House Panel Approves Reauthorization of Ryan White CARE Act

The House Committee on Energy and Commerce on Wednesday voted 38-10 to approve a draft bill that would reauthorize the Ryan White CARE Act for the next five years, the San Francisco Chronicle reports (Epstein, San Francisco Chronicle, 9/21). The draft bill in the House, sponsored by Commerce Committee Chair Joe Barton (R-Texas), would reauthorize the CARE Act through 2011 and appropriate about $2 billion for fiscal year 2007 in grants to state and local governments for medications, health care and social services, CQ Today reports. The measure would change how the grant money is distributed in order to provide funds to areas with increasing numbers of HIV-positive people. The legislation would give states a "hold-harmless" period of three years during which a state's CARE Act funding would not be reduced by more than 5% from its FY 2006 appropriation (Wayne, CQ Today, 9/20). Rep. Anna Eshoo (D- Calif.) co-sponsored an amendment to the bill that would have authorized more funds and would have "protected" San Francisco's CARE Act funding, according to the Chronicle. The committee voted 22-21 to reject the amendment (San Francisco Chronicle, 9/21).

Senate Bill
The Senate Committee on Health, Education, Labor and Pensions in May voted 19-1 to approve a similar measure (S 2823) -- co-sponsored by HELP Committee Chair Mike Enzi (R-Wyo.) and Sen. Edward Kennedy (D-Mass.) -- that would amend the CARE Act by allocating more federal HIV/AIDS funding to Southern and rural states. The Senate bill would include revising the formulas for funding calculations to include HIV cases, and not just AIDS cases, and would create a tiered system of larger and smaller cities in an effort to distribute funds to more rural states. The measure also would mandate 75% of funding go to "core medical services," such as medications and physician visits, and also would set a minimum drug formulary. Sen. Hillary Rodham Clinton (D-N.Y.) was the only HELP committee member to vote against the bill, saying states with urban centers are most affected by HIV/AIDS and should not have their funding reduced, adding that New York state could lose $20 million under the proposed revisions (Kaiser Daily HIV/AIDS Report, 9/18).

Reaction
Legislators from states with large urban areas -- including California, New Jersey and New York -- voted against the House bill, saying it could harm HIV/AIDS programs in areas with higher HIV prevalence, the AP/Washington Post reports (Werner, AP/Washington Post, 9/20). "This bill is designed to have clear winners and losers in funding, and there should be none," Rep. Eliot Engel (D-N.Y.) said, adding that the New York House delegation opposes the bill (CQ Today, 9/20). House Minority Leader Nancy Pelosi (D-Calif.) in a letter to the Commerce Committee wrote that the CARE Act's current hold-harmless provision "was adopted to protect the epicenters of this disease from experiencing drastic reductions in funding from year to year that would disrupt the systems of care in place, and eliminating it now would cause this very consequence." According to the Chronicle, San Francisco, which receives about $28 million annually from the CARE Act, could lose $10.4 million in HIV/AIDS funding by the fourth year of the program under the House proposal (San Francisco Chronicle, 9/21). In contrast, Alabama's CARE Act funding would increase from $11 million to $18 million annually if the measure becomes law. "It shouldn't matter where you live in the country when it comes to accessing medical care and therapy," Barton said (AP/Washington Post, 9/20). "It is time for Ryan White funds to be distributed more evenly, so all patients -- not just those living in New York, San Francisco and Boston -- can receive the care they need," Sen. Richard Burr (R-N.C.) said (San Francisco Chronicle, 9/21). It is uncertain whether Congress will pass the bill by the end of the month, the AP/Post reports (AP/Washington Post, 9/20).