[Congressional Record Volume 141, Number 119 (Friday, July 21, 1995)]
[Senate]
[Pages S10476-S10481]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


                  RYAN WHITE CARE REAUTHORIZATION ACT

  The PRESIDING OFFICER. Under the previous order, the Senate will 
proceed to the consideration of S. 641, which the clerk will report.
  The assistant legislative clerk read as follows:

       A bill (S. 641) to reauthorize the Ryan White CARE Act of 
     1990, and for other purposes.

  The Senate proceeded to consider the bill.
  Mrs. KASSEBAUM addressed the Chair.
  The PRESIDING OFFICER. The Senator from Kansas.
  Mrs. KASSEBAUM. Mr. President, I rise today to offer to the Senate 
for its consideration S. 641, the Ryan White CARE Reauthorization Act. 
This bipartisan legislation, which cleared the Labor and Human 
Resources Committee on a voice vote, is cosponsored by the ranking 
member of the Labor and Human and Resources Committee, Senator Kennedy, 
and 63 other colleagues. The act reauthorizes critical health care 
programs which provide services for individuals living with HIV and 
AIDS. Accordingly, I urge the Senate to move expeditiously to pass this 
reauthorization legislation.
  Mr. President, if I will just describe what this legislation is all 
about. The Ryan White CARE Act plays a critical role in improving the 
quality and availability of medical and support services for 
individuals living with HIV disease and AIDS. As the HIV epidemic 
continues, the need for this important legislation remains.
  Title I provides emergency relief grants to eligible metropolitan 
areas [EMA's] disproportionately affected by the HIV epidemic. Just 
over one-half of the title I funds are distributed by formula; the 
remaining amount is distributed competitively.
  Title II provides grants to States and territories to improve the 
quality, availability, and organization of health care and support 
services for individuals with HIV disease and their families.
  Sometimes I think we do not think, when we are doing legislation such 
as this, about the stress that the families are under with such a 
tragic disease. This is why this initially came about, Mr. President, 
and this is why I think it does fill an enormously important niche.
  The funds are used: to provide medical support services; to continue 
insurance payments; to provide home care services; and to purchase 
medications necessary for the care of these individuals. Funding for 
title II is distributed by formula.
  Title III(b) supports early intervention services on an out-patient 
basis--including counseling, testing, referrals, and clinical, 
diagnostic, and other therapeutic services. This funding is distributed 
by competitive grants.
  Finally, title IV provides grants for health care services and the 
coordination of access to research for children and families.
  This legislation also includes many important changes to take into 
account the changing face of the HIV epidemic. When the CARE Act was 
first authorized in 1990, the epidemic was primarily a coastal urban 
area problem. Now it reaches the smallest and most rural areas of this 
country. In addition, minorities, women, and children are increasingly 
affected.
  Chief among these improvements are changes in the funding formulas 
which are based on General Accounting Office [GAO] recommendations. The 
purpose of these changes is to assure a more equitable allocation of 
funding. These formula changes would better allocate funding based on 
where people currently live with this illness, rather than where people 
with AIDS lived in highest proportion in the past. In addition, the 
funds are better targeted based on differences in health care delivery 
costs in different areas of our country.
  Based on a request from Senator Brown and myself, the GAO has 
identified large disparities and inequities in the current distribution 
of CARE Act funding. This is due to: a caseload measure which is 
cumulative, the absence of any measure of differences in services 
costs, and the counting of EMA cases by both the titles I and II 
formulas.
  To correct these problems, the new equity formulas will include an 
estimate of living cases of AIDS and a cost-of-service component. The 
AIDS case estimate is calculated by applying a different weight to each 
year of cases reported to the Centers for Disease Control and 
Prevention over the most recent 10 year period. The cost index uses the 
average Medicare hospital wage index for the 3 year period immediately 
preceding the grant award.
  In addition, the new title II formula includes an adjustment to 
offset the double-counting of individuals by states, when such States 
also include title I cities.
  Mr. President, with any formula change, there is always the concern 
about the potential for disruption of services to individuals now 
receiving them.
  There is also a concern that someone will be getting more or someone 
will be getting less than they had before.
  To address this concern, the bill maintains hold-harmless floors 
designed to assure that no entity receives less than 92.5 percent of 
its 1995 allocation over the next 5 years.
  This reauthorization legislation also establishes a single 
appropriation for title I and title II. The appropriation is divided 
between the two titles based on the ratio of fiscal year 1995 
appropriations for each title. Sixty-four percent is designated for 
title I in fiscal year 1996. This is a significant change which should 
help unify the interests of grantees in assuring funding for all 
individuals living with AIDS--regardless of whether these persons live 
in title I cities or in States. 

[[Page S10477]]

  Because the face of the AIDS epidemic is changing so rapidly, the 
Secretary is authorized to develop and implement a method to adjust the 
ratio of funding for title I and title II. This method should account 
for new title I cities and other relevant factors. If the Secretary 
does not implement such a method, separate appropriations for titles I 
and II are authorized, beginning in fiscal year 1997.
  In an effort to target resources to the areas in greatest need of 
assistance, the bill also limits the addition of new title I cities to 
the program. The current designation criteria for title I cities was 
developed to target emergency areas. Five years after the initial 
enactment of the Ryan White CARE Act, the epidemic persists. However, 
the needs of potential title I cities are not the same as the original 
cities.
  This is so because title II funding has been used to develop 
infrastructure in many of these metropolitan areas. This decreases the 
relative need for new cities to receive emergency title I funding.
  The growth of new title I cities would be slowed beginning in fiscal 
year 1998. At that time, current provisions which establish eligibility 
for areas with a cumulative AIDS caseload in excess of 2,000 will be 
replaced with provisions offering eligibility only when over 2,000 
cases emerge within a five-year period.
  I believe this change will truly allow us to target these limited 
resources to areas where the real emergencies exist. As I talked with 
public health experts about this proposal, they indicated a rapid 
growth of AIDS cases over a five year period would truly stretch the 
limits of their existing public health infrastructure.
  Mr. President, the legislation makes a number of other important 
modifications:
  First, it moves the Special Projects of National Significance program 
to a new title V, funded by a 3 percent set-aside from each of the 
other four titles. In addition, it adds Native American communities to 
the current list of entities eligible for projects of national 
significance.
  Second, it creates a statewide coordination and planning process to 
improve coordination of services, including services in title I cities 
and title II states.
  Third, it extends the administrative expense caps for title I and II 
to subcontractors.
  Fourth, it authorizes guidelines for a minimum state drug formulary.
  Fifth, it modifies representation on the title I planning councils to 
reflect more accurately the demographics of the HIV epidemic in the 
eligible area.
  Sixth, for the title I supplemental grants, a priority is established 
for eligible areas with the greatest prevalence of co-morbid 
conditions, such as tuberculosis, which indicate a more severe need.
  I believe that the changes proposed by this legislation will assure 
the continued effectiveness of the Ryan White CARE Act by maintaining 
its successful components and by strengthening its ability to meet 
emerging challenges. Putting together this legislation has involved the 
time and commitment of a wide variety of individuals and organizations. 
I want to acknowledge all of their efforts.
  Mr. President, I would also like to say that this is a controversial 
bill. It has been ever since it was approved and became law in 1990. I 
think this is so largely because of the fear of AIDS, the concern about 
HIV, where it may strike next, and as I mentioned earlier, the changing 
face of this tragic disease, particularly when it strikes children. I 
think we wonder how can this be.
  We have in the past had infected blood transmitted by blood 
transfusions. We are beginning to try to gain control over that so that 
the frequency of that does not occur. But it becomes a ripple effect 
that goes down through families.
  It is a tragic disease, and it is one for which I think we all want 
to be able to help provide some support for a population that is viewed 
with great uncertainty and great concern, and as I said, great fear. 
That is why we always have a hard time with this legislation, Mr. 
President. We have a hard time making the case, even though there are 
63 cosponsors, that this is an important piece of legislation; it will 
help a large number of people.
  I am particularly appreciative of the constructive and cooperative 
approach which the ranking member of the Labor and Human Resources 
Committee, Senator Kennedy, has lent to the development of this 
legislation. I also wish to thank the other 63 cosponsors of this bill 
for assisting me in bringing this important legislation to the floor. I 
am not without an understanding of those who oppose this legislation 
and their concerns. These are about our limited resource dollars, our 
limited support of those in need in the health care area, and the 
question of why we are targeting this money to this particular arena.
  I hope that the Senate can act promptly and approve this measure.
  I yield the floor, Mr. President.
  Mr. KENNEDY. Mr. President, let me say at the outset how much I think 
all of us on this side of the aisle appreciate the leadership of 
Senator Kassebaum and her colleagues, our colleagues on the Labor and 
Human Resources Committee and in the Senate, in support of this 
legislation, the Ryan White CARE Reauthorization Act of 1995.
  The fact is, Mr. President, at times of human suffering or great 
national tragedies or epidemics, it has always been the leadership of 
the Federal Government that has helped our fellow citizens deal with 
difficulties. It is in that very important tradition that this 
legislation was created and I urge the Senate to accept it today. This 
is critically important legislation. I am pleased that it is the first 
Labor Committee initiative to reach the full Senate.
  For 15 years, America has been struggling with the devastating 
effects of AIDS. More than a million citizens are infected with the 
AIDS virus. AIDS itself has now become the leading killer of all young 
Americans ages 25 to 44. AIDS is killing brothers and sisters, children 
and parents, friends and loved ones--all in the prime of their lives.
  From the 10,000 children orphaned by AIDS in New York City alone, to 
the 18-year-old gay man with HIV living in the Ozarks of Oklahoma, this 
epidemic knows no geographic boundaries and has no mercy.
  Nearly 500,000 Americans have been diagnosed with AIDS. Over half 
have already died--and yet the epidemic marches on unabated.
  The epidemic is a decade-and-a-half old--almost 40 percent of the 
AIDS cases in the country have been diagnosed in the last 2 years. One 
more American gets the bad news every 6 minutes. And each day, we lose 
another 100 fellow citizens to AIDS.
  As the crisis continues year after year, it has become more and more 
difficult for anyone to claim that AIDS is someone else's problem. In a 
very real way, we are all living with AIDS. There are few of us, even 
here in the Senate, who do not know someone who is either infected with 
AIDS or directly touched by AIDS.
  The epidemic has cost this Nation immeasurable talent and energy in 
young and promising lives struck down long before their time. And our 
response to this plague--and the challenges it presents--will surely 
document in the pages of history what we stood for as a society.
  Five years ago, in the name of Ryan White and all the other Americans 
who had lost their battle against AIDS, Congress passed and President 
Bush signed into law the Comprehensive AIDS Resources Emergency Act. In 
dedicating this bill to the memory of Ryan White, the Senate Labor and 
Human Resources Committee stated in its report:

       Beginning at the age of 13, Ryan White valiantly fought not 
     only the AIDS virus, but also fear and discrimination based 
     on ignorance. With dignity, patience and unwavering good 
     cheer, Ryan White introduced America and the world to a face 
     of AIDS that caring human beings could not turn their back 
     upon. First through his courageous fight to go to school with 
     his peers, then through his tireless efforts to educate 
     others about the realities of his illness, young Ryan White 
     changed our world. By dedicating this legislation to Ryan, 
     the Labor Committee affirms its commitment to providing care 
     and compassion and understanding to people living with AIDS 
     everywhere. Ryan would have expected no less.
  America can take satisfaction that--in these difficult times--
sometimes we get it right. In the case of the CARE Act--I think we 
have.
  AIDS has imposed demands on our health care system that were totally 
unanticipated a decade ago. In 1980, no Federal, State, or local public 
health 

[[Page S10478]]
agency could possibly have foreseen the introduction of a novel and 
lethal infectious disease into 20th century society. Yet without 
warning, communities across this country were faced with an ever-
expanding epidemic--creating the need for essential health and support 
services for hundreds of thousands of Americans who previously had 
little contact with the health care system.
  In preparing to respond, the committee heard horror stories of people 
with AIDS waiting 10 or 12 days in overflowing emergency rooms--only to 
die before they were seen. I visited these hospitals and I talked with 
these families. We held hearings across the Nation. We took testimony 
in an old school house in a southern rural town, where we heard from a 
person with AIDS who traveled for many hours to reach an urban clinic--
for fear that if anyone in his home town knew his HIV status, he would 
be banished, or killed. The human tragedy brought about by AIDS was 
staggering, even unfathomable--and cried out for national relief.
  In 1990, advocates, organizations, and frontline service providers 
gave us the sound advice that the development and operation of 
community-based AIDS care networks could help shore up the Nation's 
overburdened health care delivery system, while improving the quality 
of life and efficiency of services for individuals and families with 
AIDS.
  These principles were affirmed in recommendations made by two 
successive commissions on AIDS--one appointed by President Reagan and 
chaired by Adm. James Watkins, the other created by Congress and 
chaired by Dr. June Osborn.
  In a report to President Bush, the National Commission on AIDS 
stated:

       Federal disaster relief is urgently needed to help states 
     and localities provide the HIV treatment, care, and support 
     services now in short supply. The Commission strongly 
     supports the efforts in Congress to address this need. The 
     resources simply must be provided now or we will pay dearly 
     later.

  With broad bipartisan support, and 95 votes in the U.S. Senate, we 
passed the landmark Ryan White CARE Act. We joined together in the 
interest of the Nation. We put people before politics. We took 
constructive action that has made a world of difference.
  The CARE Act contains a series of carefully crafted components that 
together form the strategy that has reduced inpatient hospitalization 
and emergency room visits--and allowed more than 300,000 Americans with 
HIV disease this year to live longer, healthier, and more productive 
lives.
  Let me for a minute mention the various aspects of the program that 
form the CARE Act.
  Title I provides emergency relief for cities hardest hit by AIDS.
  Basically, we establish a threshold of 2,000 cases. Once the cities 
reach that threshold in terms of diagnosed AIDS cases, they will be 
eligible for help and assistance. That is why a continued expansion of 
the program is necessary, as more and more cities are reaching that 
2,000 level.
  As more and more reach that 2,000 level and become eligible, we will 
need additional resources to meet this growing need.
  Title II provides funding for all 50 States to organize and operate 
care consortia, to offer home care services and lifesaving 
therapeutics, and to assist in the continuation of private insurance 
coverage for those who would otherwise be bankrupted.
  We have a funding stream targeted to the areas hardest hit by HIV. We 
also have grants that go to all 50 States to permit the States to 
develop programs to meet their growing need. As Senator Kassebaum 
pointed out, we are seeing an increasing incidence in many of the rural 
areas of this country.
  The basic thrust of these programs is to develop humane and 
compassionate ways to provide essential services to individuals and 
families with HIV. This approach is also cost-effective and reduces 
pressure on the health care systems in these seriously impacted 
communities.
  Title III provides funding for community health centers and family 
planning clinics to offer primary care and early intervention services 
to men, women, and children with HIV in underserved urban and rural 
communities which face an increasing demand for care.
  Title IV links cutting-edge pediatric AIDS research with family 
center health and support services to meet the unique needs of 
children, youth, and families with HIV.
  One of the great human tragedies is the number of babies born HIV 
positive, infants born into this world with HIV. We are providing help 
and assistance to those children as well.
  There has been some enormously significant and important research 
that has been done that has offered great hope and opportunity with 
early intervention of freeing these infants from transmission by 
providing their mothers with AZT during pregnancy and delivery.
  There has been important progress made. It is the kind of research 
that is also being done out of NIH in a coordinated way. We want to be 
able to be responsive to the needs of children, youth and families that 
have been affected and infected. This is enormously important.
  I had the opportunity to visit a center at Boston City Hospital. It 
was really one of the most moving and tragic visits I have ever made. 
But the people who are working with these infants, the volunteers that 
go in there and give care and attention to these babies is one of the 
most inspiring examples of selflessness. We want to try and at least 
maintain, as title IV does, cutting edge pediatric research with family 
centers in our country.
  Title V provides funds for national demonstration projects targeted 
to HIV populations with special needs, including minorities, the 
homeless, and Native Americans.
  Together these titles function to put in place a strong national 
response with a proven track record of success. In a very real way, the 
CARE Act has saved both money and lives.
  In Boston, the CARE Act has led to dramatically increased access to 
essential services. This year, because of Ryan White, 15,000 
individuals are receiving primary care, 8,000 are receiving dental 
care, and 9,000 are receiving mental health services. An additional 700 
are receiving case management services and nutrition supplements.
  This assistance is reducing hospitalizations, and is making an 
extraordinary difference in people's lives.
  In Newark, pediatric admissions at Children's Hospital decreased by 
33 percent and the length of stay has decreased by half because of the 
coordinated family-based care offered through the act.
  I think primarily San Francisco, which experimented with a variety of 
ways of providing community based care, has been a model from which 
other cities have drawn and made a very important difference. San 
Francisco has increased the quality of life of people living with HIV 
and also has diminished, in a very significant way, the financial cost 
of treatment.
  In Denver, emergency room visits have been reduced by 90 percent and 
hospitalizations by 60 percent as a result of a home care program for 
the uninsured paid for by the CARE Act.
  In Florida, Minnesota, and Wisconsin; the State saved more than $1 
million--or nearly $10,000 for each person with AIDS--by using CARE 
dollars to help individuals continue their private health insurance 
coverage.
  While much has changed since 1990, the brutality of the epidemic 
remains the same. When the Act first took effect, only 16 cities 
qualified for ``emergency relief''. In the past five years, that number 
has more than tripled--and by next year it will have quadrupled.
  This crisis is not limited to major urban centers. Caseloads are now 
growing in small towns and rural communities, along the coasts and in 
America's heartland. From Weymouth to Wichita, no community will avoid 
the epidemic's reach.
  We are literally fighting for the lives of hundreds of thousands of 
our fellow citizens. These realities challenge us to move forward 
together in the best interest of all people living with HIV. And that 
is what Senator Kassebaum and I have attempted to do.
  The compromise in this legislation acknowledges that the HIV epidemic 
has expanded its reach. But we have not forgotten its roots. While new 
faces and new places are affected, the epidemic rages on in the areas 
of the country hit hardest and longest.
  The pain and suffering of individuals and families with HIV is real, 
widespread, and growing. All community-

[[Page S10479]]
based organizations, cities, and States need additional support from 
the Federal Government to meet the needs of those they serve.
  The revised formulas in this legislation will make these desperately 
needed resources available based on the number of people living with 
HIV disease--and the cost of providing these essential services.
  The new formula will increase the medical care and support services 
available to individuals with HIV in many cities, including Boston, Los 
Angeles, Philadelphia, and Seattle, and in many States.
  Equally important, the compromise will ensure the ongoing stability 
of the existing AIDS care system in areas of the country with the 
greatest incidence of AIDS. The HIV epidemic in New York, San 
Francisco, Miami, and Newark is far from over--and in many ways, the 
worst is yet to come.
  This legislation represents a compromise, and like most compromises, 
it is not perfect and it will not please everyone. But on balance, it 
is a good bill--and its enactment will benefit all people living with 
HIV everywhere in the Nation.
  We have sought common ground. We have listened to those on the 
frontlines. And we have attempted to support their efforts, not tie 
their hands.
  Congress must now once again put aside political, geographic, and 
institutional differences to face this important challenge squarely and 
successfully. The structure of the CARE Act--affirmed in this 
reauthorization--and its well-documented effectiveness provide a sound 
and solid foundation on which to build that unity.
  Hundreds of health, social service, labor, and religious 
organizations helped to shape the reauthorization's provisions. The 
reauthorization has been praised by Governors, mayors, county 
executives, and local and State AIDS directors and health officers. It 
has required all levels of government to join together in providing 
services and resources. And success stories of this coordination are 
now plentiful.
  Community-based AIDS service organizations and people living with HIV 
have had critically important roles in the development and 
implementation of humane and cost-effective service delivery networks 
responsive to local needs.
  Although the resources fall far short of meeting the growing need, 
the Act is working. It has provided life-saving care and support for 
hundreds of thousands of individuals and families affected by HIV and 
AIDS. Through its unique structure, it has quickly and efficiently 
directed assistance to those who need it most.
  The Ryan White CARE Reauthorization Act, however, is about more than 
Federal funds and health care services. It is also about the caring 
American tradition of reaching out to people who are suffering and in 
need of help. Ryan White would be proud of what has happened in his 
name. His example, and the hard work of so many others, are bringing 
help and hope to our American family with AIDS.
  The CARE Act has been a model of bipartisan cooperation and effective 
Federal leadership. Today that tradition continues. Sixty-three 
Senators join Chairman Kassebaum and me in presenting this bill to the 
Senate. It has been unanimously reported by both the Labor and Human 
Resources Committee in the Senate and the Commerce Committee in the 
House.
  We must do more and do it better to provide care and support for 
those trapped in the epidemic's path. And with this legislation, we 
will.
  Mr. President, again, I thank our chairperson, Senator Kassebaum, for 
her leadership and for working through a number of recommendations and 
changes. There have been changes in the way the funding will be 
distributed, and any time you engage in that, there will always be some 
winners and some losers.
  It is a compromise which I support. It took a good deal of time to 
work this through, but I commend her for her diligence and for her 
ability to bring us all together on to some common ground.
  Finally, I think those individuals who are looking to this 
legislation for some hope ought to find it as we go forward. It has 
broad bipartisan support. We expect that, as the majority leader has 
indicated, we will pass this in the very near future --certainly in the 
period of time before the August recess. If you take the progress being 
made in this area, the progress being made in the Office of AIDS 
research at the NIH, and the progress we have made with the Americans 
With Disabilities Act in the not too recent past, I think what 
Americans can take some satisfaction in is that we are trying to deal 
with this issue as a public health issue. We are trying to deal with it 
in a humane fashion. We are putting aside, during this debate, ideology 
and rhetoric in dealing with the facts at hand. We should follow 
scientific, and medical judgements and reflect caring and compassionate 
leadership, which we are about when we are at our best.
  So this is really a hopeful piece of legislation. It will make a 
difference to tens of thousands of our fellow citizens. It is an area 
of important need. It is building on solid records of achievement and 
accomplishment. It reflects a number of the recommendations that have 
been made by Republicans and Democrats alike. It is a reflection of 
many of our colleagues' good recommendations and suggestions. We are 
very grateful to all of those that have been a part of this 
legislation. I am very hopeful that the Senate will pass it in the very 
near future.
  I yield the floor.
  Ms. MIKULSKI. Mr. President, I rise today in strong support of the 
Ryan White Comprehensive AIDS Resources Emergency [CARE] Act 
reauthorization. This act that honors the memory of a teenager who 
touched the lives of all Americans by bringing to the public's 
consciousness the need to respond to people living with AIDS. I am 
proud to be a cosponsor of this legislation and I urge my colleagues to 
join me in keeping the ``care'' in the Ryan White CARE Act.
  My home State of Maryland, and Baltimore in particular, has benefited 
greatly from the services funded under the Ryan White CARE Act. Many 
Marylanders with AIDS would have gone without care or received 
substandard care if this law was not in existence. The CARE Act has 
provided primary care services and specialized HIV/AIDS care 
specifically for children, adolescents, women, men, and families 
through cost-effective community-based, family-centered comprehensive 
systems. In Maryland alone, the number of reported AIDS cases has 
increased every year since 1990 when the Ryan White CARE Act was first 
passed. In 1990, the number was 923, in 1992 it was 1,242, in 1993 it 
was 2,483, and last year it was 2,810.
  As we have seen in Maryland, the AIDS epidemic is far from over. The 
greatest spread of the disease in Maryland has been in the Baltimore 
metropolitan area. In Baltimore City alone in 1993. there was a 64.4 
percent increase in the AIDS caseload. The number of AIDS cases in 
Baltimore has multiplied more than 21 times since 1985. Sixty-one 
percent of AIDS cases in Maryland are in Baltimore.
  The Federal Government has always responded to national tragedies and 
epidemics with targeted assistance--AIDS is no different. We must make 
sure that the Ryan White CARE Act continues to provide community-based 
care as well as new care and prevention programs. I believe this Act as 
reauthorized accomplishes this goal.
  We cannot ignore the human element of this disease and the 
individuals whose lives have been affected by it. We cannot forget 
their personal plights and how this law has affected their lives. We 
have an opportunity today to do the right thing by reauthorizing this 
Act. We need to ensure that those affected by HIV and AIDS receive help 
in coping with the ravages of this dreaded disease.
  AIDS is a disease that does not discriminate among children and 
adults, rich or poor, Democrats and Republicans. It affects everyone. 
Now is the time to come together in a bipartisan way to show Americans 
living with AIDS and their families that their elected officials--their 
Congress--is standing firmly behind them in their time of need. Let's 
keep the ``care'' in the Ryan White CARE Act.
  Mrs. KASSEBAUM. I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  
[[Page S10480]]

  Ms. MOSELEY-BRAUN. Mr. President, I ask unanimous consent that the 
order for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Ms. MOSELEY-BRAUN. Mr. President, I rise in strong support for quick 
action to approve the funding for the Ryan White CARE Act. The Ryan 
White CARE Act is an example of Government at its best. It is an 
initiative that has worked well in spite of the unfortunate and tragic 
growth in the number of AIDS and HIV. This has been a difficult disease 
for the country to deal with and an even greater challenge for the 
individuals and families of individuals stricken with the disease.
  When Ryan White was first enacted, about 128,000 Americans were 
diagnosed with HIV. Now, unfortunately, there are more than 480,000 
diagnosed cases.
  Unfortunately, Mr. President, and probably predictably so, AIDS is 
one of those things that none of us like to talk about. It is a subject 
that brings fear in the hearts of anyone who even raises the question. 
But it is, I think, vitally important that we talk about it, and it is 
vitally important that we engage in debate about priorities and how we 
go about responding to what is truly an American emergency.
  AIDS is just such an emergency. HIV is just such an emergency. Ryan 
White has been there to respond in a comprehensive and sensible way to 
that emergency. It is cost effective. It is working. It is responsive. 
And again, it represents the best of America.
  Let me say at the outset that Ryan White funding plays a critical 
role in ensuring that people with HIV and AIDS receive not just health 
services but case management, home services, housing services, 
transportation, and it is a comprehensive approach to dealing with the 
entire individual and the entire community.
  The funding goes to State and local governments to deal with HIV-
infected populations within that community, as well as to provide 
support for community initiatives designed to try to provide the kinds 
of supports that will be responsive to the particular health needs of 
that community.
  One of the things that needs to be talked about during the health 
care debate is the fact that here in America no one goes without health 
services.
  If you think about it, everyone gets services in one form or another. 
If somebody falls out in the middle of the street or someone gets sick, 
somewhere, somehow or another, they will get served. The question 
becomes, how does it get paid for?
  Unfortunately, our health care system is broken--we have the finest 
health care in the world, but in many ways it is a broken one. The fact 
is, the way the system works now, uncompensated care costs get shifted 
back and forth, and so in many instances, people who go to the hospital 
and pay private pay for health coverage, for health services, wind up 
paying $100 for aspirin, and that is just an apocryphal example. But 
the reason aspirin costs $100 is because of uncompensated care provided 
to people in other points in the system.
 Hospitals have provided the care. They have to recover that cost in 
some way and very often those costs get shifted to people who have 
private insurance and the like.

  What Ryan White does, then, if you look at it in the scheme of 
things, Ryan White says here is a particular population with particular 
health needs and a community need to have these health needs met. We 
are going to provide funding to State and local governments, to health 
care institutions, to research institutions and the like, to try to 
address this specific problem so these costs will not be shifted and 
these costs will not be spread and we can be responsive in a 
comprehensive way.
  So Ryan White-funded health care services help not only keep people 
healthy, and of course I know some of my colleagues have spoken to the 
human dynamic that is involved with Ryan White, but it also helps to 
provide a way of providing health care services in a way that does not 
call for this unaccountable kind of cost shifting that we might see in 
our health care system overall in the absence of Ryan White.
  Mr. President, my State, Illinois, received in Federal funding for 
AIDS programs a total in 1994 of about $60 million. This is a lot of 
money. But certainly the fact is that the population is large and is 
growing and Ryan White has been responsive to a number of different 
institutions in the State of Illinois to provide for health care 
services: Emergency funds for care services, funds to the State health 
departments for support and care services, funds to community-based 
clinics and migrant health clinics to provide outpatient early 
intervention and primary medical services, funds to support pediatric, 
adolescent, and family programs.
  All of these are vitally important, particularly given the fact that 
the AIDS population and HIV population is growing with regard to 
pediatrics, with regards to the children--that population is expanding. 
I think we have every obligation to see to it that we respond to the 
health needs of the community and the health needs of the individuals 
who are suffering with this dread disease in a way that is efficient. 
Certainly, Ryan White is that cost-effective, that efficient approach 
to health care funding for AIDS and HIV.
  Finally, I would like to make a special appeal to my colleagues to 
look at this program and not allow us to get into a tradeoff between 
diseases, if you will. The fact is, we have a universal interest in 
seeing to it that the health care of America is something that we 
respond to as a society, not just because it is good for the 
individuals but because it is good for our society as a whole.
  I do not think it can ever be argued that one disease versus another 
disease should be competitive. Indeed, if anything, we have, I think, 
an obligation to provide people with quality health care and access to 
health care and the availability of funding for that health care in a 
system of health care that is responsive to our total population needs.
  I understand this legislation has broad-based bipartisan support and 
so this is not a partisan issue. This is certainly not an issue that 
should be controversial in any way. I hope there will not be any 
controversy.
  I certainly want to applaud Senators Kassebaum and Kennedy for 
working through the issues surrounding this legislation. Senator 
Kassebaum has been a leader in the health area for a long time and I 
applaud her for her efforts in this regard and applaud her for this 
legislation, and I urge its quick passage by the U.S. Senate.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Hawaii.
  Mr. AKAKA. Mr. President, I am pleased that the Senate is now 
considering S. 641, the Ryan White Comprehensive AIDS Resources 
Emergency, CARE, Reauthorization Act of 1995. In 1990, Congress enacted 
the Ryan White CARE Act, named in honor of the young hemophiliac who 
devoted enormous energy educating Americans about the need for a 
compassionate response to people living with AIDS.
  The Ryan White CARE Act is the cornerstone of Federal funding for 
AIDS-specific care and has played a critical role in improving the 
quality and availability of medical and support services for 
individuals with HIV and AIDS. Since its enactment, the CARE Act has 
provided life-sustaining services to over 300,000 people with HIV/AIDS, 
including primary health care, prescription drugs, home health care and 
hospice care, dental care, drug abuse treatment, counseling, case 
management, and assistance with housing and transportation.
  I commend the sponsors of this legislation, Senators Nancy Kassebaum 
and Edward Kennedy, for their leadership on this issue of national 
importance. S. 641 would amend the CARE Act and extend authorization of 
the grant programs, which expire on September 30, 1995. As AIDS is the 
leading cause of death of young adults, we cannot let reauthorization 
of the CARE Act be delayed any longer nor diluted through negative 
amendments. I am a cosponsor of this legislation and believe that it 
will strengthen the CARE Act and enhance our ability to be responsive 
to the evolving nature of this epidemic. The measure, which enjoys 
bipartisan support, was favorably reported out of the Senate Labor and 
Human Resources Committee by a unanimous vote on March 29, 1995.
  The sponsors of this legislation recognize that the changing 
demographics of the AIDS epidemic require a more 

[[Page S10481]]
equitable distribution of funding in order to balance the needs of 
people across this country living with HIV and AIDS. Accordingly, S. 
641 builds on the program's strengths and makes significant 
improvements by modifying the funding formulas to reflect the changing 
nature of the AIDS epidemic. The legislation before us would assure a 
more equitable allocation of funding as it restructures formulas based 
on an estimation of the number of individuals currently living with 
AIDS and the costs of providing services
  I urge my colleagues to support, without amendment, S. 641, the Ryan 
White Care Reauthorization Act of 1995.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Kansas.
  Mrs. KASSEBAUM. Mr. President, I thank the Senator from Hawaii and 
prior to the Senator from Hawaii speaking, the Senator from Illinois, 
Senator Moseley-Braun, for their cosponsorship and assistance with this 
legislation as we have been putting it together and as it is now ready 
to be considered by the full Senate.
  I just wish to thank the Senator from Hawaii for his support.
  Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. LEAHY. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. LEAHY. Mr. President, I am proud to be a cosponsor of the Ryan 
White CARE Act.
  Today, AIDS is the leading cause of death among Americans between the 
ages of 25 to 44 years. Truly, a staggering statistic.
  Since the beginning of the epidemic in 1981 through June of 1994, the 
number of reported AIDS cases in Vermont is 213. Eighty-two of these 
cases were reported in the previous year alone. This represents an 
increase of 242 percent over the reported total in 1991-92.
  AIDS knows no gender, sexual orientation, age, or region of the 
country. AIDS is something that affects all of us.
  Since its enactment in 1990, the Ryan White CARE has done so much to 
help provide health care and services to the growing number of people 
with HIV/AIDS. I hope that we can work toward a speedy passage.
  Mr. President, I ask unanimous consent to be able to proceed as if in 
morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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