Omnibus Appropriations Act, 2009

Floor Speech

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Mr. ENZI. Madam President, I rise to discuss amendment 668. This amendment relates to the Ryan White Program. We reauthorized that program 3 years ago. We did it on a very bipartisan basis. I need to expose how one person has once again overruled a bipartisan, bicameral effort to create fair and equitable funding mechanisms for the program. I did this last year. It was funneling money specifically to one area that had less people. The idea behind the bill was to make sure we had money for the people with HIV/AIDS, and the money is supposed to follow the people. Why do I bring this up? I was involved in the original reauthorization. We will be doing that reauthorization later this year. I can tell Members that Wyoming is not affected one way or the other by my amendment. But 46 States are affected by this amendment; 46 States are affected adversely if this amendment does not pass.

If anybody wonders which States those are, I am more than happy to tell them who the losers will be. And it will probably be a lot easier to say who the winners would be. I will get to that in a little bit.

The Ryan White CARE Act provides funding to States across this country to provide HIV/AIDS treatment, care, and prevention to individuals in need. In 2006, the committee reauthorized the program and established new bipartisan, bicameral funding formulas that provided more equity in the program. It required funding determinations to be made based on the number of people with HIV and AIDS. This is a major distinction.

Before 2006, funding was only based on AIDS cases. The Omnibus Appropriations Act includes a provision that will modify and dramatically change these bipartisan funding formulas. It allows larger cities to receive more Ryan White funding simply because they received more money in the past. The cities that had a high number of people with AIDS before 2006 will benefit, and those that have seen an increase in HIV and AIDS since 2006 will not be awarded the funding they need. Sadly, larger cities, most notably San Francisco, will receive more money than other cities for all the wrong reasons.

Unfortunately, this is not new language. We have seen it in the appropriations bills in the past. We know exactly what the language does. It primarily benefits San Francisco--a city that continues to receive funding to care for people who are deceased. All the while, nearly every other city would have reduced funding so San Francisco can receive more riches.

According to data put together by GAO--these are not my numbers; these are GAO's numbers, provided last Friday--so according to data put out by the Government Accountability Office, the language in the bill will ensure an additional $6.7 million will be awarded to San Francisco, while the other large cities will see a decrease in funding. I do not know why they did not ask to print $7 million more and put it in there instead of taking it from other people. That is kind of what we are doing these days.

That additional funding is not based on the number of people they are treating or how many new cases they have. As a hold-harmless provision, it is related to what that city has received before. Let me expand on that. If your city's problem is increasing, under the omnibus, you will get less money. You will be penalized if your city's HIV/AIDS problem is increasing. Now, if your city's problem is decreasing, according to the omnibus, you will get more money. If we are giving cities with more people with HIV/AIDS less funding, and cities with less people with HIV/AIDS more funding, how fair is that?

What is even more egregious is that after being exposed more than a year ago, someone has the audacity to include the language again. Of course, that may be because in conference they were able to get that pulled out and it happened anyway, even after a very substantial vote on this side of the building.

Our bipartisan reauthorization was based on a pretty simple idea: The
money should follow the patients. We modernized funding formulas in order to fight this deadly disease on its new front lines. More people in rural areas and the South, more women, and more African Americans are being infected with HIV/AIDS every day, and we made sure these populations could get the treatment they needed. It was a bipartisan, bicameral agreement. We were very clear about the implications of those new formula changes. In fact, we provided GAO reports with estimates on how the new formulas would change funding levels for grantees that were nearly identical to how the funding would be distributed today--but because of the language in the appropriations bill, it has not. Yes, that is how we did this vote last year, which, again, I repeat, Wyoming had no gain or loss in. We are not even involved in this issue. I have been involved in this issue trying to take care of HIV/AIDS patients. My amendment was taken out so the language can continue, and it is very unfair. It is unfair to the people in rural areas and the South, where more women, more African Americans are being infected with HIV/AIDS every day. We made sure treatment could be gotten. It passed this body. It passed the House. We agreed to these formulas. We were clear about the implications of the new formula changes. As I have mentioned, the GAO reports are practically the same this time as they were a year ago.

Those funding formulas included hold-harmless provisions to ensure that the formula funding would not decrease by more than 5 percent for anybody. Now, when we did that, I think we all thought that was going to be 5 percent for each of 3 years. As it turned out, it was a total of a 5-percent decrease over the 3 years for anybody. I would have preferred no hold-harmless provisions or ones that allowed for more dramatic fluctuations so the money could follow the HIV-infected person, but that was what we agreed on. That is the agreement we reached in this bipartisan, bicameral bill.

We did not pull the wool over anyone's eyes. We provided clear information about the implications of those funding formulas. We found the third way. Now, with one simple pen stroke, someone is again undoing all those carefully crafted bipartisan, bicameral compromises by inserting another hold-harmless provision with little thought to how this change would affect others. Last year we had the list of people, and we have that again, of who gains and who loses, and it was an easy vote to win.

This change does not allow money to follow the patient. It allows money to follow those who are in power. We want to change that with this amendment.

I do not know about you, but I find this reprehensible. This is simply unfair to those cities and States that are struggling to come up with the moneys for basic HIV/AIDS treatments. What is worse, the majority--well, what is worse is that this bill continues to cheat others. Not just once, not twice, but this would be the third year that San Francisco will have benefited from this language.

In 2007, I brought up this exact issue. A very strong majority of the Senate agreed with me. Unfortunately, it did not change. They are still willing to try to institute an unfair and unjust formula. I object to that provision and the implications of it.

We changed the formula to have money follow the problem. In 2007, we passed my amendment to focus the funding on people living with HIV/AIDS. Most of the people in this Chamber voted with me. Of the ones who are still here, it is a vast majority.

Now, I understand that after passing it with those kinds of numbers, it was dropped in conference. I understand that will probably happen this year too. But I do think we need to send the message and hope for fairness. Without this amendment, there will be no fairness.

You realize that--last year--only a couple of States have a city that is helped. Most of you will be contributing money from your cities to help those with declining problems. Where I come from that is called cheating. So if you wonder if your State gains or loses, check with me.

The amendment I am offering is simple. It states that the language in the omnibus bill will not change the funding formulas we agreed to in a bipartisan, bicameral process in 2006. If you support an equitable system that distributes funding on the true basis of need, I believe you should support my amendment.

Madam President, I ask unanimous consent that a letter from GAO to me dated March 6, 2009, and relevant material be printed in the Record.

There being no objection, the material was ordered to be printed in the RECORD

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Mr. ENZI. Mr. President, this amendment is an issue of the fairness of HIV/AIDS funding on which most of my colleagues who were here last year voted with me. With just those votes again, my amendment would be adopted.

When we passed the last reauthorization of Ryan White 3 years ago, we changed the formula to follow the HIV/AIDS patients. We did not just keep increasing the amounts the cities got. The amount had to relate to HIV or AIDS patients who were still living. We even put in a hold harmless clause so no one would lose more than 5 percent over the 3-year period. The reauthorization passed unanimously with the House agreeing with our changes.

This amendment does not affect Wyoming, but I am sensitive as chairman of the committee when we passed the reauthorization. The omnibus has a provision which, according to the GAO, only four States gain money. Of the $10 million being redistributed, San Francisco gets $6.7 million. New York, New Jersey, Connecticut, and California are the only States that gain. This is redistributed money, which means it is not new money. This is money being taken from those with an increasing problem to pay for those with a decreasing problem.

This language is an attempt to change a formula for which most of my colleagues voted. I ask my colleagues to vote for the amendment.

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