While we don't know the exact impact on HIV/AIDS legislation and funding, we will likely face similar, or worse, challenges on many fronts. Had John Kerry won the election, we would have been able to pursue a proactive agenda of holding him to the promises made through AIDSVote, including increased funding for care, treatment, research, prevention and housing programs; an end to the ban on HIV positive immigrants and visitors; and support for the Early Treatment for HIV Act (ETHA), which would allow states to expand their Medicaid programs to include low income HIV-positive people who aren't diagnosed with AIDS.
Instead, because President Bush did not respond to the AIDSVote questionnaire, we can only look to his record over the past four years to get a sense of what might lie ahead for HIV-related programs. That record is one of highly inadequate funding for HIV/AIDS services, including the Ryan White CARE Act and the AIDS Drug Assistance Program. The President has also not expressed support for ETHA or any other proposal that would expand access to care and treatment for people with HIV. Instead the Bush administration has actively pushed proposals to cap federal funding to Medicaid and establish block grants to states, initiatives that would certainly harm HIV-positive Medicaid beneficiaries.
There have also been major changes in the Bush Administration since the election. Several members of the Cabinet have resigned, including Health and Human Services Secretary Tommy Thompson. On December 13, President Bush named former Utah Governor Michael Leavitt as his choice to replace Thompson. In 2003, Leavitt issued a press release praising the Bush Administration's "Medicaid Modernization Proposal", which would have essentially turned Medicaid into a block grant under the guise of "flexibility."
In general, Congress has become more conservative since the election. It is also thought that the Republicans may try to increase its majority on the all important committees where most Congressional work is conducted. In the last session of Congress we saw Democrats cut out of important discussion during deliberation and crafting of legislation. There were some pieces of legislation where members barely had time to read carefully before having to place a vote. This tactic to mitigate opposition could be used more effectively with a larger majority.
There are also several new Senators who may play a role on HIV/AIDS issues. Most notably is Dr. Tom Coburn, a Republican from Oklahoma. Dr. Coburn served in the House of Representatives from 1995 until 2001, and for the last two years was co-chair of the President's Advisory Council on HIV/AIDS. While he has been highly involved with AIDS issues, many of his positions have been opposed by Project Inform and other advocates. He has been a strong advocate for abstinence education, mandatory testing, names reporting and partner notification. He has expressed his public support for the AIDS Drug Assistance Program, but proposed taking money from other programs in the Ryan White CARE Act to increase ADAP funding.
Dr. Coburn is expected to be appointed to the Senate Health Education Labor and Pensions (HELP) Committee, which will be the first group in the Senate to consider reauthorization of the Ryan White CARE Act. He was a leader in the 2000 reauthorization and will very likely play a major role in drafting legislation next year. We can expect that several challenges will arise from his participation.
Another incoming Senator to watch is Jim DeMint, a Republican from South Carolina who served three terms in the House of Representatives. He is one of a handful of Representatives who have authored letters asking for investigations into AIDS organizations that protested Secretary Thompson at the 2002 International AIDS Conference in Barcelona and is a strong proponent of abstinence education. It is not known if Senator-elect DeMint will be appointed to a committee that will deal with AIDS issues.
On the positive side, Senator-elect Richard Burr from North Carolina has signed several "Dear Colleague" letters calling for increased funding for the AIDS Drug Assistance Program. Hopefully he will be a part of a bipartisan effort to get adequate money for ADAP and other HIV/AIDS programs. In addition, incoming Senator Barack Obama, a Democrat from Illinois, was a lead sponsor of several HIV-related bills as a State Senator, and spoke out on the need for a better response (particularly on global AIDS) from the federal government.
Finally, there are some major changes regarding who will lead key Senate committees in the next few years. Senator Mike Enzi, a Republican from Wyoming, will be the new Chair of the Senate HELP Committee, which will oversee reauthorization of the Ryan White CARE Act. Senator Thad Cochran, a Republican from Mississippi, will be the new Chair of the Senate Appropriations Committee (Senator Arlen Specter from Pennsylvania will continue to chair the Senate subcommittee that first votes on funding for HIV/AIDS care, treatment, prevention and research programs).
Even though it is still unknown what specific challenges we will face with all of these changes, we do know that a lot of education and advocacy will be needed early next year. There are several new House Representatives and Senators that may not know much about federal HIV/AIDS programs and how their districts and states are affected by the epidemic. Letters, phone calls and meetings (either in the district or in Washington) will be needed so that AIDS gets on their radar screen.
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