What’s next for HIV/AIDS services?

With drastic budget cuts looming, federally-funded HIV/AIDS treatment, prevention and education programs could be lost completely

Phyllis Guest
Taking Notes

On Dec. 15, four HIV/AIDS policy, planning and treatment groups offered a webinar entitled “Is No Deal a Good Deal? Deficit Reduction, HIV Services and What Comes Next.”

Experts from the AIDS Foundation of Chicago, AIDS United, Harvard Law School Center for Health Law & Policy Innovation and the Treatment Access Expansion Project took turns speaking about different aspects of the challenges HIV/AIDS service providers face in light of political realities in DC. They divided their presentation into four parts and used 50 illustrative slides.

Part 1 was the overview: Deficit Reduction and the Budget Control Act of 2011.

So why does the U.S. have a deficit when, as George W. Bush took over the White House in January 2001, the federal government had a surplus of more than $237 billion? The answer is a trifecta: Bush-era tax cuts (“It’s your money!”), war in Afghanistan (“Gotta get al-Qaida!”) and war in Iraq (“Weapons of mass destruction!”). Thus, in a single decade, we went from the largest surplus in U.S. history to the largest deficit.

The fiscal woods thicken here, so let’s just note that Congress has passed and the president has signed the Budget Control Act of 2011. The act pledges the federal government to sharply reduce the deficit over the next 10 years.

What will such deficit reduction mean for HIV/AIDS programs? According to the webinar presenters, if there is no agreement on revenue increases and the deficit reduction comes solely through spending cuts, it will severely impact three programs of interest to many of us: Ryan White, prevention funding and two so-called entitlements, Medicaid and Medicare.

­THEN AND NOW  |  When George W. Bush took over the White House in January 2001, the federal government had a budget surplus of more than $237 billion. In 2011, the deficit stands at $1.3 trillion.

­THEN AND NOW | When George W. Bush took over the White House in January 2001, the federal government had a budget surplus of more than $237 billion. In 2011, the deficit stands at $1.3 trillion.

A spending-cuts-only approach would affect the HIV/AIDS community in several ways. First, cutting prevention efforts would mean higher rates of infection, worse health outcomes and higher long-term health care costs.

Since Medicare and Medicaid help millions living with HIV/AIDS, cutting the former would likely cause more physicians to drop Medicare patients, and cutting federal funds for the latter would shift the cost to treat very low-income persons to the states. (Good luck with that, Texans.)

Cuts to general health care reform efforts would virtually assure higher costs going forward.

Still with me? Good.

So when the Congress and President Obama could not come to any fiscal agreement, they punted to the Super Committee. The Super Committee was tasked with recommending huge changes to taxes, entitlement programs (including Social Security, Medicare, Medicaid) and discretionary spending (including Ryan White).

The SC came up with nothing. Nada. Zilch.

That means there will be no immediate spending cuts to entitlement programs. But automatic spending cuts  — sequestration — will kick in January 2013 for both defense and non-defense programs.

According to the nonpartisan Congressional Budget Office, without new revenues, domestic spending will drop from about 4.4 percent of Gross Domestic Product this year to about 2.7 percent in 2021. It will then be much lower than it has been since the end of WWII.

Looking at appropriations for the year we’re entering now, suffice it to say that the differences between what the HIV/AIDS research and health care community is seeking and what the Congress is proposing are huge.

Also, the community “vehemently” opposes two policy riders added by Republican members of Congress. The first bans the use of federal funds for syringe exchange programs. The second funds abstinence-only programs.

The webinar ended with a plea for advocacy. Here are the talking points the experts hope we will use:

• The Super Committee actually succeeded in one area: It prevented major cuts to Medicare, Medicaid, Social Security and other essential programs.

• The president and Congress must stick to their promise to cut defense and non-defense spending equally; no caving to deep-pocketed militarists.

• New revenue is essential; without it, HIV/AIDS outreach, prevention, education and treatment programs are lost.

• Preventing new HIV/AIDS cases, providing early treatment for those who do get infected, and funding support services such as housing are not just humane; they are cost-effective.

HIV/AIDS is still running rampant, and no magic cure is in sight. Call, fax, email and snail mail every member of Congress as well as the president.

Work with other activists. Think of other things to do, and do them all. Jan. 2 is not too soon to begin.

Phyllis Guest is a longtime activist on political and LGBT issues and is a member of Stonewall Democrats of Dallas. Send comments to editor@dallasvoice.com.

This article appeared in the Dallas Voice print edition December 23, 2011.

—  Michael Stephens