Washington Blade - September 11, 2009
Lou Chibbaro Jr.

Democratic and Republican members of the influential House Subcommittee on Health promised this week to work out the details for reauthorizing the Ryan White federal HIV/AIDS treatment and care act before the multi-billion dollar program expires Sept. 30.

The pledge came Wednesday as representatives of nearly 300 AIDS services and advocacy organizations, all of which have endorsed a draft bill to reauthorize the program, called on lawmakers to quickly resolve a number of technical issues that remain as points of disagreement among members of Congress.

"I think an overarching theme that will emerge is that with some relatively plain fine tuning, the Ryan White program can continue to do its good work -- providing services to those most in need -- for another three years," said Rep. Henry Waxman (D-Calif.), chair of the House Committee on Energy & Commerce, which includes the Health subcommittee.

Waxman and the late Sen. Ted Kennedy have been credited with playing key roles in helping to create and revise the Ryan White program since Congress first approved it in 1990. The program, among other things, provides medical care and support services to people with HIV or AIDS who lack health insurance or have insufficient insurance to cover their treatment regiments.

Although both Republicans and Democrats expressed overall support at Wednesday's hearing for reauthorizing the Ryan White program, Rep. Michael Burgess (R-Texas), was concerned about program costs.

Burgess said he might offer an amendment during a Sept. 21 markup hearing, where the bill's final wording is to be approved, that would eliminate language in the draft bill allowing for limited increases in funds for states "as are necessary" for assisting people with HIV/AIDS who are eligible for the program.

Jose Zuniga, president of the International Association of Physicians in AIDS Care, said such an amendment could prevent states from providing HIV-related services to patients in need.

"If introduced during mark-up, we will strenuously oppose any amendment to flat-fund this critical life-saving program," Zuniga said.

Through its AIDS Drug Assistance Program, also known as ADAP, the Ryan White program subsidizes the cost of providing life-saving but expensive medication to thousands of people who otherwise would not be able to obtain the drugs they need.

Mary Wakefield, administrator of the U.S. Health Resources & Services Administration, an arm of the Department of Health & Human Services, which operates the Ryan White program, told the Health Subcommittee Wednesday that as of this year, about 529,000 people across the country receive Ryan White program-related services.

Wakefield noted that through HRSA's HIV/AIDS Bureau, federal grants are awarded to cities, states and local community organizations that, in turn, carry out the program by providing primary medical care and support services to people living with HIV or AIDS.

Ronald Johnson, deputy director of AIDS Action, a national AIDS advocacy organization, said most national AIDS groups that provide services to gay male clients with HIV are backing a draft Ryan White reauthorization bill, which was compiled with input from the groups.

Johnson and Carl Schmid, an official with the AIDS Institute, another national group, said nearly all members of the coalition pushing for renewal of the Ryan White program believe the program should continue even if Congress passes a separate health care reform bill proposed by President Obama.

The two said that health care reform that enacts the type of changes Obama and most congressional Democrats are seeking wouldn't immediately become operational. They noted that AIDS groups believe at least three years would be needed to determine whether a national health care reform bill would cover the medical needs of people with HIV and AIDS.

Under the draft Ryan White reauthorization measure under consideration in the House and Senate, a three-year extension of the program is being proposed.

"In order to maintain health stability for persons living with HIV/AIDS, it is essential to secure extension of the Ryan White program as soon as possible while the larger issues of our nation's health care system and a national strategic plan for HIV prevention, care and treatment are developed, implemented and assessed," said Julie Scofield, executive director of the National Alliance of State & Territorial AIDS Director.

The draft renewal bill calls for retaining a change in the Ryan White program that created a controversy when it was first enacted by Congress in 2006 as part of the program's last reauthorization. The change, made at the request of the U.S. Centers for Disease Control & Prevention, linked the level of Ryan White funding that states and local jurisdictions receive to the number of people living there with HIV and AIDS.

Under the previous funding formula, adopted when the Ryan White program first took effect in 1990, funding levels were tied to the accumulated number of AIDS cases in a state or local jurisdiction. This formula included people who had died of AIDS. The old formula allocated greater funds to large states that were hit hardest during the earliest stages of the AIDS epidemic, especially New York and California.

At the request of officials from New York and California, along with other states, Congress included a "hold harmless" provision in the 2006 reauthorization. The provision prevents the new formula of linking funding to the number of people living with HIV/AIDS from significantly reducing the overall funding for states during a transitional period.

The "hold harmless" provision remains in the draft reauthorization bill being considered by the House Subcommittee on Health.
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