AIDS funding proposal triggers rural-urban battle

Proposals for an HIV/AIDS funding bill are pitting urban states against rural states, with bucolic areas claiming an increased need for money while populated areas fear a shift in funds could gut current treatment infrastructures.

Proposals for an HIV/AIDS funding bill are pitting urban states against rural states, with bucolic areas claiming an increased need for money while populated areas fear a shift in funds could gut current treatment infrastructures.

Strategies for reauthorizing the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act have also triggered tensions between Sen. Tom Coburn (R-Okla.) and Senate Health, Education, Labor and Pensions (HELP) Committee Chairman Mike Enzi (R-Wyo.).

“I’ve dealt with this long enough to know that it is impossible to do without ruffled feathers, without winners and losers,” Sen. Richard Burr (R-N.C.) said during a HELP Committee hearing last week. “We need to make sure more have an opportunity to be in the winner column, regardless of where they are geographically.”

Committee member Sen. Jeff Sessions (R-Ala.) cited reports of Hurricane Katrina survivors who had received $1,200 a month under the CARE Act while living in urban New Orleans but were given only $1,200 for the entire year when they were displaced to rural areas.

Funding formulas under the law give higher amounts to areas with more HIV/AIDS patients. Senate staffers say the complex formulas have not been changed over the years to reflect the demographic and geographic shifts in HIV/AIDS cases, which are increasing in rural areas, the Midwest and the South. They cite data from the Government Accountability Office showing uncounted patients in rural areas, as well as urban areas receiving money for patients who are double-counted or deceased.

“We are very aware of these funding disparities as you go across the country,” Elizabeth Duke, administrator of the Health Resources and Services Administration (HRSA), the agency overseeing the CARE Act, said during committee testimony. “This is one of those Solomonese situations in which we’re going to have to recognize people already helping.”

The CARE Act, which falls under jurisdiction of the Senate HELP and House Energy and Commerce committees, was originally passed in 1990 and reauthorized in 1996 and 2000. A request by the HRSA asks for $2.16 billion for fiscal year 2007, an increase of $95 million over fiscal year 2006.

“I hope that we don’t try to expand the reach of the CARE Act by removing resources from areas that have historically been hardest hit by the domestic AIDS epidemic,” said HELP Committee member Sen. Hillary Rodham Clinton (D-N.Y.). “If the administration’s principles were implemented — as I understand them at this point — New York would experience decreases in funding that would terribly impact our ability to provide CARE treatment to the 100,000 people we have living with HIV.”

States such as New York, Massachusetts and California would experience a funding decrease based on HRSA proposals and a bill offered last week by Coburn.

Staffers say Coburn, who wrote the 2000 CARE Act when he was in the House, would codify President Bush’s proposals on reauthorizing the measure.

Chairman Enzi and ranking member Edward Kennedy (D-Mass.) vowed to create their own version of the CARE Act, indicating tacit disapproval of Coburn’s bill.

Enzi spokesman Craig Orfield said that because it falls under HELP jurisdiction the committee, rather than Coburn, would write any reauthorizing bill that is ultimately passed.

Coburn spokesman John Hart said his boss would welcome an Enzi-Kennedy bill.

“The competition of ideas is a good thing in a deliberative body,” Hart said.

Enzi said more than 50 AIDS groups have been heard from in the reauthorization process.

Lobbying records show the Regional Medical Center at Memphis, the DCI Group and the AIDS Alliance for Children, Youth & Families have tapped Susan White and Associates, Dewey Square Group and in-house lobbyists, respectively.

“Everybody wants to get the bill authorized,” said Patricia Bass, chairwoman for the Communities Advocating Emergency AIDS Relief, a group that opposes Coburn’s bill. “We just have to get through all the areas of discontent.”

The HRSA’s Duke agrees.

“It is a very complex law, and its complexity comes out of the fact that this is a complex epidemic,” Duke said. “Our hope is that all of us working together can do something that is fair and equitable and understandable.”

On the House side, staffers on the Energy and Commerce Committee have held preliminary meetings on the issue but have not scheduled hearings or markups.

“The Ryan White CARE Act is one of the top agenda items for the chairman,” said committee spokesman Terry Lane.

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