HHS Proposes Principles for Ryan White CARE Act Reauthorization; Focus Is on Need-Based Grant DistributionHHS Secretary Mike Leavitt on Wednesday called on Congress to reauthorize the Ryan White CARE Act and outlined the changes the Bush administration would like to see in the program, including distributing funding based on severity of need, CQ HealthBeat reports. The law authorizing Ryan White programs -- which fund HIV/AIDS prevention and treatment activities nationwide -- expires on Sept. 30 (CQ HealthBeat, 7/27). Speaking at a meeting with members of the Presidential Advisory Council on HIV/AIDS, CDC officials and representatives of HIV/AIDS-related nongovernmental organizations, Leavitt outlined five principles that President Bush would like to be included in the legislation reauthorizing the act. The principles include serving the neediest first, focusing on life-extending services, increasing prevention efforts, increasing accountability and increasing flexibility. "The need for modernization and improvement of the Ryan White CARE Act is more evident than ever," Leavitt said, adding, "HIV/AIDS in the United States is becoming more and more like the global epidemic, which challenges us to enact legislation that is more flexible and responsive to a segment of the population who otherwise would not have access to modern treatment and care."
Details of Principles
Under the principles, a list of core medical services for HIV-positive people would be developed in order to prioritize federal funding, states and local service providers would be required to increase coordination of care delivery, states would be required to implement routine HIV testing at public facilities, and unspent funds would be allocated to the state AIDS Drug Assistance Programs with the most need (HHS release, 7/27). ADAPs are federal- and state-funded programs that provide HIV/AIDS-related medications to low-income, uninsured and underinsured HIV-positive individuals (Kaiser Daily HIV/AIDS Report, 6/10). The administration is proposing that 75% of Ryan White funds in Titles I-IV be spent on core medical services, and HHS would develop and maintain a list of core ADAP drugs. In addition, the Bush administration would like to end current provisions that allow certain metropolitan areas to be "held harmless" from possible Ryan White grant reductions (HHS fact sheet, 7/27).
Sen. Mike Enzi (R-Wyo.), chair of the Senate Committee on Health, Education, Labor and Pensions, said, "The general principles outlined are very similar to the ones we on the HELP Committee adopted when we began our work on this key legislation," adding, "Together, we will develop crucial legislation that will appropriately target key funding to domestic HIV/AIDS programs, increase accountability and recognize the evolving needs of those infected and affected by HIV" (HHS release, 7/27). Sen. Tom Coburn (R-Okla.), former PACHA co-chair, said, "President Bush and his administration have made responding to the HIV/AIDS pandemic with a compassionate and proven public health approach a priority, and I applaud his continued leadership. I encourage Congress to take up and approve these thoughtful and much needed updates to the CARE Act before the program expires on Sept. 30" (Coburn release, 7/27).
Advocates' Reaction to Principles
AIDS Healthcare Foundation President Michael Weinstein said, "We strongly support Secretary Leavitt and HHS for today's announcement to overhaul the Ryan White CARE Act by directing more dollars toward core services, particularly the proposal to require local planning councils to direct up to 75% of Ryan White Funding toward medical care" (AHF release, 7/27). The first priority of the Ryan White "modernization" needs to be strengthening ADAP, Linda Frank, public policy co-chair of AIDS Action, said (AIDS Action release, 7/27). The HIV Medicine Association, which supports HHS' proposed principles, said it will work to expand the Ryan White CARE Act to encourage training, recruitment and retention of HIV care providers. "Experienced providers are closing their practices, and there aren't many new ones willing to take on this demanding, complex field," Paul Volberding, chair of the HIVMA board of directors, said (HIVMA release, 7/27).
Problem With 'Hold Harmless' Elimination
San Francisco AIDS Foundation Executive Director Mark Cloutier said the elimination of the hold harmless provision would "undermine the continuity of care for thousands of San Franciscans living with HIV disease" (SFAF release, 7/27). AIDS Project Los Angeles Executive Director Craig Thompson said the federal government needs to ensure that states that are reporting HIV prevalence rates "way out of proportion to their percentage of the population" are complimenting federal funding with state funds, "as California has historically done." He added, "Otherwise, we'll have a race for the bottom" (APLA release, 7/27).
Jeanne White-Ginder -- who is the mother of the late Ryan White, whom the law was named after, and a member of The AIDS Institute board of directors -- said, "I urge the Congress to move expeditiously, and, more importantly, for the Congress and the [Bush] administration to provide adequate funding for the CARE Act so that everyone who is in need of these lifesaving medications and medical care, no matter where they live, can have the chance to stay alive" (TAI release, 7/27). National Minority AIDS Council Executive Director Paul Kawata said NMAC wants the Bush administration to devote "a full compliment" of financial resources and services to "all communities of color to address the spread of the disease." According to CDC, about 50% of HIV-positive people in the U.S. are black and about 12% are Latino, although they make up only a small percentage of the total U.S. population (NMAC release, 7/27).