Congressional Leaders Write to President on Behalf of HIV/AIDS Funding
February 6, 2004
Washington, D.C.-Leading congressional Democrats today called on the Bush Administration to adequately fund access to care, treatment and life saving medications for uninsured and under-insured people living with HIV/AIDS.
Under an ambitious new initiative, "Advancing HIV Prevention," the Centers for Disease Control and Prevention (CDC) is promoting HIV testing with the goal of diagnosing Americans who are currently unaware that they are infected with HIV. However, the Bush Administration's budget fails to provide resources for all the services in the Ryan White CARE Act to treat these newly diagnosed patients.
Ryan White CARE Act programs provide the foundation for therapies and services for low-income individuals with HIV and AIDS, including access to needed medications through the AIDS Drug Assistance Program.
The letter was signed by House Democratic Leader Nancy Pelosi, House Democratic Whip Steny Hoyer, Rep. Henry A. Waxman, Ranking Member of the Government Reform Committee, Rep. Barney Frank, Rep. Sherrod Brown, Ranking Member of the Energy and Commerce Subcommittee on Health, Rep. Donna M. Christensen, Chair of the Congressional Black Caucus Health Braintrust, Rep. Barbara Lee, Chair of the Congressional Black Caucus Task Force on Global HIV/AIDS, and Rep. Tammy Baldwin.
The following is the full text of the letter:
The Honorable Tommy G. Thompson
Secretary of Health and Human Services
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201
Dear Mr. Secretary:
We are writing to ask you to ensure that the new initiative to increase HIV testing that is being sponsored by the Centers for Disease Control and Prevention (CDC) will not leave thousands of Americans with a diagnosis of HIV infection but without access to life-saving medications and medical care.
There is a gap between CDC's public health efforts and the President's budget for the Ryan White CARE Act. On one hand, CDC is promoting HIV testing in the hopes of diagnosing Americans who are currently unaware they are infected. This campaign will create new demand for HIV treatments and medical care. On the other hand, the President's fiscal year 2005 budget asks for insufficient HIV/AIDS funding including less than one-sixth of the increase needed to ensure that all HIV-positive Americans have access to essential therapies.
This scenario is unacceptable. While CDC's testing initiative may be important to slowing the spread of HIV, it should be matched by efforts to help those diagnosed with HIV to live longer, more productive lives. We urge you to intervene to assure that the President's budget adequately funds the Ryan White CARE Act, including AIDS drug assistance.
CDC's new initiative, called "Advancing HIV Prevention," was launched in early 2003. The premise is simple: because Americans who do not know they are infected are believed to be more likely to pass HIV to others, improving the diagnosis of HIV has the potential to slow the course of the epidemic.1
To promote early detection, CDC is pursuing a wide and ambitious agenda. CDC is funding community-based organizations to test for HIV in non-medical settings such as correctional facilities and is leading a national campaign to encourage health care providers to offer routine HIV testing.2 The agency has already purchased and distributed 250,000 rapid HIV tests and has broadcast via satellite a series of educational programs to thousands of health care providers.3 The agency's goal is to reduce the number of Americans who are unaware of being infected to less than 5% of all those who are infected.4
One important - but unaddressed - outcome of this initiative will be a marked increase in the demand for HIV treatment as new diagnoses are made. The CDC hopes to "ensure that every person with HIV infection has the opportunity to get tested, has access to state of the art medical care, and ongoing prevention services."5 However, while the CDC plan will increase testing and diagnosis, the Administration has not made a corresponding commitment of resources to assure access to medication and primary medical care, under the Ryan White CARE Act, for those diagnosed through this initiative.
Congress passed the Ryan White CARE Act in 1990 to assure access to HIV/AIDS care for all Americans. Title I provides funds to areas hit the hardest by the HIV/AIDS epidemic for outpatient care and case management. Title II funds grants to states to improve the quality, availability, and delivery of health care for HIV-infected individuals. Title III funds nonprofit groups to provide primary care, early intervention, and capacity-building and planning services. Title IV provides funds to meet the special needs of women, infants, and children living with HIV.
While the CDC initiative will increase demand for all Ryan White CARE Act services, the impact will most clearly be seen in those programs funded by Title II, which includes the AIDS Drug Assistance Program (ADAP). Originally created by Congress in 1987 to help states purchase AZT for uninsured Americans with AIDS,6 ADAP was moved to the Ryan White CARE Act in 1990 to provide for a range of HIV/AIDS treatments. More than a decade later, ADAP still serves as a key safety net across the country. In June 2002, ADAP served more than 80,000 Americans with 257,000 prescriptions.7
Unfortunately, ADAP suffers from substantial underfunding and state-to-state variation in the drugs covered. Despite federal spending of $714.3 million in fiscal year 2003, there are about 800 people waiting to be enrolled in drug assistance programs and 15 states with waiting lists or other cost-containment strategies that impact access.8
In 2003, the National Alliance of State and Territorial AIDS Directors (NASTAD) estimated that an increase of $280 million was needed in the fiscal year 2004 budget to provide for those waiting to receive ADAP services and to cover all effective treatments.9 This estimate did not include the additional costs of drugs for new patients diagnosed because of the CDC initiative. After NASTAD's ADAP Crisis Task Force negotiated $65 million in discounts and rebates from pharmaceutical companies, and Congress increased ADAP funding by $34.5 million in fiscal year 2004, a gap of $180.5 million still remains.
Using conservative assumptions, it can be estimated that an additional $45.3 million will be needed in fiscal year 2005 to fund ADAP just to care for those diagnosed as a result of the CDC initiative.10 This figure is very likely an underestimate.11
The President, however, has proposed just a $35 million increase in ADAP funding for fiscal year 2005.12 This increase does not come close to matching the $180.5 million ADAP shortfall estimated by NASTAD, and it does not match the estimated $45.3 million projected ADAP need for funds due to the CDC initiative. It provides less than one-sixth of the total $225.8 million increase needed for ADAP next year. The President's budget also fails to increase other elements of Ryan White CARE Act funding adequately.
By failing to provide necessary funds for HIV/AIDS care, the Administration is risking the success of the CDC's HIV testing initiative. Patients and providers may be less likely to test if lifesaving medications cannot be obtained. Communities may be reluctant to partner with CDC to encourage widespread testing while many of their citizens are languishing on ADAP waiting lists.
We understand that the CDC/HRSA Advisory Committee on HIV and STD Prevention and Treatment recently asked HHS to model the impact of the CDC initiative on demand for ADAP services. Analysis of this gap by HHS is critically important. However, there is already ample evidence to justify a major increase in the President's fiscal year 2005 budget.
We urge you to reverse this retreat from critical, life-saving HIV care. At a time when this Administration is pursuing a major commitment to AIDS overseas, it is wrong to overlook the epidemic's sufferers at home. We look forward to receiving your response to this letter.
Steny H. Hoyer
Henry A. Waxman
Ranking Minority Member
Committee on Government Reform
Member of Congress
Ranking Minority Member
Subcommittee on Health Committee on Energy and Commerce
Donna M. Christensen
Health Brain Trust
Congressional Black Caucus
Task Force on Global HIV/AIDS
Congressional Black Caucus
Member of Congress
1 Centers for Disease Control and Prevention, Advancing HIV Prevention: The Science behind the New Initiative (2003) (online at