California: CARE Act Changes Could Cost San Francisco $9 Million

San Francisco officials said the city stands to lose at least $9 million in Ryan White CARE Act (RWCA) funding over five years if proposed changes announced July 27 by US Health and Human Services Secretary Mike Leavitt are congressionally approved. Leavitt announced the framework proposal before the Presidential Advisory Council on HIV/AIDS, the Health Resources and Services Administration/CDC Advisory Committee on HIV and STD Prevention and Treatment and stakeholder groups.

The Bush administration wants to end RWCA's allocation of funding based on AIDS case numbers -- which currently includes all AIDS cases over the previous decade -- arguing that cities with newer epidemics now receive disproportionately less than those facing longstanding ones. Another proposal that ends "double counting," where metropolitan cities' AIDS cases are counted once in city figures and a second time in state counts, could cost California $20 million and the city $2 million, advocates said.

Local officials and AIDS advocates said that ideas contained in the proposal were not set in stone and many lacked congressional support. In addition, lobbying efforts have already begun with congressional staff members during Congress' August recess and will increase once legislators return.

City lobbyists proposed a 21 percent reduction on "hold harmless," a provision limiting the extent of year-to-year cuts, rather than an administration proposal to immediately eliminate it entirely, said Ernest Hopkins, director of federal affairs for the San Francisco AIDS Foundation. "There is plenty of room for negotiation," Hopkins said. Lobbyists have already convinced administration officials to spread changes to the provision over RWCA's five years.

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