WASHINGTON, DC—Lawmakers were working to find consensus last month on draft legislation reauthorizing the Ryan White Program.

The program, which is the main federal resource for primary care services, drug assistance, education and outreach to HIV-positive people, was set to expire on Sept 30, 2009.

The Ryan White Program was last reauthorized in 2006 and currently serves about 529,000 individuals. At a hearing held by the House Committee on Energy and Commerce’s Health Subcommittee lawmakers discussed draft legislation under consideration that would renew the law for three more years. “With today’s hearing, we begin that process which I hope will culminate in a piece of legislation that members from both sides of the aisle can strongly support,” said Rep Henry A Waxman, D-Calif., who chairs the full committee.

Funding Ryan White

The draft legislation under consideration is backed largely by Democrats and by the Administration. Republicans signaled that they were not satisfied with some provisions contained in the current draft bill. “If we really care about this population, we will focus on patients and make sure to make time to work across the aisle to produce such a bill,” said Texas Republican Rep Michael Burgess.

One element in the draft bill that some Republicans said that they did not support was funding. While the 2006 reauthorization law included authorization levels for each of the three fiscal years that the bill was renewed for, the new draft legislation includes “such sums as necessary” language. This language would allow appropriators to decide the funding amounts that may be necessary for each of the fiscal years.

HIV/AIDs organizations that support the clause believe that it will allow for the HIV needs to be better met. “The Ryan White Program has been seriously underfunded for many years and many grantees are struggling to provide the necessary services to all those that are in need,” according to Julie Scofield, who testified on behalf of the National Alliance of State and Territorial AIDS Directors.

Republicans on the committee, however, said that specific funding amounts should be stipulated in the reauthorization bill, rather than using the “such sums as necessary” language. “In a period of increasing deficits and national debt, it is hard for us to go back and say ‘blank check.’ It would be much better if we did some analysis, ‘saying here is the population, here is the need, and here is the amount we need,’” said Illinois Republican Rep John Shimkus.

Funding Transitional Grant Areas

Another area of disagreement among some lawmakers is over funding for “transitional grant areas.” When the bill was last reauthorized in 2006, Congress divided funding into two separate categories—Emerging Metropolitan Areas and Transitional Grant Areas. TGAs are jurisdictions with at least 1,000, but fewer than 2,000 cumulative AIDS cases, during the prior five calendar years.

Currently, there are 6 TGAs that potentially will lose their eligibility in fiscal year 2011 because they have decreasing numbers of AIDS cases. The draft bill would prevent their loss of eligibility by extending the TGA status for three years to all TGAs that previously received an award.

Some Republicans expressed concern about providing TGAs funding that do not meet eligibility. “There has always been this process that there is this 3-year grant period and then they would be re-evaluated. So, that doesn’t concern you that other areas may be underserved because you are going to allow these[6]TGAsto be grandfathered?”RepEdWhitfield, R-Texas, askedHRSAAdministrator Mary K Wakefield, PhD, RN, who testified before the subcommittee.

Wakefield told the subcommittee that the administration supports the provision to extend TGA status. She said that a loss of funding for these areas could potentially result in “destabilization of HIV care delivery systems, significant reductions in essential services and neighboring jurisdictions being burdened with an influx of new or displaced patients from former TGAs.”

Hold Harmless

The 2006 reauthorization of the Ryan White program mandated that funding for states and local jurisdictions be determined by the number of people living with HIV and AIDS. Previously, funding was determined by estimating the number of people living with AIDS and did not account for HIV cases.

This new formula meant that some states would be eligible for more funding than they had been under the old formula, since HIVcases would now be taken into account. It also meant that some states with large urban areas that have grappled with AIDS would potentially lose some of their funding under the new formula. As a compromise, Congress included a “hold harmless” provision in the 2006 reauthorization that would prevent the new formula from significantly reducing the overall funding for states that might be lose funding under the new formula. The 2009 draft bill keeps this hold harmless provision.

back to October articles