Deficits vs. Austerity: Where do either leave ADAPs

Once again, Congress demonstrated that its effectiveness as a governing institution is in serious peril. Congress was unable to complete its Constitutional and Statutory duty to approve a federal budget and send it to the President for his signature. Annually, thirteen appropriation bills must be passed by Congress prior to the end of the fiscal year, which ends on September 30th. They fund those programs, projects and activities that operate within the discretionary sector of the Federal budget - including the AIDS Drug Assistance Programs (ADAPs) under the Ryan White Program. The federal government is now operating under a short-term spending authorization - otherwise known as Continuing Resolution - but it certainly leaves the fate of funding for the cash-strapped ADAPs up in the air.

Article I, Section 9, Clause 7 of the Constitution provides that "no money shall be drawn from the Treasury but in Consequence of Appropriations[.]" More accurately however, it can be characterized like making sausage.

In recent history, Congress has been forced to lump a litany of federal programs together during a messy, non-transparent legislative process...ending with an "Omnibus" spending package. Omnibus spending bills provide both opportunities and challenges for important federally-funded programs. But in the current fiscal environment, many HIV/AIDS advocates are concerned that needed funding increases will fall by the wayside.

In fact, there is already some indication that programs like ADAP could be facing even harder times. The House Appropriations Committee earlier this year released its draft fiscal year 2012 Labor, Health and Human Services (LHHS) Appropriations. The spending bill includes federal funding for programs within the Departments of Labor, Health and Human Services, Education, and other related agencies.

Upon releasing its LHHS spending bill, House Appropriations Chairman Hal Rogers said, “Many of the programs and services funded in this bill protect the health and safety of the American people and provide assistance to the most vulnerable among us. However, excessive and wasteful spending over the years has put many of the programs and agencies funded in this bill on an irresponsible and unsustainable fiscal path. To protect critical programs and services that many Americans rely on – especially in this time of fiscal crisis – the bill takes decisive action to cut duplicative, inefficient, and wasteful spending to help get these agency budgets onto sustainable financial footing.”

While most observers agree that something needs to be done about the ballooning federal deficit, it begs the question whether deficit spending or austerity measures are more harmful to the public safety net. Are the current 6,489 people living with HIV/AIDS being denied access to appropriate, timely care and treatment "duplicative" as described by Rep. Rogers since the Committee proposed no new ADAP funding?

With respect to Ryan White the draft appropriations bill reads:

"For carrying out title XXVI of the PHS Act with respect to the Ryan White HIV/AIDS program, $2,311,665,000, of which $1,980,670,000 shall remain available to the Secretary of Health and Human Services through September 30, 2014, for parts A and B of title XXVI of the PHS Act, of which not less than 25 $885,000,000 shall be for State AIDS Drug Assistance Programs under the authority of section 2616 or 311(c) of such Act: Provided, That in addition to amounts provided herein, $25,000,000 shall be available from amounts available under section 241 of the PHS Act to carry out parts A, B, C, and D of title XXVI of the PHS Act to fund Special Projects of National Significance under section 2691."

ADAPs under this scenario would be flat-funded, despite thousands of people living with HIV/AIDS languishing on waiting lists in twelve states. Carl Schmid, Deputy Executive Director of The AIDS Institute, summarized this Republican-backed approach accurately when he said, "If ever passed, this spending bill would set back the progress we are making in preventing HIV and providing basic care and treatment for those who have HIV/AIDS in our country."

According to the National Alliance of State & Territorial AIDS Directors (NASTAD) there were 6,489 individuals in 12 states on ADAP waiting lists, as of October 27, 2011 - including 44 individuals in Alabama, 3,260 individuals in Florida, 1,415 individuals in Georgia, 2 individuals in Idaho, 489 individuals in Louisiana, 11 individuals in Montana, 8 individuals in Nebraska, 78 individuals in North Carolina, 0 individuals in Ohio, 60 individuals in South Carolina, 31 individuals in Utah and 1,091 individuals in Virginia.

The House legislation would not only flat-fund ADAPs, but also cut certain prevention programs and ban federal funding of syringe exchange programs. Unfortunately, things don't look much better on the Senate side either. When the Senate Appropriations Committee passed its FY12 Labor, Health and Human Services, Education and Related Agencies Appropriations bill, it proposed only a $15 million increase for ADAPs despite the waiting list crisis. Fortunately, other HIV/AIDS-related programs were not cut in the Senate's pending version.

In the final analysis, thousands of people living with HIV/AIDS on ADAP waiting lists will be looking to the Congress...and President Obama...to address this ongoing crisis by making sound decisions on fiscal policy and public health, which aren't mutually exclusive. Whether it's deficit spending, or austerity measures steps need to be taken by the leaders in Washington, DC to enhance the AIDS Drug Assistance Programs. Period!