For the second year in a row, President Bush approved a budget that results in funding cuts for nearly all federal AIDS programs. The only exception is the AIDS Drug Assistance Program (ADAP), which received a nominal increase.

Congress finally passed the federal budget at the end of November, two months into the new fiscal year. The president signed the bill into law on December 8. As is becoming increasingly common, Congress finalized work on appropriations by combining several unfinished appropriations bills into one massive "omnibus" bill.

The omnibus bill President Bush signed authorizes $388 billion in spending for 13 government departments and dozens of agencies, not including the Defense and Homeland Security departments that were handled separately. The measure consists of more than 3,000 pages and represents one of the most austere budgets for domestic programs in the last decade. Most line items were flat funded - meaning no increase over FY04. As a last minute cost-savings measure, Congress authorized a 0.8% across-the-board cut for all programs.

The news is not good for AIDS programs.

The only program spared from the chopping block was ADAP, which received an increase of $38.7 million for a total appropriation of $787 million. While welcome, this increase is inadequate to sustain a program experiencing escalating enrollment across the country. The AIDS community determined that $965 million, an increase of $217 million, is needed to keep ADAPs solvent across the country this coming year.

The Housing Opportunities for People with AIDS (HOPWA) program administered by the Department of Housing and Urban Development received a $13.2 million cut, the largest funding reduction in the program's history. All titles in the Ryan White CARE Act received cuts, and HIV prevention and surveillance services at the Centers for Disease Control and Prevention were reduced by more than $5 million. For more appropriations information, see the funding chart provided by the HIV Medicine Association.

As the president pursues legislation to implement his top domestic priorities, including the privatization of Social Security, tax cuts, war and anti-terrorism spending, Congress will try to reduce health-related costs as a way to finance these priorities. AIDS advocates will need to work harder than ever to protect programs that deliver vital health care services to people with HIV/AIDS, especially the CARE Act and Medicaid. Advocates are also concerned that lawmakers will attempt to narrow CARE Act services through reauthorization legislation debated next year.

The FY06 appropriations process will begin in earnest in February 2005 when President Bush unveils his proposed budget. AIDS advocates expect it will include plans to reformulate Medicaid into block grants and reduce discretionary spending-which may include a third consecutive year of AIDS program cuts.

The AIDS Foundation of Chicago will monitor the FY06 appropriations process, as well as other federal administrative and regulatory issues, and keep you informed.

For more information please contact Jim Pickett at 312-922-2322.