Local leaders say impact could be devastating on programs providing housing, lifesaving medication, other services to low-income clients


STAYING UPBEAT | AIDS Services of Dallas resident Matthew Kowalewski, who was homeless after losing his partner to AIDS and surviving cancer before moving into Hillcrest House in July, shows off one of the Christmas trees he decorated to make the holidays festive for residents. (David Taffet/Dallas Voice)


DAVID TAFFET  |  Staff Writer

If Democrats and Republicans don’t reach a deal to avoid the “fiscal cliff,” automatic 8.4 percent federal budget cuts could have a devastating impact on local HIV/AIDS services.

While other LGBT-related programs would be affected — including funds for the FBI to investigate hate crimes and for the education department to implement anti-bullying programs — cuts to HIV/AIDS service organizations would directly affect the healthcare, nutrition and housing of people with HIV.

The Housing Opportunities for People with AIDS program would lose $27 million nationally, according to Nancy Bernstine, executive director of the Washington, D.C.-based National AIDS Housing Coalition. Locally HOPWA cuts would affect AIDS Services of Dallas, which provides housing to people with AIDS who would otherwise be homeless.

“The policymakers don’t expect this to take place, but they sure are playing it close to the edge,” Bernstine said.

The two sides reportedly were edging closer this week to a deal that would raise some taxes and cut spending to avert the fiscal cliff. If a deal is not reached by Dec. 31, the Budget Control Act mandates all taxes revert to the level prior to the Bush-era tax cuts and all federal spending is cut by 8.4 percent, referred to as sequester.

Bernstine said if there is sequester on Jan. 1 but a resolution by March 1, most agencies won’t have a problem. That’s because federal subsidies of local programs aren’t paid on Jan. 1. Payments are staggered.

HOPWA isn’t the only program delivering lifesaving services to people with AIDS that would be affected.

The Ryan White program, the largest federal funding source for a number of programs for low-income people with AIDS, would be cut by $196 million. That includes $77 million in cuts to the AIDS Drug Assistance Program, or ADAP, which provides medication for people who do not have insurance. Although 7,000 people are already on ADAP waiting lists nationally, Texas does not have a waiting list. But one estimate projects that 2,000 people now receiving lifesaving drugs nationwide would lose their medication.

Resource Center Dallas CEO Cece Cox said cuts to Ryan White would affect programs like the insurance program that makes COBRA payments and helps clients with doctor co-pays. She said the $1 million in premiums RCD pays would be more than it could find a way to replace.

“The threat is real and will impact real people here in our community,” she said.

But Cox was not trying to panic her clients.

On Dec. 5, Cox attended a White House meeting with 80 other Texans to discuss the fiscal cliff. She said one purpose was to coordinate their message. They agreed it was important for people to contact their representatives to let them know how these budget cuts could affect them.

RCD has a template letter on its website (ResourceCenterDallas.org), as well as a tool to find your representative. But Cox suggested that people write personal letters about how AIDS service agencies make a difference in their lives.

Cox described the average client of RCD as someone who is working and receives some nutrition assistance, doctor co-pays or insurance assistance that helps them stay healthy and continue to get to work.

“There are still quite a few unknowns,” she said. “But we won’t be able to serve as many clients.”

Legacy Counseling Center Executive Director Melissa Grove said potential cuts to healthcare would be short-sighted. She compared the $25,000 per year cost of keeping someone healthy to the $500,000 cost of treating someone whose HIV infection has progressed to AIDS.

She said when Legacy prevents just one new infection, it covers the annual cost of running her agency.
AIDS Arms CEO John Carlo agreed.

“Every case you prevent saves a half million in healthcare costs,” he said.

Before moving into his new position, Carlo worked for Homeland Security. He said the executive branch’s position was to not make plans for the fiscal cliff. The fear was that if there were plans in place, at some point they could be implemented.

“We’re all bracing for impact,” Carlo said. “It’s hard to put numbers against projections, but there will be an impact.”

He said his agency has a diversity of funding and for the short-term he isn’t panicking. But he added that any cuts would put a burden on providing healthcare for several thousand people who rely on AIDS Arms.

“I’m concerned with how we proceed not just with the fiscal cliff but with healthcare reform,” he said.

In Fort Worth, AIDS Outreach Center Interim Director Shannon Hilgart said as much as $250,000 could be cut from her annual budget. That translates into four staff positions.

“And we don’t get to choose where those cuts come from,” she said.

She said her nutrition and case management budgets were already cut in half this year. The agency has learned be more efficient, but Hilgart said she doesn’t know how it can serve its clients on an even slimmer budget.

She said donations from individuals is already what’s keeping the nutrition program running.

One group of people served by AIDS service providers will be able to continue to access their healthcare without interruption. The Budget Control Act, which mandates these cuts, exempts Medicaid from sequestration.

Carlo said he’s worried most about cuts that would restrict access to lifesaving medication. “We don’t want it to be 1993 again,” he said.

This article appeared in the Dallas Voice print edition December 14, 2012.