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Volume 34
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AIDS flatlines again in Bush budget plan
AIDS flatlines again in Bush budget plan
Kai Wright, Black AIDS Insitute

A host of domestic AIDS programs would be cut or kept at level funding for the sixth year in a row under a fiscal year 2007 budget proposal that the White House submitted to Congress earlier this month.

President Bush's Feb. 6 budget plan would increase overall domestic AIDS spending by $188 million, but it would leave at current funding levels almost all programs under the Ryan White CARE Act, which is the primary federal vehicle for funding AIDS services. If passed by Congress in the fall, those programs would enter 2007 operating at 2002 funding levels. The National Institutes of Health's AIDS research budget would be chopped by $15 million.

The proposal comes at a time when the U.S. Centers for Disease Control and Prevention has announced that more Americans are living with HIV and AIDS than at any previous time, with an estimated 40,000 new infections occurring each year.

Bush's budget plan would also draw down federal Medicaid spending by $14 billion over the next five years and nearly $35 billion over a decade. Medicare spending would be cut by almost $36 billion over five years and $105 billion over a decade.

Those cuts would come on top of reductions already scheduled for this fiscal year. On Feb. 8, Bush signed into law a budget for the current fiscal year that will cut Medicaid spending by $4.9 billion over five years and $26.5 billion over 10 years, largely by clearing states to charge far greater co-pays than previously allowed.

Medicaid is the nation's largest payer for AIDS treatment, and two-thirds of African Americans getting treated for HIV/AIDS pay for it with Medicaid or Medicare.

In all, Bush's $2.77 trillion budget would eliminate or cut 141 government programs, while spending a record-high $439 billion on defense. That defense budget, however, does not include costs for conflicts in Afghanistan or Iraq, which the administration funds through bills submitted to Congress outside of the normal budgeting process.

"My administration has focused the nation's resources on our highest priority," President Bush said in a statement releasing the budget plan, "protecting our citizens and our homeland."

POLITICAL WINDS

Meanwhile, the 2007 budget proposal would make permanent a suite of tax cuts the White House shepherded through Congress during the Bush administration's first term. That move would cost government $1.4 trillion in revenues over the next 10 years. When originally passed, the tax rebates were discussed as temporary cash-infusions to stimulate a sluggish economy.

The budget plan puts Republican lawmakers in a difficult position, forcing them to choose between approving deep cuts to popular domestic programs in an election year and bucking a President they have staunchly supported.

Pennsylvania Sen. Arlen Specter, the GOP chair of the Labor-HHS Appropriations Subcommittee, called the suggested healthcare cuts "scandalous" in Congressional hearings that have already turned contentious. Specter is among the most outspoken of a group of Republican moderates who are expected to be uneasy with the cuts, and he has said the Bush plan will "require substantial modifications by Congress."

But the White House and its backers on Capitol Hill have vowed to push their budget priorities through despite the election-year complications.

MEDICAID MANEUVERS

The President's proposed healthcare cuts are likely to draw the most sustained controversy.

Both state and federal budgets have been straining under Medicaid's costs for several years, and policymakers on both sides of the aisle and at all levels of government are searching for ways to control its growth. The Bush administration has pushed a plan that would turn the program into a "block grant," giving states a fixed sum of money to spend each year and leaving them to cover whatever costs go above that mark. In return, the administration would drastically loosen rules that govern how states provide benefits and structure their programs.

Governors and legislators alike have balked at that idea, saying it would stick the states with the bill for America's healthcare safety net. But the administration has still managed to advance its vision by degrees through annual reductions in the federal contribution to Medicaid.

In this year's budget proposal, the White House has broadened that strategy, according to an analysis conducted by the liberal Center on Budget and Policy Priorities (CBPP). Congress rejected a number of the administration's suggestions during last year's heated Medicaid reform debate. So this year, the CBPP analysis notes, Bush's budget plan introduces many of those same ideas as regulatory changes that do not require Congressional approval.

According to CBPP, $30.4 billion of the $35.5 billion in 10-year cuts Bush proposes would be accomplished through regulatory changes not requiring Congress' sign-off; 98% of the savings achieved would come from directly shifting those costs to the states.

But CBPP and other observers warn that as states become ever-more burdened by Medicaid's costs, they'll be left with no choice but to make drastic cuts to services, such as limiting what drugs are available, restricting who qualifies for coverage, and increasing costs to beneficiaries.

RYAN WHITE DETAILS

The President's budget does propose $188 million in new money for all domestic HIV/AIDS programs.

Of that money, $93 million would be directed to the U.S. Centers for Disease Control and Prevention for new efforts at getting people tested for HIV, particularly in high-risk populations and working through faith-based organizations.

The rest of the new money, $95 million, would go into Ryan White, which would be budgeted at $2.1 billion altogether. The vast majority of the new Ryan White money, $70 million, would go to reducing existing waiting lists for the AIDS Drug Assistance Program, or ADAP.

ADAP is a joint state-federal program that subsidizes AIDS medications for people who don't qualify for Medicaid but cannot afford private insurance. For years, ADAPs around the country have been plagued by annual budget troubles. Those in the South have had a particularly hard time meeting the demand.

As a result of these financial troubles, a number of states have developed waiting lists for people to get medication. As of Jan. 18, 954 people in 10 states were on such lists. Another 16 states had either set up other cost containment measures or expected to do so by the end of March.



Kai Wright is publications editor for the Black AIDS Institute. For more information about the Black AIDS Institute, visit: BlackAIDS.org

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