Senate Committee Passes CARE Act Reauthorization Bill

WASHINGTON (May 18, 2006)—A Senate health committee approved legislation yesterday to reauthorize the Ryan White CARE Act until 2011. 

The bill, which passed by a vote of 19-1, was introduced by the chairman and ranking Democrat of the Senate Health, Education, Labor, and Pensions (HELP) Committee, Senators Michael Enzi (R-WY) and Edward Kennedy (D-MA). The committee leaders worked closely with their House counterparts, Representatives Joe Barton (R-TX) and John Dingell (D-MI), to draft the bill.

“On behalf of an estimated 42,000 Illinoisans living with HIV/AIDS, we commend Senators Enzi and Kennedy for working toward a compromise bill,” said Mark Ishaug, AIDS Foundation of Chicago executive director. “However, we remain deeply concerned that people living with HIV/AIDS in the Chicago area and around the state will be adversely affected by deep funding cuts and the corresponding loss of services. We urge members of the Senate to carefully address these concerns so that all people living with HIV/AIDS in Illinois and throughout the country have access to the vital care and support services they need to improve their lives.”

Lawmakers and their staff engaged in heated negotiations over the past 12 months to broker a set of compromises over several contentious issues, chief among them is how CARE Act resources are to be allocated across the country. With the high cost of HIV/AIDS drugs, no decline in new HIV infections, and an estimated 1.1 million people living with HIV/AIDS in the U.S.—an all-time high—lawmakers struggled to balance several competing demands on an increasingly small pot of funding. 

The legislation—known as S.2823—increases the number of cities that receive CARE Act emergency grants from 51 to 76, and creates a new three-tier structure for cities that report high, medium, and low numbers of HIV and AIDS cases. Chicago and the surrounding nine counties would continue to qualify as a Title I area in the highest tier.

Funding projections for Title I cities under new and complicated distribution formulas remained unconfirmed yesterday afternoon, even as legislative sponsors rushed to introduce the 80-page bill that received committee approval hours later. Based on estimates calculated by the AIDS Foundation of Chicago (AFC), Title I funding awarded to Chicago could be reduced by $2.3 million or more next year under the bill’s new provisions. Chicago, which is currently funded at $23 million, would need to cut spending for essential HIV/AIDS care and support services by at least 10%. Still, preliminary versions of the bill—including legislation introduced in February by Senator Tom Coburn (R-OK)—would have likely resulted in significantly larger funding cuts for the Chicago region and Illinois.

“We remain concerned by the impact of funding cuts on hundreds of people in the Chicago area and the strain this will put on HIV/AIDS systems of care across the state,” said Jim Pickett, AFC’s policy director. “However, we remain thankful that the cuts are not deeper and appreciate that lawmakers included a new provision that will allow Illinois, which recently adopted name-based HIV reporting, to garner partial credit for these cases. Without this provision, the funding cuts to Chicago and Illinois would have been much larger, causing a devastating decline in available services.”

A compromise provision will allow Illinois and a dozen other states to approximate the number of HIV cases they report for purposes of funding determinations, which previously only factored the proportion of AIDS cases. Illinois has required HIV reporting since 1999, but only those cases reported to public health by name will count for CARE Act funding purposes. Illinois began name-based HIV reporting on January 1 of this year. Thanks to the compromise provision, Illinois will likely receive a slight Title II funding increase next year for comprehensive services and the AIDS Drug Assistance Program (ADAP).

“Allowing Illinois to approximate the number of its HIV cases is fair and a critically important provision of this bill,” said David Munar, AFC associate director. “While lawmakers will continue to entertain changes, we implore members of Congress, especially those from Illinois, to safeguard this provision, which will put states like ours on equal footing with states that have established name-based HIV reporting systems.”

AFC remains concerned with a provision requiring that no less than 75% of funding in Titles I-III be allocated for “core medical services,” given the CARE Act’s longstanding focus on reaching and bringing into care new and underserved populations. The requirement will undoubtedly force funding cuts for essential services such as transportation and case management, which frequently help vulnerable and extremely low-income people in overcoming barriers to accessing care.

AFC is also alarmed that the bill stipulates extremely low funding caps for CARE Act programs, given the myriad needs across the country and the complexity of providing HIV/AIDS care and support services. Appropriators will be hamstrung to approve necessary funding increases if these caps are not raised.

For more information on CARE Act reauthorization, see this presentation prepared by AFC. Stay tuned to AFC’s Statewide Advocacy Network for breaking news on CARE Act reauthorization.

CARE Act Action Center