A revised formula for the Ryan White CARE Act is expected to be unveiled in the House in the next week, one year after the act that provides more than $2 billion in federal funding for people living with HIV/AIDS expired. Renewal of Ryan White has been hampered by political infighting and bureaucratic procedures. Revisions to the act will likely see money distributed based on a state's total number of HIV cases, not just AIDS cases. Activists fear such a change, combined with the act's flat funding, could take money away from states and cities that have had longtime epidemics. "A certain amount of redistribution has to be done," said Edward Hopkins, director of federal affairs for the San Francisco AIDS Foundation. "But it can't be done in a way that dismantles the systems of care that already exist." Some legislators were aiming to pass the act by the end of the month, said Hopkins. Critics worry the revised formula will benefit rural regions at the expense of metropolitan areas. The new plan is widely expected to be a reworked version of a Senate plan offered earlier this year by Tom Coburn (R-Okla.). Hillary Clinton (D-N.Y.) in May cast the lone dissenting vote to approve that version in the Senate Committee on Health, Education, Labor and Pensions, arguing her state could lose $20 million under the proposed revisions. Dr. Patricia Hawkins, associate director for policy and external affairs at the Whitman-Walker Clinic in Washington, D.C., said the House plan includes a "hold harmless provision" to limit jurisdictions from losing more than 10 percent of their previous allocation. "That might protect us to some degree," she said. "But the next year, you lose more money, and the next year you lose more money, and so on," she suggested. Activists agree that what is needed is increased funding for the act. While current Ryan White allocations may appear impressive, said AIDS Action Council Executive Director Rebecca Haag, they remain insufficient. "The reality is that we need additional funding to meet that unmet need."
And so it goes. Every time the Ryan White CARE Act comes up for reauthorization, there is a battle over the funding formula. In one of the most unseemly legislative battles one can imagine, people who care for people are forced to fight each other so that they can continue to take care of the people that they care for. Notice that I didn't say "take better care" of those people, just "continue to take care" of them.
The issue is not really whether the Title I cities are getting too much money or the Title II areas getting too little. It's whether Congress ever really wanted to care for those same people and provide the funding necessary to do so. Twenty-five years ago, people really did die on the streets of America--from AIDS. For all of the commitment that Congress has shown these past five years to preventing that from recurring, we may see it again.