Critical funding for HIV/AIDS treatment could cause controversy

From IowaIndependent.com:

By Lynda Waddington 9/11/09 9:58 AM

A federal program that provides financial assistance to more than half a million Americans who have contracted HIV or have AIDS will sunset on Sept. 30 unless Congress reauthorizes it, and its prospects seem uncertain.

U.S. Rep. Bruce Braley (D-Waterloo) took part in a congressional hearing about the future of the program Wednesday. Although Braley is hopeful that reauthorization of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act will receive bipartisan support as it has in the past, he acknowledges that the current political climate could pose a challenge.

U.S. Capitol Building / Congress“I have to be frank and tell you that, in light of what we saw happening over August and what we saw on the floor of the House [on Wednesday when President Obama delivered an address to a joint session of Congress], it would not surprise me if there was some partisan opposition,” Braley said by phone Thursday morning. “I’m hoping that the better angels of our nature will win over and we can have a meaningful discussion on the importance of the reauthorization.”

The Ryan White CARE Act, which funds basic care, treatment, education and support services related to HIV/AIDS, disbursed more than $2 billion to states, local governments and advocacy groups during each of the past three fiscal years. Advocates say the funding is indispensable to ensuring that patients with HIV/AIDS get the care they need.

Because distribution of funds through the program can be granted to programs that provide assistance across state boundaries, it is difficult to determine exactly how much funding makes it way directly to Iowans or Iowa-based programs. According to one estimate from the Kaiser Family Foundation, Iowa received roughly $4.5 million in assistance in fiscal year 2007:

Distribution of Ryan White Program Funding, FY 2007

  Iowa US
Part A – Emergency assistance to eligible metropolitan areas (EMAs)
and transitional grant areas (TGAs) that meet a certain threshold of
reported AIDS cases.
$0 $578,686,334
Part B – Core medical services and support services in states and
$2,874,145 $1,150,927,400
Part C – Early intervention services, core medical services, support
services, clinical quality management costs and administrative costs for
public and private organizations
$1,545,005 $182,917,964
Part D – Funds private and public organizations with specific focus on
women, infants, children, youth and families
$0 $66,683,299
Part F – Funds several outreach programs, but Iowa money is provided
for the Dental Reimbursement Program.
$18,924 $9,198,395

The bulk of the money directed to Iowa goes toward helping patients access HIV/AIDS medications, promoting early intervention, and providing services in underserved areas. The 2006 reauthorization of the program required that 75 percent of the funds directed to a state under Part B are spent on core medical services (i.e., medications, ambulatory services, substance abuse treatment and behavioral health services), while the remaining 25 percent could be used for support services (i.e., respite care, outreach and medical transportation), unless the state receives a waiver.

Although no Iowans testified to Congress on the first day of hearings, Prof. Donna Sweet of the University of Kansas School of Medicine and chairwoman of the board of the American Academy of HIV Medicine in Washington, D.C., provided lawmakers an inside look at one Kansas program.

“The HIV Program KU Internal Medicine Midtown provides care and treatment to 1,246 patients as of today,” Sweet said. “Of these, 40 percent would have no coverage if it were not for the Ryan White CARE Act. We provide ongoing, comprehensive care to an ever-increasing number of patients, regardless of their ability to pay. My clinic has an average annual increase of 100 new patients a year — in Kansas, not New York or California. However, we are still working off the same number of Ryan White dollars we have received since 1999. To broadly paint the picture: In the last 10 years my clinic’s patient load has doubled, and my funding has remained the same.”

In order to keep the clinic afloat, Sweet reported that she and the staff have resorted to “Girl-Scout-styled fundraising.”

“There seems to be a commonly held belief that program cuts will only affect administrative functioning and that medical services for the sick will somehow always be available through Ryan White, or Medicaid or some other program; this is a false assumption,” she said.

If the program is not reauthorized, the Kansas facility as well as other programs throughout the nation will no longer have funds with which to operate. By Jan. 1, there would no longer be funds to provide services to 40 percent of the Kansas patients or make payroll for most staff members. In addition, there would no longer be money for case workers or for prescription assistance, a service that Sweet said is used by 80 percent of her patients.

“Over the past 20 years, HIV has become a highly manageable disease with proper care and treatment,” she said.

“Without the Ryan White Program, my clinic would have never been created. Without a timely reauthorization of Ryan White, it may cease to exist. Without my clinic, my patients will not receive the care they need to manage their disease. And without that care, the disease they live with every day may unnecessarily and prematurely claim their lives.”

Braley said, despite partisan challenges and the heated health care debate before Congress, he believes that the program will ultimately be reauthorized.

“The problems that led to the passage of the Ryan White Act have not changed,” he said. “We still have significant needs in the areas of AIDS awareness and prevention, and that’s why I’m confident the bill will be reauthorized.”


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