Californians cannot allow proposed changes to the funding calculations under the Ryan White CARE Act to be implemented because they "could mean an enormous loss for California's AIDS patients," according to a San Francisco Chronicle editorial (San Francisco Chronicle, 4/26). Sen. Tom Coburn (R-Okla.) last month introduced a bill (SB 2339) that would reauthorize and amend the act, which expired on Sept. 30, 2005. Coburn's bill would create new funding formulas that would take into account HIV prevalence, require that 75% of CARE funding is spent on primary care, require that facilities that receive federal funding conduct mandatory HIV testing and increase annual funding for AIDS Drug Assistance Programs -- federal- and state-funded programs that provide HIV/AIDS-related medications to low-income, uninsured and underinsured HIV-positive individuals. Under the current law, areas with large numbers of HIV/AIDS patients receive more funding (Kaiser Daily HIV/AIDS Report, 3/9). Some opponents of the current funding formula want to reduce the importance of "eligible metropolitan areas" because of a 2005 Government Accountability Office report that says states without eligible metropolitan areas are underfunded because states with eligible metropolitan areas can "double-count" HIV-positive people, the editorial says. However, according to a new analysis of the CARE Act by the not-for-profit organization Communities Advocating Emergency AIDS Relief, California is underfunded compared with the national average when all funding factors are taken into account, and changing the funding formula would cut at least $20 million in funding for the state, the editorial says. In addition, California has the third highest number of people living with AIDS nationwide, so "[t]he need here has not declined," according to the editorial. To help rural states cover "far-flung" patients without jeopardizing care in California, the "only amendment that's fair to all" is a National Alliance of State and Territorial AIDS Directors proposal to direct the $70 million in CARE funds for AIDS-related drugs authorized by the White House to states without eligible metropolitan areas, the editorial says (San Francisco Chronicle, 4/26).

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