'Down Time' for Congress Is Prime Time To Meet with Legislators at Home

As Congress begins its August recess, many of the federal issues vital to the AIDS community remain unresolved. When members return to Capitol Hill after Labor Day (Senate returns Sept. 2; House, Sept. 3), they will be debating and voting on legislation that would provide funding for federal AIDS programs in 1998, reform the Food and Drug Administration, and repeal a program that could cut the cost of AIDS drugs to agencies in your state. It is crucial that AIDS advocates take advantage of the recess period to act on these issues, especially to meet with legislators while they are in their home states and district offices.

Schedule meetings now with your representatives and senators to tell them how the decisions they make when they return to Washington will affect the communities they represent (Senate switchboard: (202) 224-3121; House switchboard: (202) 225-3121). They need your input -- don't let them leave home without it.

Appropriations

Labor, Health and Human Services, and Education (Labor/HHS) appropriations bills for FY98 -- which provide funding for HIV/AIDS prevention, care, training, and research -- have been passed by the appropriate committees in both the House and Senate. Consideration by the full House and full Senate of these bills will begin after the August recess. [Republican leaders originally intended to bring the House bill to the floor for debate before the 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. The Senate was not scheduled to begin consideration of the bill until after the recess.]

Both the House and Senate Labor/HHS appropriations bills maintain the increases for AIDS programs that were passed by their respective subcommittees (see AIDS Action Network Alert dated July 24), but they differ in how increases are distributed between programs. In addition to keeping careful watch over full House and Senate action on these bills, AIDS Action is concerned that there may be negative, hostile amendments offered on the House floor (during full House debate of the bill), including attacks on needle exchange, attempts to transfer AIDS funding to other accounts, or other HIV/AIDS-related amendments.

AIDS ACTION:

Urge legislators to:

1. fund all AIDS programs at the highest possible levels
2. keep negative amendments off of the FY '98 Labor/HHS appropriations bills

FDA "Reform"

Thanks to the work of AIDS advocates and other patient and consumer representatives, the Senate has delayed action on the Food and Drug Administration Modernization and Accountability Act of 1997 (S. 830) until after the August recess. In addition to the already alarming provisions included in this legislation (reported last in AIDS Action Network Alert dated July 18), an amendment may be offered to allow drug companies to actively promote off-label uses of FDA-approved drugs.

Off-label uses occur when doctors prescribe an FDA-approved drug for a medical use or condition for which the drug has not been fully tested and FDA-approved. Although it is legal for doctors to make determinations, in consultation with patients, about treatments involving such off-label uses, it is not legal for drug companies to aggressively market uses of their drugs which have not undergone FDA scrutiny and approval and for which additional research has not been done.

How does this affect people living with HIV?

1. Treatments that include protease inhibitors in combination with other anti-HIV therapies constitute off-label use.
2. There still remain many questions about the applications of these drug therapies (e.g., the right combinations for different populations, the long-term effects of each combination, etc.). Learning how these toxic drugs interact with one another is important in order to use them appropriately.
3. If drug companies are allowed to promote new uses of their drugs without applying for approval of these uses, there will be no incentive for them to conduct the research needed to answer these important questions.

Negotiations on the FDA reform bill have continued since the Senate Labor Committee voted on it in June. However, AIDS Action and other patient and consumer advocates have not been allowed input into the review of these provisions nor to see what changes have been made to them. It is important that patient and consumer groups have the opportunity to comment on the final version of this bill before it comes to the Senate floor in September.

AIDS ACTION:

Tell your senators that:

1. FDA reform presents serious implications for people living with HIV/AIDS
2. the voices of patients and consumers must be heard in the reform process

Federal Acquisitions Streamlining Act

The House Appropriations Committee approved, on July 31, the Treasury, Postal Service, and General Government FY98 appropriations bill, which includes language to repeal the Federal Acquisition Streamlining Act (FASA). The repeal provision, initiated by Rep. Anne Northup's (R-KY), ensures that public hospitals, state and local health departments, and state AIDS Drug Assistance Programs (ADAPs) will not have access to discounts on much-needed HIV/AIDS drugs. Compromise language, offered by Rep. Carrie Meek (D-FL), that would have exempted pharmaceutical drugs for life-threatening conditions -- including HIV/AIDS -- from the FASA repeal was defeated. (For more information, see AIDS Action Network Alert dated July 11.)

The appropriations bill will be considered by the full House when Congress returns from recess. The full Senate has already passed their version of this bill, which also contains the repeal provision.

Congress and the Clinton administration worked out a compromise in the supplemental appropriations bill in June imposing a moratorium on implementation of FASA through the end of this session of Congress. This moratorium was enacted in the hope that hearings on FASA could be held over the course of the summer. These hearings were never held, however, as industries - including pharmaceutical companies - that would be affected by FASA have moved aggressively and, so far, successfully to have the program repealed. The Veterans Administration and veteran groups are also working for FASA's repeal, claiming that the discount prices that are already enjoyed by their programs will suffer if FASA offers increased discounts for AIDS drugs.

AIDS ACTION:

Contact the following key players, urging them to support legislation that would allow HIV/AIDS drugs to be moved to the federal schedule of drugs offered to agencies at a discount:

1. Your House representatives
2. Potential members of the conference committee that will work out compromises between the House and Senate bills: Sens. Ben Nighthorse Campbell (R-CO) and Herb Kohl (D-WI); and Reps. Jim Kolbe (R-AZ) and Steny Hoyer (D-MD)
3. The White House (comment line): (202) 456-1111

MAKE A CALL! SCHEDULE A MEETING! Protect programs and funding that are vital to the lives of Americans living with HIV/AIDS.

[For additional information, and to let us know how your legislators respond, please contact AIDS Action's network correspondent, Kurt Schade, at (202) 986-1300, ext. 3060.]

Recess Alert Bonus: Budget Agreement Update

President Clinton has now signed into law a budget package that will balance the federal budget within the 5-year life of the legislation. 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:

1. allowing states to force Medicaid beneficiaries into Medicaid managed care programs without federal oversight;
2. restricting the ability of Medicare beneficiaries to leave Medicare managed care programs to return to fee-for-service plans; and
3. significantly reducing payments to hospitals that provide uncompensated care to indigent and Medicaid clients.

One provision of the bill does, however, help 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.

For more information, contact: AIDS Action Council
Kurt Schade, Network Correspondent
1875 Connecticut Ave., Suite 700
Washington, DC 20009
phone:(202) 986-1300, ext. 3060
fax: (202) 986-1345
e-mail: network@aidsaction.org