Big States Fight Loss of AIDS Money

WASHINGTON – Lawmakers from California, New York and New Jersey on Thursday denounced proposed HIV/AIDS funding changes they say could shift tens of millions of dollars from the West and Northeast to the South.

Bush administration officials and Southern lawmakers countered that changes are needed to bring fairness to the way $2 billion is distributed each year under the 1990 Ryan White CARE Act, the main federal HIV/AIDS spending law.

"The money needs to follow the infection," Rep. Charlie Norwood, R-Ga., said at a hearing of the House Energy and Commerce health subcommittee. "No one should receive the short end of the stick because of where they live."

Investigators with the Government Accountability Office have found that some funding formulas disproportionately benefit states with urban areas, due to a quirk that double-counts AIDS patients in 51 metropolitan areas. A separate quirk that counts some dead patients overwhelmingly helps San Francisco, giving the city an extra $7 million a year.

The White House wants to eliminate both these quirks, though administration officials haven't offered details on how the changes would affect states. The Health and Human Services Department's administrator of Health Resources and Services, Elizabeth Duke, could provide few details on the administration's proposals Thursday.

Lawmakers in California and New York fear the changes could cost their states more than $20 million a year each. Republicans and Democrats on the House Energy and Commerce Committee have been negotiating with their counterparts on the Senate Health Committee to try to write a compromise bill updating the law.

Thursday's hearings showed how challenging that might be.

Several California lawmakers arrived prepared to attack GAO's findings about inequitable funding. They were armed with a report released this week by the CAEAR Coalition — Communities Advocating Emergency AIDS Relief, a group made up mostly of AIDS advocates from big cities — that analyzed spending under the Ryan White act and found a much more equitable distribution than GAO did.

"I think it's skewed," said Rep. Anna Eshoo, D-Calif. "Why are we picking on the larger cities? ... It seems to me that there's excellent funding for other states."

"The chairman's state is right in the middle here," Eshoo added, referring to Georgia, home state of health subcommittee chairman Rep. Nathan Deal.

But Deal said he thinks the status quo needs to change. "It bothers me that we are allowing a system that counts deceased individuals," he said.