Congress, composed of the House of Representatives and the Senate, is the legislative branch in the tripartite system of national government institutions in the United States. Although Congress was originally intended to be the chief policy-making branch of the federal government, that role has over time been assumed largely by the president and the federal bureaucracy. Nonetheless, Congress retains its lawmaking power, control over the appropriation of revenues for public policy, oversight of the federal bureaucracy, and other perquisites. The role of Congress in responding to the AIDS crisis must be placed within a broader political and institutional context; for example, during the first decade of the epidemic, the president was a conservative Republican, but Congress was controlled by comparatively liberal Democrats.
AIDS first appeared on the American political scene in 1981, a time when conservatives of the new Right were achieving great power in American politics. The growth of this new Right was epitomized by the rise of the Moral Majority, an organization rooted in religious fundamentalism and committed to grassroots mobilization of its constituency to elect conservative politicians at all levels of government. Galvanized by the election of Ronald Reagan as president and the defeat of a number of liberal Democratic senators, the Moral Majority and other new Right groups called for the ouster of members of Congress opposed to their conservative moral agenda. The new Right consistently identified homosexuality as evidence of moral degeneracy in society as a whole and AIDS as a logical extension of homosexual behavior.
The rise of the new Right was coupled with the presidential campaign and election of Reagan in 1980. When AIDS was first reported in 1981, Reagan had just assumed office and was attempting to meet the demands of the conservative agenda by slashing social programs and cutting taxes, while at the same time embracing traditional moral principles. Consequently, Reagan never even mentioned the word "AIDS" publicly until 1987, and his administration did little in terms of supporting medical research, releasing AIDS-related drugs in a timely fashion, or promoting AIDS education. For Reagan and his advisers, AIDS was not a national problem; instead, it was a series of local problems to be dealt with by states and localities rather than by the federal government.
Members of Congress calling for a sustained federal response to AIDS had to operate in this political and electoral climate. The most active members of Congress in the early years of the AIDS crisis represented districts or states with large gay constituencies. For example, in the House of Representatives, three Democrats, Barbara Boxer of San Francisco, Henry Waxman of Los Angeles, and Ted Weiss of New York, were active in calling for a committed federal government response to AIDS. But they and their supporters faced an uphill battle given both the Reagan administration's general policies of fiscal austerity and its particular hostility to even acknowledging the potential seriousness of AIDS.
From June 1981 to June 1982, the period generally considered the first twelve months of the epidemic, the Centers for Disease Control and Prevention (CDC) spent $1 million on AIDS, compared with $9 million in response to the much smaller problem of Legionnaires' disease. In late 1982, Congress allocated $2.6 million to be targeted for the CDC's AIDS research, but the Reagan administration claimed that the CDC did not need the money and opposed any congressional supplemental appropriations designed to fund federal governmental AIDS policy efforts.
In the absence of presidential leadership, Congress was forced to ascertain on its own how much money doctors working inside government needed to address the AIDS epidemic. The Reagan administration resisted these efforts but refused to exercise an on-the-record veto of supplementary AIDS funding efforts. In the crucial early years of the epidemic, when federal resources could have been profitably spent on basic research and prevention education, federal AIDS researchers relied on supplemental funding in the form of continuing resolutions initiated by Congress. Year after year, Congress significantly increased AIDS funding relative to the Reagan budgetary proposals.
Under the leadership of Weiss, who was chair of the Subcommittee on Human Resources and Intergovernmental Relations, and Waxman, who was chair of the Subcommittee on Science and Technology, Congress investigated attempts by the U.S. Public Health Service (PHS) to address AIDS in 1983. Both subcommittees held hearings and jointly requested a study of the Reagan administration's AIDS-related policy efforts by the Office of Technology Assessment. The Weiss subcommittee requested that the Government Accounting Office perform an audit of the AIDS-related activities of the CDC and the National Institutes of Health (NIH). The Weiss report highlighted AIDS funding problems in the Reagan administration and lengthy delays in research into possible AIDS-related drugs, as well as management problems in funding, coordination, and communication within the PHS. The highly public, adversarial relationship between Congress and the Reagan administration regarding governmental responses to AIDS continued throughout Reagan's two-term presidency.
One way that congressional Democrats attempted to force the administration to increase funding and other forms of support for people with HIV/AIDS was to publicly highlight the large numbers of people affected by the epidemic. This strategy helped to concretize AIDS for the public. Indeed, Reagan himself could no longer remain silent about AIDS in the face of increasing numbers of fatalities; he gave his first public AIDS speech in 1987 on the eve of the Third International AIDS Conference, amid growing congressional concern about the lack of a coherent federal response to AIDS. By 1987, congressional concern was so pervasive that the Senate, which had been much less active than the House in addressing AIDS, called for the Reagan administration to establish an AIDS commission. In response to the request of both Republican and Democratic senators, Reagan appointed what came to be known as the Watkins Commission, after its chair, in the summer of 1987.
There was, of course, considerable conservative congressional resistance to spending federal tax dollars on AIDS-related measures. For example, Republican senator Jesse Helms of North Carolina was highly critical of federal spending on AIDS education. On October 14, 1987, Helms appeared on the floor of the Senate during a debate over a federal AIDS appropriation bill to denounce a safer-sex comic book, which he thought had been federally funded, published by Gay Men's Health Crisis of New York. A subsequent investigation revealed that no federal funds were used to support the production of the comic book; nonetheless, the Senate voted overwhelmingly to pass the Helms amendment to the AIDS appropriation bill. The Helms amendment prohibited the use of federal tax dollars for AIDS education materials that "promote or encourage, directly or indirectly, homosexual activities." Since 1987, Helms continued to offer his amendment to each appropriation bill. With these amendments, Helms and his conservative supporters in Congress, notably former California Republican representatives Robert Dornan and William Dannemeyer, helped limit federal funding for safer-sex education targeting gays and lesbians.
During the last year of the Reagan presidency, Congress considered the AIDS Federal Policy Act of 1987. This was the first legislation considered by Congress that took into account the larger societal implications of the epidemic, and that went beyond mere funding of AIDS prevention, research, and treatment efforts. The legislation, passed by Congress and ultimately signed into law by President Reagan, prevented discrimination against individuals with disabilities, including those who were infected by HIV or AIDS, in certain forms of housing and employment. This legislation set the foundation for the passage of the more comprehensive Americans with Disabilities Act (ADA) in 1990, a law that protects all Americans with disabilities, including those who are infected by HIV or AIDS, from discrimination in public accommodations and the workplace. AIDS is not specifically mentioned in the law, but people with HIV/AIDS are included owing to a variety of subsequent judicial and regulatory decisions.
During the 1992 presidential campaign, candidate Bill Clinton was critical of the administration of President George Bush for supporting an immigration policy that prevented HIV-positive individuals from entering the United States. Congress had originally imposed this ban in 1987 but voted to rescind it in 1990. In May 1993, Congress reinstated the ban without a challenge from President Clinton, much to the dismay of AIDS activists and others who expected Clinton to keep his campaign promise to make immigration policy less restrictive.
In 1990, Congress passed the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, legislation that was signed into law by Bush, and that was originally designed to provide federal assistance for urban areas that were hardest hit by AIDS. Money was distributed under the Ryan White CARE Act according to formulas based on local caseloads. Conflict between President Bush and Congress characterized the funding for and the implementation of the legislation, as Bush consistently opposed funding the Ryan White CARE Act to the degree its congressional supporters requested.
With the election of Clinton and a Democrat-controlled Congress in 1992, there was considerably less conflict between Congress and the president on AIDS policy concerns. Indeed, Clinton quickly followed through on his campaign promise to increase federal funding for the Ryan White CARE Act. The reauthorization of the original legislation was introduced in 1995, and supporters claimed that because AIDS had spread to smaller cities and rural areas, the funding formula needed to be adjusted to provide these areas with much-needed federal support. The reauthorization discussion, however, took place within a more conservative Congress; Republicans swept the 1994 midterm elections and took control of both houses of Congress for the first time in four decades.
The Republican takeover of Congress meant that virtually all federal government efforts with respect to AIDS would undergo considerable scrutiny. This was especially true of the Clinton administration's policy initiatives, such as they were. But this did not stop congressional supporters of a more active federal government role in AIDS from supporting the AIDS Cure Act, which was first introduced in May 1994 and reintroduced in March 1995. If funded, the AIDS Cure Act would have cost $1.84 billion over five years. The goal of the project was to seek an effective treatment for AIDS without duplicating the research that was already being done by the major pharmaceutical companies. Underlying the legislation was a belief that the major drug companies could not be trusted to come up with timely drug treatments on their own; under the AIDS Cure Act, the research efforts of smaller drug companies would have received more federal support than ever before.
The prospects for passage of this and other federally funded AIDS legislation became even grimmer when the Republicans passed budgetary legislation that would balance the federal budget by 2002 and turn over authority for various social programs to states and localities. Many of the cuts would be borne by the Medicare and Medicaid programs, programs that had provided much-needed medical support for people with HIV/AIDS. Preserving Medicare and Medicaid funding was viewed as particularly important by AIDS activists, given the lack of funding for other AIDS-related policy initiatives that might have assisted those who could not afford the high cost of medical care. President Clinton promised an all-out fight to protect Medicare and Medicaid funding, signaling a new round of conflict with the Republican-controlled Congress.
By 1996, conflict between the president and Congress over AIDS-related policy initiatives had become the norm. Over the years, Congress has attempted to balance competing pressures, appease an array of interest groups across the ideological spectrum, and placate the general public. In doing so, Congress joins the presidency in earning its share of blame for the halting and largely ineffective federal response to AIDS.
Court Cases; Gay Rights; Health Care Reform; Housing; Immigration and Travel Restrictions; Legislation, U.S.; Politicians and Policy Makers, U.S.; Political Parties, U.S.; Presidency, U.S.; Public Assistance; State and Local Government, U.S.; United States Government Agencies; Workplace Issues
appropriations, Congress, House of Representatives, legislation, Senate, [individual legislators by name]
Foreman, C. H., Jr., Plagues, Products, and Politics: Emergent Public Health Hazards and National Policymaking, Washington, D.C.: Brookings Institution, 1994
Moen, M., The Christian Right and Congress, Tuscaloosa: University of Alabama Press, 1988
Panem, S., The AIDS Bureaucracy, Cambridge, Massachusetts: Harvard University Press, 1988
Perrow, C., and M. F. Guillen, The AIDS Disaster: The Failure of Organizations in New York and the Nation, New Haven, Connecticut: Yale University Press, 1990
Shilts, Randy, And the Band Played On: Politics, People, and the AIDS Epidemic, New York: St. Martin's, 1987
Vaid, U., Virtual Equality: The Mainstreaming of Gay and Lesbian Liberation, New York: Anchor, 1995
The Encyclopedia of AIDS: A Social, Political, Cultural, and Scientific Record of the HIV Epidemic, Raymond A. Smith, Editor. Copyright © 1998, Raymond A. Smith. Carried by permission of Fitzroy Dearborn Publishers.
Encyclopedia of AIDS $25 US/832 pp/Illustrated
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