Bush Administration Releases Principles for CARE Act Reauthorization

On July 27, 2005, just days before Congress adjourned for its annual August recess, Secretary of Health and Human Services (HHS) Mike Leavitt released the Bush Administration's Principles for Reauthorization of the Ryan White CARE Act. (These can be viewed at http://wwwhhs.gov/news/press/2005pres/ryanwhite.html). Unfortunately, the long-anticipated proposals would weaken the CARE Act and would significantly undermine CARE Act-funded services in California and in cities hardest hit by the epidemic. The impact on San Francisco would be especially damaging since the Title I CARE Act award would be reduced by at least $7.5 million, significantly altering the City's ability to maintain high quality HIV services for the thousands of individuals being served today. (See the AIDS Foundation's news release regarding this threat at www.sfaf.org).

Remarkably, even after the long delay, the Bush principles lack important specifics that are needed to accurately assess their impact. That being said, a few policy implications are clear. HHS intends to shift control of resources to governments and away from local community planning bodies. In addition, funding would be re-directed from high HIV/AIDS incidence states and urban areas to states with fewer HIV/AIDS cases but longstanding health care access problems that pre-exist the HIV epidemic. The Administration would speed up this process by eliminating a provision that protects cities and states from experiencing rapid declines in federal HIV funding. The elimination of this provision-called the "hold harmless"-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 principles would also disallow the counting of 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, where the vast majority of people living with AIDS reside in metropolitan areas.

Despite steadily increasing numbers of people with HIV who depend on the CARE Act for treatment and support services, the HHS principles were presented without a commitment of new funding to the CARE Act. The Bush Administration has largely flat-funded the CARE Act since coming into office five years ago.

Generally, the national AIDS community views the Bush principles as the start of the reauthorization process in Congress. The delayed release leaves little time before the September 30, 2005 expiration of the CARE Act to debate issues raised by the principles, particularly the overarching question of what is the appropriate role of the federal government in ensuring health care access for low-income and uninsured people with HIV/AIDS.

A variety of national AIDS advocates and coalitions have presented their recommendations for reauthorization to Congress and now those proposals will be compared to the Administration's principles in an effort to reach consensus on key components of the legislation. 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 minimize damage to funding streams to San Francisco and other Title I cities. The Foundation will advocate for policies that strengthen existing HIV service delivery systems, promote local flexibility in establishing the scope of services, sustain continuity of HIV care and maintain community involvement in decision making.