease to Breast Cancer, each demanding their own consolidated appropriation at NIH. AIDS advocates, led by the AIDS Action Council, began immediate lobbying efforts, for once with the assistance of the administration. An impressive array of scientists were corralled to defend the OAR and its new director, William E. Paul, M.D. A letter-writing campaign (organized by a coalition that included Nobel-laureate David Baltimore as well as noted researchers Barry Bloom, Bernard Fields, David Ho and Arnold Levine) attracted almost 200 scientific signatures. The debate finally turned a corner when NIH Director Harold Varmus weighed in with a powerful letter to the subcommittee.

The opposition, under the direction of John Porter (R-IL), still refused to budge. Even after Porter, an ardent, longtime NIH supporter, met personally with Bill Paul, he continued to make it a priority to undo the consolidation. Ultimately, though, Porter remained silent at the subcommittee's final hearing, choosing instead to battle about vocational/technical schools and the national vaccine strategy. (Porter also tried unsuccessfully to increase NIH spending overall by swiping money from drug treatment programs, among others.)

And Now the Senate

Many believe that it is possible to get the Senate appropriations subcommittee to increase the amount allocated for overall NIH research and for AIDS research in particular. Individuals and organizations are urged to write to Senator Tom Harkin (D-IA), the chairman of the Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies. If you reside in a state whose Senator sits on the subcommittee, please contact that Senator without delay (see box for a list of these Senators and a sample letter). Your telephone calls or letters could mean that more desperately needed funds are allocated for AIDS research.

>Derek Hodel is the treatment and research director at the AIDS Action Council, a Washington based lobbying organization representing nearly 1,000 Community based AIDS organizations nationwide. In July, Derek joins GMHC as Director of Federal Affairs.<

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