Bush Administration's CARE Act Principles Would Undermine S.F. and California's Systems of HIV Care

Today the U.S. Department of Health and Human Services in conjunction with the White House issued the Bush Administration's principles for reauthorization of the Ryan White CARE Act. The Ryan White CARE Act is set to expire in September 2005 and is scheduled to be renewed this year. No legislation has yet been introduced, but the principles issued by the Administration are expected to send a "green light" to Congress to begin to move this process forward. We expect to see actual legislation in the coming weeks. A copy of the principles can be viewed at http://www.hhs.gov/news/press/2005pres/ryanwhite.html.

Unfortunately, many of the proposals, if enacted, would do serious and substantial harm to San Francisco's HIV infrastructure and would also have a very negative impact on California's HIV funding levels. In particular, the principles call for the elimination of the hold harmless provision that protects cities from experiencing rapid declines in resources that could dismantle systems of care. Such a change could mean a $7 million cut to San Francisco's direct HIV funding. This represents a 25% reduction from the $28 million San Francisco currently receives.

There are other proposals that could harm California overall, including a proposal that calls for not counting AIDS cases from metropolitan areas in determining the allocation of CARE funds to the states (known as Title II funds) because metropolitan areas also receive direct federal funding. 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.

Also troubling is the information provided about a proposal to create a "severity of need" index that would be used to distribute funding. The details are scarce, but the index that is described appears to shift federal resources away from jurisdictions and states that provide state, local and private resources to fight the epidemic to jurisdictions that do not provide such resources. San Francisco and California--which have been quite generous in providing local and state resources for HIV programs--could be seriously disadvantaged under such a system.

The document also eliminates the requirement that community planning bodies--made up of people living with AIDS and other community stakeholders--set priorities for spending CARE Act resources. Without the power to determine how the money is allocated and prioritized, many communities will run the risk of being totally at the will of the state and local government.

Attached is a press release we distributed today expressing our concerns about these principles and the potential impact on San Francisco and California's HIV care infrastructure.

How the Congress will react to these principles, which could shift resources significantly throughout the country, remains to be seen. We expect legislation to be introduced in the U.S. Senate in the coming weeks. We urge individuals who are concerned to track these developments and to weigh in with your elected officials at the local, state and federal levels about concerns you may have about these proposals. We will be sending out more specific action alerts on this topic in the coming weeks as more details become available.

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