Changes to the Ryan White CARE Act Could Jeopardize San Francisco's System of HIV Care

The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act serves as a lifeline for thousands of Americans living with HIV/AIDS, providing over $2.1 billion annually to fund primary medical care, pharmaceutical treatments, and critical support services that help people obtain and stay in treatment. San Francisco's HIV care and service infrastructure relies heavily on these federal funds; currently, the City receives more than $28 million in direct CARE Act funding, which supports a range of HIV care and support services to approximately 11,000 San Franciscans living with HIV.

First enacted by Congress in 1990, the CARE Act has been renewed twice--in 1996 and again in 2000. Its authorization expires again this year, and Congress is looking at reauthorizing it in the coming months. Each time it is renewed (every five years), the President and Congress scrutinize the existing law and consider modifications to update and reshape the legislation.

As the reauthorization process has moved forward this year, significant changes have been proposed by the Bush administration and various stakeholder groups, some of which could radically alter the CARE Act. In July of this year, U.S. Secretary of Health and Human Services (HHS) Mike Leavitt released the Bush administration's principles for reauthorization. Although many of these principles lacked specifics, some policy implications were immediately clear:

Funding would be re-directed from states and urban areas with high incidences of HIV/AIDS cases to states with fewer HIV/AIDS cases but longstanding health care access problems that preexist the HIV epidemic.

The administration would speed up this process by eliminating a provision that currently protects cities and states from experiencing rapid declines in federal HIV funding. The elimination of this provision would result in funding cuts to San Francisco of at least $7.5 million and would allow for dramatic shifts in resources throughout the country.

The administration would disallow the inclusion of HIV/AIDS cases from metropolitan areas in determining the allocation of CARE funds to the states. This change could result in a reduction of nearly $20 million in HIV funding to California.

The administration would shift control of resources to city and local governments and away from local community planning bodies.

"We are deeply troubled that the administration has called for such significant changes to the CARE Act without any provision that would protect cities and states from rapid declines in resources," said Mark Cloutier, Executive Director of the San Francisco AIDS Foundation. "These proposed changes would undermine the continuity of care for thousands of Americans living with HIV disease."

Despite steadily increasing numbers of people living with HIV who depend on the CARE Act for treatment and support services, the administration's principles were presented without a commitment of new funding to the CARE Act. The Bush Administration has not significantly increased funding of the CARE Act since coming into office five years ago.

"While we support the administration's effort to supply additional resources to regions where the epidemic is growing, this should not come at the expense of eliminating access to lifesaving services in San Francisco and other cities throughout the nation," said Ernest Hopkins, the Director of Federal Affairs for the San Francisco AIDS Foundation. "Without additional resources, disparities in access to HIV care and services will continue to exist and people with HIV will needlessly suffer and face reduced life expectancy. The solution is to supply new federal dollars to keep pace with the epidemic, not simply shift the problem from one part of the country to another."

Release of the administration's principles was seen as the start of the reauthorization process in Congress. The delayed release, however, left little time for Congress to debate the issues raised by the principles. Despite the fact that it expired in September 2005, reauthorization of the CARE Act is not likely until year's end, or even early in 2006.

The San Francisco AIDS Foundation is actively engaged in the national CARE Act reauthorization debate and will continue to work with national partners like the Communities Advocating Emergency AIDS Relief (CAEAR) Coalition to help minimize damage to funding streams and services for San Francisco and other metropolitan areas.

For more information about this issue or to get involved in advocacy efforts on the reauthorization process, please visit our website atwww.sfaf.org/policy/ryanwhite/  or contact us at 415-487-3080.