Treatment Issues, Volume 12, Number 12 - December 1998
Derek Link

Virtually all legislative activity relevant to people with HIV occurred in the two weeks before the November 3 election, which shaved the Republican majority in the House of Representatives to a narrow five-vote lead. The omnibus budget package passed on October 20 contained an $855 million increase in AIDS funding, the largest in history, and the first increase for HIV prevention in four years ($33 million, for a total of $657.8 million). Research for an AIDS cure and vaccine received a substantial boost to $1.792 billion, a 12% increase. Congress further committed itself to doubling the overall NIH budget, including AIDS research, over the next five years. For this year's AIDS research increases, the NIH is prioritizing vaccine development and behavioral investigations. Both will help to decrease HIV transmission. The behavioral studies are also geared to using the available treatments more successfully. An exact breakdown of expenditures is due in mid-January.

Ryan White programs also did well. Funding for hard-hit cities got a $40 million boost to $505 million, and AIDS Drug Assistance Programs (ADAPs) for the uninsured increased by $175 million to $461 million. Congress is directing more modest increases to state AIDS programs, which will increase overall by $19 million to total $277 million. Early intervention clinics gained $18 million to reach $94.3 million. Services for women and children will receive an extra $5 million, while funds to train healthcare providers went up $2.7 million.

Addiction treatment and prevention programs will get a $297 million infusion, for a total of $1.607 billion.

Both the size of the increases and the allocation of new funding to substance use, prevention and research programs in communities of color are due to the leadership and perseverance by the Congressional Black Caucus. Earlier this year, the Caucus declared the HIV epidemic a state of emergency in African-American communities and called for funding targeted to nonwhite populations.

Other Legislation

Additional legislation important to people with HIV also passed. Congress recently passed a law, which the President has signed, restoring immigrants' eligibility for SSI (Supplemental Security Income, i.e. disability) and Medicaid, which the Social Security Administration had previously scheduled to end in late September. This is critical for New York City, where one-third of the population is foreign-born and Medicaid is the major payer of AIDS care. Noncitizens receiving SSI as of August 22, 1996 (the date the welfare reform law was enacted) will be "grandfathered" into the Social Security system, and will not be required to document their immigration status as previously indicated.

Congress also approved a plan that would allow a number of Haitian refugees to remain permanently in the United States. This story had an ugly beginning seven years ago, when the refugees were held by the U.S. in a squalid detention camp in Guant namo Bay, Cuba. Additional advocacy is needed, however, for the many refugees who have HIV.

The Ricky Ray Hemophiliac Relief Act also passed Congress in the wee hours before the election. Named for a hemophiliac boy with HIV whose house in rural Florida was burned down by his neighbors, the Ray Act will provide financial compensation of up to $100,000 for each person with hemophilia who contracted HIV through contaminated clotting factor products. Although Congress rolled the legislation into its omnibus spending bill, it voted no funding for the program. No compensation will be made until at least next year, assuming Congress appropriates money as expected. If Congress approves the $100,000 award, then the cost of the Act is projected at around $750 million. A major issue in debate was whether people infected through blood transfusions should also receive compensation. Inclusion of this second group would balloon the Act's cost to almost $2 billion. In the end, Congress decided that only hemophiliacs could apply.

Just before the Senate left for the election, it approved the nomination of Dr. Jane Henney as Commissioner of the Food and Drug Administration. The Commissioner holds one of the most important government posts for people with HIV, as the FDA regulates AIDS drugs and vaccine development. Dr. Henney was supported by GMHC and other health groups because of her extensive experience as a cancer researcher, public health advocate and former FDA official.

Henney is the first woman to run the nation's premier public health agency. She was confirmed only after promising not to push a tough anti-tobacco agenda or advocate for approval of RU-486, the so-called "abortion pill."

The New Congress: Is This Progress?

Major leadership changes in the House of Representatives are occurring this year as the 106th Congress comes into session. The new Speaker, Dennis Hastert, is a 57-year-old, 12-year Republican representative from a rural district west of Chicago. Rep. Hastert rarely speaks on the floor of Congress, but is known for his backroom deal-making. To AIDS advocates, he is best known as one of the leading opponents of needle exchange programs. AIDS Action, a Washington-based lobbying group, gave Rep. Hastert's AIDS record in the 105th Congress a rating of 16%, one of the lowest in Congress.

By comparison, former Speaker Newt Gingrich received a 0% rating. Robert Livingston (R-TX), who was originally slated to succeed Gingrich but is now resigning from the House instead, scored 40%. Taking over Rep. Livingston's position as chair of the powerful Appropriations Committee will be C.W. "Bill" Young, a 15-term congressman from St. Petersburg, Florida. Rep. Young has worked productively with AIDS advocates over the years and earned a 50% rating from AIDS Action.

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