Issue:  Vol. 48 / No. 3 / 18 January 2018

Senate panel OKs CARE Act


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Reauthorization of the Ryan White CARE Act (S. 2823) zipped through the Senate Committee on Health, Education, Labor, and Pensions on May 17. Senator Hillary Rodham Clinton (D-New York) was the only one voting against it. She claims that New York will lose $20 million under the new formula for distributing funds.

Most AIDS advocates greeted passage with a sense of exhaustion and relief that the changes were not worse. The essential problem is that funding has not kept pace with the growing number of people living with HIV/AIDS. A reauthorization bill does not appropriate money.

San Francisco AIDS advocates were unable to get an additional year included in the legislation to preserve its "hold harmless" status. As it stands now, the hold harmless provision in the draft legislation is set at three years; San Francisco officials had been hoping it would be extended to four years. The city likely will see its CARE Act funding reduced over three years.

Speaking for the HIV Medicine Association, Newark, New Jersey physician Anita Vaughn said, "We're extremely happy the lawmakers included substance abuse and mental health treatment as a core medical service." But the group also warned that underfunding could lead to rationing of medications.

Activists said that one troubling new provision is adoption of language that bans use of funds for "promoting or encouraging IV drug use or sexual activity, either homosexual or heterosexual." Similar language in legislation governing the Centers for Disease Control and Prevention's HIV prevention activities has led to what many see as harassing auditing of AIDS services organizations, most notably the Stop AIDS Project in San Francisco.

But there appears to be little that AIDS advocates can do at this point. The effort to move Ryan White reauthorization forward has been bipartisan and bicameral. The exact same draft legislation is set to move through committee in the House, and both chambers are set to vote on the final bill no later than June. Amendments will not be allowed and a conference will be avoided.

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