But measure’s fate uncertain; committee still working on legislation
Senator Tom Coburn, a Republican of Oklahoma, introduced a measure to re-authorize the Ryan White CARE Act on Feb. 28, five months after the previous authorization for the act expired.
A pediatrician, Coburn played a major role in the 2000 re-authorization of the CARE act when he was a member of the House. After retiring as a congressman, he served as co-chair of the Presidential Advisory Council of HIV/AIDS. He won election to the Senate last year.
“This program is critical to meeting the needs of more than a half-million Americans living with HIV and AIDS and must be renewed and updated,” Coburn said when he introduced the legislation. “The fact that it hasn’t is a national shame.”
Because Coburn doesn’t serve on the committee responsible for the Ryan White act, chances for his measure are uncertain. Committee staff members have been trying to work out differences among the panel’s members. But so far, no legislation has emerged from the committee.
Representative David Weldon, a Republican of Florida, said he would introduce Coburn’s measure in the House. Weldon, a physician, helped the Army develop an HIV screening program and treated AIDS patients in his private practice.
A key provision focuses 75 percent of federal funds on providing primary medical services to people with HIV. The provision specifically excludes spending on case management for non-medical services and transitional housing, for instance. The Senator also recommends an increase in
government outlays for the AIDS Drug Assistance Program, calling for $70 million a year more over the five years of the reauthorization. Under the measure, the program would also cover co-infections with hepatitis B and hepatitis C.
Organizations devoted to fighting AIDS had a wide range of reactions, but most expressed reservations about portions of the legislation.
While praising the Senator for moving the process forward, many advocates said Coburn’s legislation defines “primary medical services” too stringently. They said reserving 75 percent of Ryan White’s funds to that purpose would cause needed programs to suffer.
“Mandating that 75 percent of the funds go toward primary care and treatment as defined by this bill would be shortsighted,” Dr. Howard Grossman, executive director of the American Academy of HIV Medicine, said. “Primary care includes more than drugs and doctors’ visits.”
The Academy recommended that primary medical care be more broadly defined. It should include, at a minimum, treatment adherence counseling and substance abuse counseling, Grossman said.
AIDS Action, a Washington-based group representing community AIDS agencies, also objected.
“The provision of housing, case management, nutrition, transportation and other services is critical to maintaining the health and well-being of people living with HIV and AIDS,” said Ronald Johnson, co-chair of the group’s public policy committee.
AIDS Project Los Angeles agreed. Craig E. Thompson, the group’s executive director, explained it this way: “Today, the majority of people living with HIV and AIDS are poor and marginalized people who need more, not fewer, support services. It doesn’t do any good to fund a medical clinic but take away the bus pass a poor person needs to get to appointments.”
The National Minority AIDS Council also objected to the bill’s intent of reserving 75 percent of spending for primary medical services.
“More and more urban areas don’t have primary care,” Damon Dozier, director of government relations and public policy, said. “So it leaves out the crucial question of how do you get there to get the care.”
He added: “When you start bringing in hepatitis B and C, then you get into funding issues. In a tight funding environment where we are shifting resources because we can’t give any more money to the Act, then you are adding new coverage, that is problematic as well.”
In pushing for early diagnosis and care, Coburn’s bill would reduce or eliminate many AIDS prevention activities.
“Ryan White is not supposed to be an employment opportunity bill,” Coburn said. “It is supposed to be a bill that solves people’s problems that are infected with HIV.”
“The patient should come first,” he added.
Michael Weinstein, president of the AIDS Healthcare Foundation, said he applauded the introduction of Coburn’s measure, and appeared to agree that more money should go to fund medical services.
“The revolution in treatment of HIV that took place 10 years ago made it a treatable disease,” he said, referring to the introduction of protease inhibitors.
But Weinstein said the CARE Act has not been changed to reflect that advancement.
The measure would have a major effect on large cities where the epidemic first caught hold.
Under Coburn’s legislation, the city of San Francisco would lose about $7.5 million a year.
“In talking with the Senator’s staff, it is unclear what the impact on San Francisco would be,” said Earnest Hopkins, a lobbyist for the San Francisco AIDS Foundation. “There is no way the city could possibly maintain its current system of care. It would collapse.”
Hopkins said work on the bill would continue.
This article appeared in the Dallas Voice print edition, March 10, 2006.