Departments of Labor , Health and Human Services, and Education, and Related Agencies Appropriations Act, 2008
Floor Speech
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION APPROPRIATIONS ACT, 2008 -- (Senate - October 23, 2007)
BREAK IN TRANSCRIPT
Mrs. FEINSTEIN. Mr. President, I rise in opposition to the Enzi amendment. I congratulate the chairman and the ranking member for the work they have done on this bill. But this amendment significantly disadvantages at least nine jurisdictions facing HIV/AIDS crises throughout the country because it essentially would prevent any stop-loss provision enacted by the House from going into effect.
Senator Enzi, Senator Kennedy, and the rest of the HELP Committee worked tirelessly for most of last year to reauthorize the Ryan White CARE Act. I voted for this reauthorization, and I recognized at the time that the method of counting HIV/AIDS victims had to change to more clearly reflect living victims. However, this then mandated huge cuts to vital programs, despite the fact that States and eligible metropolitan areas were assured that no jurisdiction would face destabilizing losses.
The HELP Committee staff provided GAO data during the debate projecting that San Francisco would receive approximately $17.1 million in fiscal year 2007. But San Francisco did not receive that amount. Their formula award totaled $14.6 million, which is $2.5 million less than estimated.
A compromise was to offset losses by clearly making available supplemental award funding so that the Health Resources and Services Administration could consider the funding losses when awarding this supplemental funding. This amendment seeks to do away with all of this.
Despite these estimates and built-in protection, several areas of the country received significant funding cuts when the 2007 awards were announced earlier this year.
The San Francisco eligible metropolitan areas, which also include Marin and San Mateo Counties, lost approximately $8.5 million. That is just those three counties--an $8.5 million loss. This accounts for 30 percent of the Ryan White funding--a loss too great for any jurisdiction to absorb in 1 year.
It didn't surprise me when San Francisco lost money in 2007. The city knew it would likely face losses. But the protections put in place clearly were not adequate. The loss of one-third of total funding is clearly destabilizing. To be very candid with you, I find it highly objectionable.
This isn't only unique for San Francisco. Five other cities also lost 20 percent or more of their funding: Hartford, CT, 32.1 percent; New Haven, CT, 23.7 percent; Nassau-Suffolk County, NY, 21.7 percent; Ponce, Puerto Rico, 28.9 percent; Caguas, Puerto Rico, 34.3 percent.
No jurisdiction can absorb cuts of this magnitude in 1 year without significant harm to those they serve. To address this, the House of Representatives included a stop-loss provision to cap the losses faced by these jurisdictions in their version of the fiscal year 2008 Labor-HHS appropriations bill. This provision limits the fiscal year 2007 losses for eligible metropolitan areas, or EMAs, to 8.4 percent--not 30 percent but 8.4 percent--which is a manageable amount. Transitional grant areas will have their losses capped at 13.4 percent.
So there is a willingness to respond to the mandate; that is, change your method of counting and, secondly, absorb reasonable cuts. I don't think that
is too much to ask. I think this is overkill.
I was the mayor who first found AIDS, and I can take you back to 1981 and I can tell you what it was like. You won't like it. What I tried to do in the task force of the Conference of Mayors was to bring mayors into the modern day. San Francisco essentially led the Nation in the fight against AIDS. I think to have to take a 30-percent cut, when we are seeing some regeneration of AIDS, is a terrible mistake.
Senator Enzi's amendment could nullify the House's solution. Let me be clear. Under the House language, San Francisco would still lose $2.3 million. All of the cities will still face significant cuts. This provision is designed not to stop all reductions but to limit them to a level that can be absorbed in 1 year. The House provided funding for the stop-loss on top of a $23 million increase for part A of the Ryan White CARE Act. So virtually every area across the country sees an increase in funding. But these areas take a dramatic 30-percent cut in funding. I don't think that is right, and I don't believe we should accept it.
The Government Accountability Office examined the impact this stop-loss provision would have on jurisdictions in 2008. In addition to benefiting the 11 jurisdictions whose cuts are reduced, the House bill results in increased funding for 42 of the remaining 45 jurisdictions. The very minor cuts projected in the remaining three jurisdictions are less than one-tenth of 1 percent. A reduction of 30-percent is simply not manageable.
The provision makes no changes to the underlying reauthorization. It doesn't prevent it from moving forward at all. It caps the total losses faced by any jurisdiction in fiscal year 2007 with a one-time solution. It doesn't reopen the reauthorization so carefully crafted by Senators KENNEDY and ENZI and their committee.
The epidemic, as I mentioned, is far from over in San Francisco. AIDS continues to be the second leading cause of premature death in the city and counting. Nearly 23,000 people are currently living with HIV/AIDS in San Francisco, which is more than at any point in the epidemic. Listen to that--nearly 23,000 people in San Francisco are living with HIV now, and that is more than at any point during the epidemic. In addition, the population of San Francisco living with HIV/AIDS is increasingly impoverished, homeless, and struggling. Many have serious medical needs.
About 2 weeks ago, the San Francisco Chronicle reported that San Francisco doctors diagnosed 15 HIV patients with Kaposi sarcoma. That is a form of cancer commonly found in patients early in the epidemic but had become rare.
I will never forget, in a staff meeting I had with department heads back in 1981, when the director of public health said: Madam Mayor, something is happening. We are finding patients with large purple lesions all over their bodies, and we don't know what it is.
His name is Merv Silverman. I said: Merv, find out what it is and come back and tell me.
Three weeks later, they came back, and it was the discovery for the first time of AIDS in this country. So I feel very sensitive about it. I started the first AIDS program in the Nation. We funded it with property tax dollars. That is how we became a leader in the area.
To take a 30-percent cut when we have the largest number of HIV/AIDS victims in our history in the city, to me, is discriminatory, wrongheaded, and it need not happen. So I very much hope this body will respond.
I understand Senator Enzi wants to protect the reauthorization and the funding formula he authored, but I think we have to admit that the impact on some areas of the country was not anticipated. Fixing these unintended consequences does not require reopening the legislation. It can be addressed with a one-time solution that will still leave some cities with a decline in funds; that means the House solution of stop-loss.
I urge my colleagues to join me in opposing the Enzi amendment, which would strike a dastardly blow to a city that has seen too much suffering, as well as others.
I thank the chair and yield the floor.
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Mr. COBURN. Mr. President, I wish to make a couple of points.
I know this is a large step down for San Francisco EMA and a smaller step down for some of the others. But the thing that needs to be kept in mind is the amount of dollars spent per HIV patient in those areas is 2 1/2 times what the average is around the rest of the country--2 1/2 times. We spend 2 1/2 times more per HIV case in those areas than we do in North Carolina or Florida or Mississippi or Michigan or Kansas or Texas or Arizona. So what we are talking about is proportionality; giving the same opportunities to everybody who has HIV, not more opportunities.
So with the 30-percent cut, you are still going to be spending 1 1/2 to 1 3/4 times more per HIV case in San Francisco as you are in the rest of the country. So I appreciate the work of the Senator in the HIV area, which is exemplary, and I understand she would want to protect this, but it is not fair to the rest of the country. It is not fair to tell somebody that you are going to spend 2 1/2 times as much on somebody with HIV in San Francisco as you are in Dallas, TX, or Miami, FL. That is what this amendment is about--keeping the fairness that was in the Ryan White Act.
I yield the floor.
The ACTING PRESIDENT pro tempore. The Senator from California.
Mrs. FEINSTEIN. Mr. President, I don't think it is fair to take a 30-percent cut in 1 year when you have the largest number of HIV/AIDS victims in the history of the epidemic in a city that has suffered such as no other city in America. I am not saying there shouldn't be cuts. I voted for the reauthorization knowing there would be cuts. What I am talking about is the level of cuts and the way these cuts fall because they decimate programs in an area that was ground zero on AIDS in the United States.
If you are going to take cuts, take those cuts so the communities involved in fighting HIV with prevention, with education, with care, with treatment, with drugs, with all of it, can essentially meet the mandate, which is to prevent the suffering of AIDS in HIV patients and also to prevent the disease from spreading. That is not easy to do, I can tell you that firsthand.
You take a 30-percent cut in 1 year and you decimate these programs. That is why the House put the stop-loss in. Take a moderate cut, and we will stand up like men and women and we will take that cut. Take a third cut and it is much more difficult and you affect services to people. That is all I am saying.
So I would very much hope the Senate would understand the need and the compassion to defeat this amendment and, once again, I would urge a ``no'' vote.
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Mrs. FEINSTEIN. Through the Chair, Mr. President, if I may, to the distinguished Senator from Pennsylvania, first of all, it is my knowledge that the cut to San Francisco and to 11 other jurisdictions is very large. With respect to the reauthorization of Ryan White, we do not agree that it applies only to the fiscal year 2007 cuts. It takes resources, actually, from other jurisdictions. The Pelosi fix in the House ensures a significant increase for title I that would both reduce cuts to a manageable level for 11 jurisdictions and still increase for other jurisdictions. So this isn't taking money away from other jurisdictions, as I understand it. The provisions in the House bill increases funding for 42 of the remaining 45 jurisdictions under title I.
Now, I don't know the particulars, to be candid with you, of how these cuts fell, but I do know the cut received in the Bay Area was substantial. I suspect it was from the way they counted AIDS cases, and they knew they had to change the methodology. But basically the point is the cut is substantially large and means you have to cut 30 percent across the board of AIDS programs at a time when San Francisco has the largest number of HIV/AIDS cases in its history--23,000.
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