Is the RWCA dead?

By: 

Eddie Hamilton

Director

ADAP Educational Initiative

There has been a lot of chatter and disputes in the HIV/AIDS advocacy world regarding the Ryan White Program Care Act (RWCA) expiration on September 30, 2013. Granted, there are numerous valid arguments for and against Ryan White Program RWCA reauthorization and for reprioritization. There are inherent dangers by acting now and also waiting until 2015 until the numerous impacts of the ACA are known. With the ACA enrollment issues, it may be even longer than 2015 before all of the impacts are fully understood.

However, I truly believe that there are two bigger and dangerous elephants in the room that needs to be addressed by all nationwide advocacy groups.

The first is sequestration where organizations are already feeling tremendous negative impacts in service delivery and those impacts will only get worse. There is not much being said publically about Sequestration 2.0.

The second and more immediate issue is a much bigger problem. Upon further research from credible government sources, I have found that it is very possible that the Ryan White Program no longer legally exists due to sloppy appropriations writing and Washington gridlock.

Many HIV/ AIDS organizations are relying on the argument that “Even though there is not a 'sunset' provision, the RWCA program is just fine because there is money being appropriated for the program.”

I had to question that argument because it was too easy of an answer to such an important question.

Question: Is the RWCA dead? Short Answer: In other words, Maybe no but most likely so.

Long Answer: There are a few different sources of information regarding “Unauthorized Appropriations” primarily from the U. S. Government Accountability Office (GAO).  An “Unauthorized Appropriation” is where Congress has allocated money for a program whose primary authorization has since expired that could be subject to a point of order within either chamber that could possibly kill the bill.

In this toxic political atmosphere, anything can happen as it only takes one representative from either chamber to raise a point of order. In the case of the Ryan White program, the authorization had expired on 9/30/2013. The Program has already hit the list for Unauthorized Appropriations.

An authorization bill is known as an enabling statute or a program’s “organic’ authority that articulates a program parameters and an agencies’ mission within in a program. In usual course, no funds can be expended until an actual separate dedicated appropriation authority with specific language directing programs goals and requirements has been initiated.

However, when an appropriations authorization has expired, the language within a continuing resolution or appropriations bill is critical when making the determination of whether the appropriation has the force of a continuing reauthorization of its’ “organic “ authority.

In other words, unless an appropriations bill contains the explicit language reauthorizing the Ryan White Program, the “organic” authority laying out the priorities is still expired and therefore, dead. A catch-all sloppy appropriation to an agency (i.e. HRSA) on January 13th (the new appropriation date) is and will be insufficient without the adequate instructions for the Ryan White Program because there is no valid authorization on the books. The last CR that was passed to stop the shutdown does not explicitly lay out any new authority for the RWCA.

Therefore, in my opinion, the RWCA is legally dead!

Do we have a Plan B in the event the states cannot issue new operating rules (based on ACA or Medicaid expansion) based on the fact that the RWCA is dead?

I also argue at a bare minimum that the any state law and rules, Request for Proposals, bids and contracts constructed and awarded listing the RWCA 2009 as their source of authority, immediately become inoperative when the entity spends the last dollar authorized in their budgets (prior to 9/30/2013) for FY 2013 because they refer to RWCA 2009 as their source of authority. Rebate monies will not count towards this authority as this money comes from the pharmaceutical companies and not the Federal Government.

As a result, I would highly encourage that the entire HIV advocacy community do some appropriate research before coming out with blanket statements on such a vital program.

Various national HIV advocacy groups who are making assumptions that the status quo will be maintained are not viable options. It is imperative that both of these issues be addressed as our lives depend on it!   Hollow words of advocacy no longer cut it anymore.

References:

• GAO-04-2618P Principles of Appropriations Law, U.S. Government Accountability Office (2004), p.69-71, http://www.gao.gov/assets/210/202437.pdf
• CBO Testimony (Douglas Holtz Eakin) , Unauthorized Resolutions and Senate Resolution 173, Congressional Budget Office, http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/44xx/doc4400/07-09-uaea.pdf
• GAO-06-382SP Principles of Appropriations Law, U.S. Government Accountability Office (2006), p.32-36, http://www.gao.gov/assets/210/202819.pdf
• Unauthorized Appropriations and Expiring Resolutions, Congressional Budget Office (Jan. 15, 2013) Page 24.
• Analysis H. R. 2775 Continuing Resolution for 2014, http://www.gop.gov/bill/113/1/hr2775-senateamendment

Survey Reveals Sequestration Impacting AIDS Care while Number of Patients Increase

By: 
Carl Schmid
Deputy Executive Director
The AIDS Institute

A survey conducted by The AIDS Institute found that HIV care in the United States is suffering as a result of sequestration and cuts in the Budget Control Act, while the number of AIDS patients is increasing. One hundred and thirty-one AIDS organizations in 29 states and the District of Columbia took the survey on the impact of these cuts, and the findings were troublesome.

In the last year, domestic HIV/AIDS programs have been cut nearly $380 million. As a result of these and other cuts 85% of the organizations surveyed experienced funding reductions. At the same time, 79% experienced an increase in clients.

As a result of cuts, 52% of survey respondents who detailed the impact of their lost funding indicated they have had to reduce staff, while 38% had to cut prevention education programs, and 22% cut back on HIV testing.  At least one organization had to close down completely.

Staff reductions impacted case management, administrative and clinical staff the hardest, and researchers, educators, and peer advocates were also cut from organizations. The majority of responding organizations had to lay off three to five staff members due to these cuts.

According to survey respondents, the funding reductions have resulted in cuts to patient services, including longer times between appointments and increased wait times at the clinic.  Some have even stopped seeing certain patients.

During the same period , the number of clients was increasing. The average increase in clients since January 1, 2012 was 18% according to surveyed organizations, compared to the average reported reduction in funding of 17%.

This survey demonstrates that the severe cuts enacted by the Budget Control Act are having real, negative consequences on HIV/AIDS organizations and their patients across the nation.  These budget cuts, coupled with an increasing number of HIV patients, have impacted their ability to provide timely, quality care and prevent future HIV infections.  If these cuts continue, they will certainly lead to increased infections, more deaths, and higher healthcare costs.

At a time when we know how to reduce an infectious disease such as HIV through prevention and treatment, and we have a National HIV/AIDS Strategy grounded in science, now is not the time to reverse the substantial progress that has been made.

There are nearly 50,000 new infections each year in the U.S. and only one third of the nearly 1.2 million people with HIV in the US have been prescribed antiretroviral treatment.

We have a long way to go before we can realize the dream of an AIDS-free generation.  We urge the Congress and the President to reverse the cuts caused by sequestration and adequately fund critical public health programs, including those that prevent HIV and provide for care and treatment for people living with HIV.

Negotiations going on right now in the Congress on the budget will directly impact if these cuts continue in the future.  The AIDS Institute hopes that these survey results, which have been forwarded to all members of congress, will help convince budget conferees that these cuts to domestic HIV programs must end.

The full survey results can be found at: http://bit.ly/1hwV52p.