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Congress Begins Recess: Funding for AIDS Programs Hangs in the Balance

Members of Congress return to their home states today to begin a month-long recess, leaving, yet unfinished, full floor action on both House and Senate FY98 Labor, Health and Human Services and Education (Labor/HHS) appropriations bills, which provide funding for AIDS prevention, care, training, and research. Republican leaders originally intended to bring the House bill to the floor for debate before recess. They postponed consideration of the bill, however, when it became apparent that a group of conservative members would offer a slew of amendments, stalling the bill or even making it completely unacceptable to enough Democrat and moderate Republican members that it might not pass.

AIDS Action is extremely concerned that this situation might hold hostage federal funding that is desperately needed. The House Labor/HHS appropriations bill contains increases for all AIDS programs including the Ryan White CARE Act and the AIDS Drug Assistance Program (ADAP), which are the medical care and prescription drug lifelines for un- or under-insured people living with HIV/AIDS.

The House will debate and vote on the bill in September when the Senate will also consider its version of the FY98 Labor/HHS bill. While both House and Senate versions of the bill provide increases in AIDS-related funding, they differ in how increases are distributed between programs.

Anxious that these bills be passed quickly and in the best interests of people living with, and at risk for contracting, HIV/AIDS, AIDS Action will be working during the August recess to keep hostile amendments from being added to the House Labor/HHS appropriations bill, while urging both House and Senate members to provide the highest possible funding for all AIDS programs.

FDA "Reform" Delayed in Senate

Unable to reach a final agreement, the Senate delayed taking action on the Food and Drug Modernization and Accountability Act of 1997 (S. 830) until members return from the August recess. AIDS Action and other national patient and consumer groups continue to be concerned that the bill will weaken the authority of the Food and Drug Administration (FDA) to ensure that products made available to the American public are safe and effective. Proposals in the bill would lower the current "gold standard" for new drug approvals, remove important safeguards for patients taking medications for serious and life-threatening conditions, and allow drug companies to market their products based solely on economic criteria. Reauthorization of the Prescription Drug User Fee Act (PDUFA) also remains threatened, having been tied to these other contentious "reform" provisions.

The Senate bill would also allow drug companies to actively promote off-label uses of FDA-approved drugs. Off-label uses occur when physicians prescribe an FDA-approved drug for a medical use or condition for which the drug has not been fully tested and FDA-approved. Off-label marketing undermines FDA scrutiny of new drugs and their medical applications, and removes important incentives for companies to conduct additional research into new drug uses. Such a disincentive is particularly threatening for people living with HIV/AIDS, as there remain many questions about the applications of protease inhibitors and the different combination therapies that involve them.

House Committee Repeals FASA,
Denies Savings in Purchase of Life-Saving Drugs

The House Appropriations Committee completed action on the Treasury, Postal Service, and General Government appropriations bill, which included language to repeal the Federal Acquisition Streamlining Act (FASA). FASA authorizes state and local agencies to purchase products and services at reduced prices that are currently available only to federal agencies. AIDS Action has been working to save this program, because it could allow public hospitals, state and local health departments, and state AIDS Drug Assistance Programs (ADAPs) to take advantage of discounts on some prescription drugs, potentially allowing agencies purchasing AIDS medications to save between 31 percent and 62 percent.

As the appropriations bill will not be considered by the full House of Representatives until Congress reconvenes after the Labor Day weekend, there remains a slim opportunity to remove the FASA repeal language. The Senate version of the appropriations bill also contains a provision repealing the FASA program.

Budget Agreement Cuts Health Care Funding, Consumer Options

Congress and the Clinton administration settled this week on a budget package that will balance the federal budget within the 5-year life of the agreement. The plan not only reduces funding for important health and social programs, but cuts federal tax revenue by $91 billion in the next five years, diminishing the resources available for health and social spending and hindering the ability of federal and state agencies to respond to changing public health needs. Many programs vital to people living with HIV/AIDS, including Medicaid, Medicare, and Social Security Income (SSI), are affected by the agreement. Significantly, the balanced budget deal will cut 16% in total discretionary spending for health programs. Medicaid spending will be cut by $13.6 billion; Medicare will be reduced by $115 billion.

Advocates had also been concerned that the balanced budget agreement would, in addition to cutting funding for health and social services, mandate a massive restructuring of Medicaid and Medicare, thereby restricting eligibility for, access to, and quality of, health care for people living with HIV/AIDS and other vulnerable Americans. Although such an overhaul did not occur, there do remain some provisions that constitute net losses for Medicaid and Medicare beneficiaries, such as:

• allowing states to force Medicaid beneficiaries into Medicaid managed care programs without federal oversight;

• restricting the ability of Medicare beneficiaries to leave Medicare managed care programs to return to fee-for-service plans; and

• significantly reducing payments to hospitals that provide uncompensated care to indigent and Medicaid clients.

AIDS Action does, however, welcome a provision that might mitigate some of the negative effects of last year's welfare reform legislation by restoring SSI eligibility -- which is also a requirement to qualify for Medicaid health care coverage -- to legal immigrants who were in the country as of August 22, 1996. Also, a new tax on cigarettes (10 cents per pack) will fund a $24 billion, five-year plan to expand health coverage to 5 million of the estimated 10 million uninsured children.

AIDS Action: The National Voice on AIDS
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(202) 986-1300
www.aidsaction.org