Statement of Christine Lubinski
Deputy Executive Director, AIDS Action Council
to the Subcommittee on Labor, Health and Human Services,
Education and Related Agencies
House Committee on Appropriations
Part 2 of 2:
The Ryan White CARE Act
The Ryan White CARE Act is the cornerstone of the federal response to the critical need for health care and care-related services for Americans living with HIV/AIDS. This program has experienced significant funding increases in recent years, yet escalating case loads and the rising cost of new drug therapies threaten the continuation of services that are already stretched thin trying to meet the needs of people living with HIV/AIDS. The CARE Act provides a wide range of comprehensive services. These include:
- emergency formula and competitive grants to those metropolitan areas most disproportionately affected by the HIV/AIDS epidemic to develop and deliver comprehensive HIV/AIDS health care services (Title I);
- formula grants to States to improve the quality, availability and organization of health care and support services, to fund the AIDS drug assistance programs, health insurance continuation and home-based care services (Title II);
- grants to existing community-based clinics and public health providers serving traditionally undeserved populations to deliver early and ongoing comprehensive HIV/AIDS primary health care services (Title IIIB); and
- grants to provide pediatric, adolescent and family HIV care programs (Title IV).
Ryan White CARE Act dollars currently fund all of these vital programs. We urge you to appropriate FY 1996 funding for the four titles of the Ryan White CARE Act for the remainder of fiscal year 1996 which reflects the President's request of $91 million in additional funding for Ryan White programs. In addition, because of the serious funding crises being experienced by a number of state ADAP programs and the urgent need to introduce many individuals dependent upon the ADAP program for drug assistance to triple combination therapy, AIDS Action respectfully requests an emergency FY 96 appropriation of an additional $75 million for the AIDS Drug Assistance Program. As you identify funding levels for FY'97, we urge you to consider the needs of all titles of the CARE Act and the growing demand for services.
Under the pending CARE Reauthorization Act, two critical AIDS training and service programs previously funded through other public health programs will be added to the CARE Act: the AIDS Education and Training Centers (AETCs) program and the HIV/AIDS Dental Reimbursement program.
The AIDS Education and Training Program (AETC)
The AETC's serve as the main vehicle for the dissemination of state of the art treatment protocols from researchers to caregivers and link HIV-infected individuals with research clinical trials. This modest program has provided training to over 400,000 health care professionals. The rapidly evolving standard of care for HIV treatment and the continuing spread of the epidemic into suburban and rural communities requires continuing support of the AETC program at the FY '95 level of $16.3 million for FY 96 to respond to education and training needs in all 50 states.
AIDS Dental Reimbursement Program
The HIV/AIDS Dental Reimbursement program is the "safety net" dental program, ensuring that dental institutions provide quality oral health care to people living with HIV/AIDS, while at the same time training dental professionals to effectively and safely deliver the appropriate dental care so critical to maintaining the overall health of people living with HIV/AIDS. At a minimum, AIDS Action urges that this program be funded at the FY '95 level of $6.937 million for FY 96.
Agency for Healthcare Policy Research (AHCPR)
The AHCPR is the lead agency coordinating research into the health policy implications of the AIDS epidemic. This year, AHCPR is conducting a new utilization study, the HIV Costs and Services Utilization Survey (HCSUS), which in addition to collecting cost and utilization data about health care services to HIV-infected persons, will also provide information on access and barriers to care in different geographical locations and among varied health care delivery systems. We are concerned that without adequate funding for AHCPR, this survey will never be completed and critical data with which to construct reliable cost-benefit analyses of HIV treatment delivery systems and interventions will be lost. We recommend funding of $11 million for AHCPR AIDS programs for FY 96.
CDC AIDS Prevention Programs
Absent a preventive vaccine, our only hope of halting further HIV transmission is through a comprehensive, targeted approach to AIDS prevention throughout the nation. Investing in prevention programs is cost effective. On average the health care costs associated with a single case of AIDS exceed $100,000 per year. In contrast, studies conducted at the University of California, San Francisco, found that the cost of interventions per case of HIV infection prevented ranges between $4,000 and $11,000. By the most conservative estimates, $1 spent on prevention saves $10 in future health care expenditures.
One of the primary accomplishments in the fight against AIDS has been the establishment of HIV Community Planning. Half of CDC's HIV prevention budget is dedicated to programs funded under the auspices of HIV Community Planning. These programs are carried out through state and local health departments in partnership with community groups, business and religious leaders and groups at risk for HIV infection. Unfortunately, these vital efforts may be impeded because of lack of funding. In FY' 95, over $87 million in proposals for new program initiatives were submitted by states and local health departments, but CDC was able to provide only $44.0 million to fund critical gaps in our nation's HIV prevention efforts. Federal funding to national minority organizations and local minority community-based organization are also critical elements of a national prevention strategy aimed at responding effectively to populations at greatest risk for HIV infection.
CDC also plays a critical national role in monitoring the course of the epidemic in partnership with state and local health departments. CDC's sophisticated surveillance system tracks the number of AIDS cases in every state, identifying the continuing spread of HIV/AIDS into new populations such as women and adolescents. If we are to bring an end to this epidemic, it is vital that we not short change efforts to track and analyze the movement of the epidemic. As the Subcommittee makes decisions about funding levels for HIV prevention in fiscal year 1997, we hope the committee will be mindful of the role HIV prevention programs at the CDC play in monitoring the movement and changing demographics of the epidemic and empowering communities to develop and implement targeted prevention programs which reflect community values and needs. Continued aggressive support for prevention programs will save lives and reduce the economic costs related to health care services and lost productivity.
Substance Abuse & Mental Health Programs
Seventy five percent of the estimated 40,000 new HIV infections in 1994 involved drug use. This reality cries out for the expansion of substance abuse treatment and prevention services, which will help reduce HIV transmission, enhance the lives of infected drug and alcohol dependent individuals and reduce health care costs associated with HIV disease. Accordingly, AIDS Action urges that the Committee adopt generous funding levels for the substance abuse block grant, SAMHSA AIDS outreach programs and funding for treatment services for pregnant women and women with dependent children for fiscal year 1996 and 1997.
SAMHSA's HIV/AIDS Mental Health Services Demonstration Program is the first federal demonstration program that specifically develops and evaluates needed mental health services for persons living with HIV/AIDS. Funded through a cooperative agreement between SAMHSA's Center for Mental Health Services (CMHS), the Health Resources and Services Administration, and the National Institutes of Health, this program has established mental health demonstration projects at ten community health centers across the nation, with a strong evaluation component linked to funding. CMHS contributed $1.5 million to initiate this project in the fall of 1994, with an additional $2.6 million contribution from NIH and HRSA. We strongly recommend that funding for this program be preserved.
We hope that you will see fit to conclude FY '96 appropriations process by honoring the President's request of $723.5 million for Ryan White funding, and $16.3 million for the AIDS Education and Training Centers; to appropriate $75 million for emergency assistance for the AIDS Drug Assistance Program (ADAP); and to fund the other critical health programs outlined here in the areas of substance abuse, mental health and health policy at sufficient funding levels.
The absence of FY 1996 funding levels for many federal AIDS programs makes it difficult to provide recommendations for FY 1997 funding levels. However, we urge the Subcommittee to keep the growing needs and opportunities documented in the testimony in mind as it begins its deliberations about FY 97 funding. AIDS Action will provide the Committee with additional recommendations about FY 97 funding for AIDS programs in the FY 1997 Labor-HHS- Education appropriations bill after a baseline for FY 1996 is in place and the Administration's FY 1997 line item budget request is released.
Thank you for affording AIDS Action Council the opportunity to testify about funding issues for AIDS-related programs in the FY 96 and FY 97 budgets under the jurisdiction of the committee.
For more information, contact
AIDS Action Council
1875 Connecticut Avenue NW #700
Washington DC 20009