Some New York AIDS groups and public health officials may oppose the renewal of a federal bill that has funded AIDS services for the past 15 years because they say that new language in the bill could significantly cut dollars coming to the state.
“We need to decide now if no bill is better than a bad bill,” said Patrick J. McGovern, executive director of Harlem United, an AIDS service group, at a September 21 forum held at the Gay Men’s Health Crisis (GMHC).
The bill, the Ryan White Comprehensive AIDS Resources Emergency Act, was enacted in 1990 and it is reauthorized every five years. The act distributed $2.l billion to states for AIDS services in the current fiscal year. After Medicaid and Medicare, the government-run health plans, the act is the single largest source of federal AIDS funding. New York City has received roughly $120 million in Ryan White annually in recent years.
The proposed reauthorization requires that 75 percent of the funds go to “core medical services,” which could mean cuts to other services, such as treatment adherence, hot meals, transportation, and legal services.
In the old bill, half of the money in one portion of the bill, called Title I—which will account for $604 million in the 2007 federal fiscal year beginning October 1—was divided among eligible metropolitan areas (EMA) according to the number of their estimated AIDS and HIV cases. Those areas competed for funds from the other half.
In the proposed version, an EMA must have at least 1,000 new AIDS cases in the prior five years or 1,500 living AIDS cases to get Title I funds. Two-thirds of the funds are distributed according to living AIDS and HIV caseload and the EMAs compete for the remaining third, based on the strength of their applications.
In the old version, Title II of the act distributed 80 percent of its funds according to AIDS cases in each state. That benefited states with large caseloads. The remaining 20 percent went to jurisdictions that were not Title I EMAs.
In the new version, 75 percent of the cash is distributed according to AIDS caseload and 25 percent goes to jurisdictions that did not get Title I funds. The new act would spend $1.2 billion in Title II funds in the 2007 fiscal year.
Perhaps the greatest impact of the new bill is to shift funds from cities, where the majority of the AIDS and HIV cases are, to rural areas of the country.
“New York is not the only state that would be negatively impacted by this bill,” said Robert Cordero, vice president of development and government relations at Housing Works, an AIDS group. “Southern and Midwestern legislators were determined that new funding would go to rural areas.”
In 2010, the split in Title II ends and funding is determined by a “severity of need index,” or SONI, by which states apply by demonstrating the impact HIV has had in their state. The index may shift funds dramatically from states, such as New York, that have generous Medicaid and other public benefit programs to those that spend much less on healthcare, and therefore have greater unmet needs.
“SONI takes full consideration of the local services when deciding appropriations,” said Humberto Cruz, executive deputy director of the state health department’s AIDS Institute. Calling the index “disastrous,” McGovern said it would move funds “from states that tend to tax to those that don’t.”
The proposed bill sets the expenditures for the next five years. It flat funds some parts of the act and increases Titles I and II by 3.7 percent per year through 2011.
“We would be fighting each other for that small pot of money,” Cordero said.
The city health department projected that with the smaller pool of funds to apply for in Title I it could lose just under $18 million in the 2007 fiscal year and as much as $78 million over five years.
With the change in eligibility for Title I funding, advocates said that Nassau, Suffolk, and Dutchess Counties eventually might not have enough cases to qualify.
“Congress has the clear intent to phase out some of the smaller eligible metropolitan areas,” said Matthew Lesieur, director of federal affairs at the New York AIDS Coalition, which has roughly 200 member groups throughout New York.
Because some AIDS groups and states will benefit from the new act, there is no national consensus among those groups and the states over how to respond.
In June, 18 U.S. senators supported the new bill in committee with only Democrat Hillary Rodham Clinton voting no. On September 20, a House committee backed the bill in a 38 to 10 vote.
As Gay City News went to press on September 27, U.S. Senator Frank Lautenberg and Congressman Frank Pallone, both New Jersey Democrats, had introduced legislation to extend the old provisions of the act for one year, according to a press statement from Garden State Equality, that state’s gay lobbying group. Other action on the matter also took place in Congress, but no resolution on the act resulted in either the Senate or the House.
“It looks like they’re going to push to get this bill finished by the end of the month,” Cordero said.