[Congressional Record Volume 142, Number 58 (Wednesday, May 1, 1996)]
[House]
[Pages H4355-H4366]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  CONFERENCE REPORT ON S. 641, RYAN WHITE CARE ACT AMENDMENTS OF 1996

  Mr. BILIRAKIS. Mr. Speaker, I ask unanimous consent that it now be in 
order to proceed immediately to consider the conference report on the 
Senate bill (S. 641), to reauthorize the Ryan White CARE Act of 1990, 
and for other purposes, and that all points of order against the 
conference report and against its consideration be waived, and that the 
conference report be considered as read.
  The Clerk read the title of the Senate bill.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Florida?
  Mr. WAXMAN. Reserving the right to object, Mr. Speaker, I want to 
clarify that this will allow us to move forward on the House floor to 
consider the Ryan White reauthorization bill, allowing discussion of 
that legislation and a vote.
  Mr. BILIRAKIS. Mr. Speaker, if the gentleman will yield, I would say 
to the gentleman, yes, by all means.

[[Page H4356]]

  Mr. WAXMAN. I withdraw my reservation of objection, Mr. Speaker.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Florida?
  There was no objection.
  The SPEAKER pro tempore. Pursuant to the unanimous consent agreement, 
the conference report is considered as having been read.
  (For conference report and statement, see proceedings of the House of 
Tuesday, April 30, 1996, at page H4287).
  The SPEAKER pro tempore. The gentleman from Florida [Mr. Bilirakis] 
and the gentleman from California [Mr. Waxman] will each be recognized 
for 30 minutes.
  The Chair recognizes the gentleman from Florida [Mr. Bilirakis].

                              {time}  1830

  Mr. BILIRAKIS. Mr. Speaker, I yield myself such time as I may 
consume.
  (Mr. BILIRAKIS asked and was given permission to include extraneous 
material.)
  Mr. BILIRAKIS. Mr. Speaker, I rise in strong support of the 
conference agreement on the Ryan White CARE Act Amendments of 1996. 
This conference report represents a balanced compromise between the 
House and Senate positions and updates and improves these important 
programs.
  I want to join my colleagues in saying how pleased I am that the 
conference on the Ryan White program has finally been completed. It has 
taken much longer than any of us would have liked. We are now at the 
point where the remainder of the fiscal year 1996 funds are about to be 
distributed to the States. Without the reauthorization and an 
adjustment to the formula, approximately 20 States were expected to 
lose a significant portion of their grants relative to fiscal year 
1995. It is our expectation that those remaining funds will be 
allocated based on the formulas contained in the conference agreement.
  I want to briefly summarize some of the key provisions of the 
conference agreement. The bill charges the criteria by which cities 
become eligible for title I funds and modifies both the title I and 
title II formulas. The allocations to cities under title I for 
emergency relief grants will be based on the estimated number of living 
cases of AIDS in the area over the most recent 10-year period.
  The formula for the title II CARE grants to the States are based on 
two distribution factors: The State factor and the non-EMA factor. The 
minimum allotments to States with 90 or more cases is increased from 
$100,000 to $250,000.
  The conference agreement provides criteria for how members of title I 
planning councils should be selected; these criteria include conflict 
of interest standards. Additionally, it requires that the composition 
of the planning council reflect the demographics of the epidemic in the 
area. The conference agreement requires the Secretary to give priority 
in awarding supplemental grants to cities that demonstrate a more 
severe need based on the prevalence of: Sexually transmitted diseases, 
substance abuse, tuberculosis, mental illness, and homelessness.
  The bill also requires cities to allocate a percentage of its funds 
for providing services to women, infants, and children, including 
treatment measures to prevent the perinatal transmissions of HIV. It 
also defines and places limits on administrative costs.
  Other provisions of the bill provide that: States must spend a 
portion of their grants on therapeutics to treat HIV disease including 
measures for the prevention and treatment of opportunistic infections; 
all four titles contribute 3 percent to the projects of National 
Significance; clarification that the intent of title IV is to increase 
the number of women and children in clinical research projects; 
transfer of the dental reimbursement program from title 7 of the Public 
Health Service Act; and reauthorization of all programs at such sums 
through fiscal year 2000.
  This is a conference report which represents compromise and hard work 
by both the House and Senate. We are proud of our efforts and are 
hopeful that by passing this conference report today, we can provide 
much-needed services, education, and treatment to those afflicted with 
this terrible disease.
  I also want to take this opportunity to thank my staff, especially 
Melody Harned, for their hard work on this legislation as well as Kay 
Holcombe of the committee's minority staff.
  I include a section-by-section summary of the bill in the Record at 
this point.

  Summary of Conference Agreement on S. 641, The Ryan White CARE Act 
                           Amendments of 1996

       Section 1. Short Title.
       Section 2. References.
       Section 3. General Amendments.
       Part A--Emergency Relief for Areas With Substantial Need 
     for Services (Cities):
       1. Eliminates the ability for an area to become eligible 
     based on per capita incidence of 0.0025. Changes the 
     timeframe of the cumulative AIDS case count from total 
     cumulative (from the beginning of the epidemic) to the total 
     for the 5-year period prior to the year for which the grant 
     is being made.
       2. Limits eligibility for new grants to cities with 
     populations of 500,000 or more. (All cities currently 
     receiving funds and cities which will receive funds in FY 
     1996 are grandfathered).
       3. Adds to the list of representatives to be included on 
     the planning councils: (a) federally qualified health 
     centers, (b) substance abuse treatment providers, (c) 
     individuals from historically underserved populations, (d) 
     the State Medicaid agency and the State agency administering 
     Title II, and (e) grantees under Part D.
       4. Clarifies that in establishing priorities, planning 
     councils are to use the following factors: (a) documented 
     needs of the HIV-infected population, (b) cost and outcome 
     effectiveness data of proposed interventions, (c) priorities 
     of HIV-infected communities for whom services are intended, 
     and (d) availability of other resources.
       5. Requires the planning council to participate in the 
     statewide coordinated statement of need.
       6. Requires the composition of the planning council to 
     reflect the demographics of the epidemic in the area. Also 
     requires that nominations to the council be conducted through 
     an open process based on publicized criteria which includes a 
     conflict of interest standard. Prohibits the planning council 
     from being chaired solely by an employee of the grantee.
       7. Prohibits the planning council from designating or 
     otherwise being directly involved in the selection of 
     specific service providers.
       8. Requires planning councils to develop grievance 
     procedures. Requires the Secretary to develop model grievance 
     procedures.


                         Distribution of Grants

       1. Formula Grant--Specifies that no city may receive a 
     reduction from the amount received in FY95 greater than 0 
     percent in FY96, 1 percent in FY97, 2 percent in FY98, 3.5% 
     in FY99 and 5% in FY 2000.
       2. Supplemental Grant--Requires cities applications for 
     supplemental grants to demonstrate the inclusiveness of the 
     planning council membership and that proposed services are 
     consistent with local and statewide statements of need, and 
     that funds for the preceding year were spent in accordance 
     with the priorities developed by the planning council.
       3. Supplemental Grant--Requires the Secretary to give 
     priority in awarding supplemental grants to cities that 
     demonstrate a more severe need based on the prevalence of: 
     sexually transmitted diseases, substance abuse, tuberculosis, 
     mental illness, and homelessness.
       4. Prohibits the Secretary from awarding a grant unless 
     funds for the preceding fiscal year were expended in 
     accordance with the priorities established by the planning 
     council.


                             Use of Amounts

       1. Clarifies that substance abuse and mental health 
     treatments and prophylactic treatment for opportunistic 
     infections are permissible uses of funds.
       2. Clarifies that substance abuse treatment programs and 
     mental health programs are eligible to receive funds from 
     cities to provide services.
       3. Requires the city to allocate a percentage of its funds 
     for providing services to women, infants, and children, 
     including treatment measures to prevent the perinatal 
     transmissions of HIV. The minimum for each city will be the 
     percentage of the HIV population constituted by women, 
     infants and children infected with HIV.
       4. Specifies that administrative costs of all subgrantees 
     may not exceed an average of 10 percent. Defines 
     administrative activities.


                              Application

       1. Authorizes the Secretary to phase-in the use of a single 
     application and a single grant for formula grants and 
     supplemental grants.


                 Technical Assistance; Planning Grants

       1. Authorizes the Secretary to make grants of $75,000 to 
     cities who will become eligible for Part A grants (cities) 
     the following fiscal year. The purpose of the grant is to 
     assist the area in preparing for the responsibilities 
     associated with being a Part A grantee.
       2. A maximum of 1 percent of Part A funds may be used for 
     planning grants. If a city receives a planning grant, the 
     amount it receives the subsequent fiscal year (under the Part 
     A formula) will be reduced by the amount of the planning 
     grant.
       3. Permits current grantees to provide technical assistance 
     to new grantees.

[[Page H4357]]

       Part B--Care Grant Program (States)
       1. Specifies that an authorized use of funds is to provide 
     outpatient and ambulatory health and support services 
     (services authorized under Part A).
       2. Amends the 15 percent set-aside for women and children 
     to require states to allocate a percentage of its funds for 
     providing services to women, infants, and children, including 
     treatment measures to prevent the perinatal transmissions of 
     HIV. The minimum for each state will be the percentage of the 
     HIV population constituted by women, infants and children 
     infected with HIV.


                           HIV Care Consortia

       1. Specifies that private for profit entities are eligible 
     to receive funds to provide services, if they are the only 
     available provider of quality HIV care in the area.
       2. Clarifies that substance abuse and mental health 
     treatment and prophylactic treatment for opportunistic 
     infections are permissible uses of funds.
       3. Requires the consortium to consult with Part D grantees 
     in establishing a needs assessment.
       4. Deletes the requirement that states with 1% or more of 
     the AIDS cases must spend 50% of their grant on consortia.


                        Provisions of Treatments

       1. Requires States to spend a portion of its grant on 
     therapeutics to treat HIV disease including measures for the 
     prevention and treatment of opportunistic infections.
       2. Requires states to document the progress made in making 
     therapeutics available to individuals eligible for 
     assistance.
       3. Requires the Secretary to review State drug 
     reimbursement programs and assess barriers to expanded 
     availability.


                           state application

       1. Requires the State in its application to provide a 
     description of how the allocation of resources is consistent 
     with the Statewide statement of need. Requires the State to 
     periodically convene a meeting of specified individuals to 
     develop the statement of need.


                planning, evaluation, and administration

       1. Prohibits States from using more than 10 percent of its 
     grant for planning and evaluation. Prohibits states from 
     using more than 10 percent of its grant for administration. 
     However, the total for planning, evaluation and 
     administration cannot exceed 15 percent. Requires states to 
     ensure that the average of administrative costs of entities 
     that receive funds from the states does not exceed 10 
     percent. Defines administrative activities.


                          technical assistance

       1. Clarifies that the technical assistance which the 
     Secretary may provide includes technical assistance in 
     developing and implementing statewide statements of need.


                              coordination

       1. Requires the Secretary to ensure that the Health 
     Resources and Services Administration, the Centers for 
     Disease Control and Prevention, and the Substance Abuse and 
     Mental Health Services Administration coordinate Federal HIV 
     programs. Requires the Secretary to report to Congress by 
     October 1, 1996 on such coordination efforts.

                  Part C--Early Intervention Services

       1. Requires grantees to spend not less than 50 percent of 
     the grant, providing on-site or at sites where other primary 
     care services are rendered, the following four service 
     categories: (a) testing, (b) referrals for health services, 
     (c) clinical and diagnostic services, and (d) provision of 
     therapeutic measures.
       2. Specifies that private for profit entities are eligible 
     to receive funds to provide services, if they are the only 
     available provider of quality HIV care in the area.


                    planning and development grants

       1. Authorizes the Secretary to make grants to assist 
     entities in qualifying for a Title III(b) grant. The amount 
     of each grant is not to exceed $50,000. Preference is given 
     to entities that provide HIV primary care services in rural 
     or underserved areas. A maximum of 1 percent of the Title 
     III(b) appropriation is authorized to be used for such 
     grants.


                          required agreements

       1. Adds planning and evaluation to activities considered 
     administration and increases the permissible percentage from 
     5% to 7.5%.
       2. Requires applicants to submit evidence that the proposed 
     program is consistent with the statewide statement of need.


                    authorization of appropriations

       1. Reauthorizes the program at such sums as necessary for 
     fiscal years 1996 through 2000.

  Part D--Grants for Coordinated Services and Access to Research for 
                  Women, Infants, Children, and Youth

       1. Clarifies that the purpose of the grants is to (a) 
     provide opportunities for women and children to participate 
     as subjects in clinical research projects and (b) provide 
     health care to women and children on an outpatient basis.
       2. Clarifies that the Secretary may not make a grant unless 
     the applicant agrees: (a) to make reasonable efforts to 
     identify women and children who would be appropriate 
     participants in research and offers the opportunity to 
     participate, (b) to use criteria provided by the research 
     project in such identification, (c) to offer other specified 
     services such as referrals for substance abuse and mental 
     health treatment and incidental services such as 
     transportation or child care, (d) to comply with accepted 
     standards of protection for human subjects.
       3. In order for a grantee to continue receiving funds (in a 
     third or subsequent year), the Secretary must determine that 
     a significant number of women and children are participating 
     in projects of research. Permits the Secretary to take into 
     account circumstances in which a grantee is temporarily 
     unable to comply with this requirement for reasons beyond its 
     control (i.e., completion of the clinical trial). Authorizes 
     the Secretary to grant waivers of the significant number 
     requirement if the grantee is making reasonable progress 
     toward achieving this goal. This waiver authority expires 
     Oct. 1, 1998.
       4. Clarifies that receipt of services is not dependent upon 
     a patient's consent to participate in research.
       5. Clarifies that grant funds are not be to used to conduct 
     research, but to provide services which enable women and 
     children to participate in such research.
       6. Requires the Secretary to establish a list of research 
     protocols to which the Secretary gives priority regarding the 
     prevention and treatment of HIV disease in women and 
     children.
       7. Requires the coordination of the NIH with the activities 
     carried out under this title. Requires the Secretary to 
     develop a list of research protocols which are appropriate 
     for the purposes of this section. Requires the entity 
     actually conducting the research to be appropriately 
     qualified. Specifies that an entity is to be considered 
     qualified if any of its research protocols have been 
     recommended for funding by NIH.
       8. Reauthorizes the program at such sums as necessary for 
     fiscal years 1996 through 2000.


                        evaluations and reports

       1. Requires the Secretary to conduct an evaluation provided 
     for in current law by October 1, 1996.


               special projects of national significance

       1. Modifies the funding source for SPNS. Current law funds 
     SPNS through a 10 percent tap on Title II. The bill would 
     impose a 3 percent tap on all four titles.
       2. Clarifies that special projects should include the 
     development and assessment of innovative service delivery 
     models designed to: address the needs of special populations 
     and ensure the ongoing availability of services for Native 
     Americans.
       3. Requires the Secretary to make information concerning 
     successful models available.


  transfer of the aids education and training centers (aetcs) and the 
                      dental reimbursement program

       1. Transfers to Title 26 from Title 7 of the Public Health 
     Service Act section 776, the AIDS Education and Training 
     Centers (AETCs) and the Dental Reimbursement Program.
       2. Clarifies that training health care personnel in the 
     diagnosis, treatment, and prevention of HIV infection, 
     includes the prevention of perinatal transmission and 
     measures for the prevention and treatment of opportunistic 
     infections.
       3. Reauthorizes both programs at such sums as necessary for 
     fiscal years 1996 through 2000.
       Sec. 4 Amount of Emergency Relief Grants (Cities)
       1. Modifies the Title I formula. Allocations to cities will 
     be based on the estimated number of living cases of AIDS in 
     the area. The number of living cases is determined through a 
     weighted average of cases over the most recent 10 year 
     period.
       Sec. 5 Amount of Care Grants
       1. Modifies the Title II formula. Distributes Part B funds 
     to states based on a formula that calculates two distribution 
     factors: the state factor, based on weighted AIDS case counts 
     for each state and the non-EMA factor based on weighted AIDS 
     case counts for areas within the state outside of Part A 
     eligible areas. The state factor is given a weight of 80% and 
     the non-EMA factor is given a weight of 20%. This formula 
     results in the transfer of funds among states. As a result 
     funding losses are capped at the following percentages 
     relative to FY95 funding levels: 0% in FY96, 1% in FY97, 2% 
     in FY98, 3.5% in FY99, and 5% in FY2000.
       Minimum allotments to states with 90 or more cases is 
     increased from $100,000 to $250,000.
       Funds appropriated specifically for the Drug Assistance 
     Program (an eligible use of funds under Part B) shall be 
     allocated based on states entire weighted case counts. ($52 
     million provided for FY96).
       Sec. 6 Consolidation of Authorization of Appropriations
       1. Reauthorizes Part A and Part B at such sums as necessary 
     for fiscal years 1996 through 2000.
       2. Authorizes the Secretary to develop a methodology for 
     adjusting the amounts allocated to Part A and Part B. 
     Requires the Secretary to report on such methodology by July, 
     1996.
       Sec. 7 Perinatal Transmission of HIV Disease
       1. Requires all states to implement the CDC guidelines on 
     voluntary HIV testing and counseling for pregnant women.
       2. Authorizes $10 million in grant funds to: (a) make 
     available to pregnant women counseling on HIV disease; (b) 
     make available outreach efforts to pregnant women at high 
     risk of HIV who are not currently receiving prenatal care; 
     (c) make available to such women voluntary HIV testing; (d) 
     implement mandatory newborn testing at an earlier date than 
     required. Only states that implement the CDC guidelines are 
     eligible for

[[Page H4358]]

     these funds. Priority is given to states with high HIV 
     seroprevalence rates among childbearing women.
       3. Requires the CDC, with 4 months of enactment, to develop 
     and implement a reporting system for states to use in 
     determining the rate of new AIDS cases resulting from 
     perinatal transmission and the possible causes of 
     transmission.
       4. Requires the Secretary to contract with the Institute of 
     Medicine to conduct an evaluation of the extent to which 
     state efforts have been effective in reducing perinatal 
     transmission HIV and an analysis of the existing barriers to 
     further reduction in such transmission.
       5. Within two years following the implementation of the CDC 
     reporting system, the Secretary will make a determination 
     whether mandatory HIV testing of all infants in the US whose 
     mothers have not undergone prenatal HIV testing has become a 
     routine practice. This determination will be made in 
     consultation with states and experts. If the Secretary 
     determines that such testing has become routine practice, 
     after an additional 18 months, a state will not receive Part 
     B funding unless it can demonstrate one of the following:
       (a) A 50% reduction (or a comparable measure for states 
     with less than 10 cases) in the rate of new AIDS cases 
     resulting from perinatal transmission, comparing the most 
     recent data to 1993 data:
       (b) At least 95% of women who have received at least two 
     perinatal visits have been tested for HIV; or
       (c) A program for mandatory testing of all newborns whose 
     mothers have not undergone perinatal HIV testing.
       6. Requires states which implement mandatory testing of 
     newborn infants to prohibit health insurance companies from 
     discontinuing coverage for a person solely on the basis that 
     the person is infected with HIV or that the individual has 
     been tested for HIV. Prohibition does not apply to persons 
     who knowingly misrepresent their HIV status.
       Sec. 8 Spousal Notification
       1. Prohibits the Secretary from making a grant to a State 
     unless the state takes such action to require that a good 
     faith effort be made to notify a spouse of a known HIV 
     infected person that such spouse may have been exposed to HIV 
     and should seek testing.
       Sec. 9 Optional Participation of Federal Employees in AIDS 
     Training Programs
       1. Provides that a Federal employee may not be required to 
     attend or participate in an AIDS or HIV training program if 
     such employee refuses, except for training necessary to 
     protect the health and safety of the employee (training in 
     universal precautions to prevent transmission of HIV). 
     Provides that an employer may not retaliate in any manner 
     against such employee.
       Sec. 10 Prohibition on Promotion of Certain Activities
       1. Prohibits funds being used to develop materials, 
     designed to promote or encourage, directly, intravenous drug 
     use or sexual activity, whether homosexual or heterosexual.
       Sec. 11 Limitation on Appropriation
       1. Provides that the total amounts of Federal funds 
     expended in any fiscal year for AIDS and HIV activities may 
     not exceed the total amounts expended in such fiscal year for 
     activities related to cancer.
       Sec. 12 Additional Provisions
       1. Adds funeral service practitioners to the definition of 
     emergency response employee.
       2. Makes technical and conforming changes.
       Sec. 13 Effective Date
       1. The effective date is October 1, 1996 except for the 
     following provisions, for which the effective date is the 
     date of enactment: (a) eligibility of new cities under Part 
     A; (b) formula for Part A; (c) formula for Part B; (d) 
     provisions concerning perinatal transmission of HIV; (e) 
     consolidation of authorization for Part A and Part B; and (f) 
     the set-asides for Special Projects of National Significance.

  Mr. Speaker, I urge my colleagues to join me in supporting this 
important conference report.
  Mr. Speaker, I reserve the balance of my time.
  Mr. WAXMAN. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I am extremely pleased we have completed our work on the 
House-Senate conference and we have reached an agreement to allow us to 
reauthorize the Ryan White Act. This is an important program in dealing 
with the AIDS epidemic throughout this country.
  I think from the very beginning of this reauthorization everyone 
wanted to continue the program, but we had some issues that we had to 
resolve. One issue that took some discussion was the question of how to 
direct our attention to deal with trying to prevent the transmission of 
AIDS to newborns.
  Appropriately, the conference said that we should put an emphasis on 
encouraging pregnant women to be tested so that if they were HIV 
positive and undertook therapy, they could in fact stop the 
transmission of HIV to the newborn. But in the case where there has not 
been a test with the mother, we wanted to establish a procedure for 
having newborns tested. I think we came up with a good compromise 
position that will move things in the right direction and deal 
constructively with this problem.
  The second area that we had to resolve were the funding formulas for 
distribution of money under this act to cities and to States under 
title I and title II. It makes sense to continue the two separate 
authorizations for these two titles. Second, we agreed in changes in 
the formulas which were designed in light of new information and the 
changing nature of the AIDS epidemic. We did not want to allow large 
shifts in funding that cities and States severely affected by the 
epidemic would face, so we did have tight limits on any losses from 
these areas.
  In addition, we tailored the funding formulas appropriately to take 
into account the continuing enormous need for funding in States and 
cities like my own State of California and Los Angeles district, as 
well as the State and city of New York, States of Florida and Texas, 
and others where the AIDS epidemic began and where it will always 
remain a significant problem.
  On a personal note, I am pleased that the formulas we adopted do 
result in significant increases of funds for Los Angeles and for the 
State of California, where the need for services for people with HIV 
and AIDS and for access to drug therapies for the very large number of 
affected people remains to severe problem.
  Mr. Speaker, in conclusion, and I am going to make a further 
statement for the Record to reflect the views that I have on this 
legislation, let me say I am extremely proud to have been the original 
author of the Ryan White CARE Act and to have been a part of its 
reauthorization. This is a law that has worked, and it will continue to 
be an integral and essential part of this country's response to the 
AIDS epidemic.
  I want to express my appreciation to the chairman of the Committee on 
Commerce, Mr. Bliley, and the chairman of the Subcommittee on Health 
and the Environment, Mr. Bilirakis, for the cooperative and truly 
bipartisan way in which this legislation has proceeded. I want to 
acknowledge the hard work of the GAO staff who helped us with title I 
and II formula calculations, and I want to thank the committee staff, 
Melody Harned of the majority and Kay Holcombe of the minority, for 
their significant contributions to this process.
  Mr. Speaker, I am extremely pleased that we have completed our work 
in the House-Senate conference and have reached agreement about the 
reauthorization of the Ryan White CARE Act. Programs under this Act 
provide health care services for people with HIV disease and AIDS 
throughout this country, through public health departments in cities 
and states; through community-based organizations; and through a 
variety of primary care providers and social service organizations 
dedicated to helping patients and families affected by this devastating 
disease. One very important Ryan White program focuses on the need for 
more research on AIDS and HIV disease in woman and children. Another 
focuses on programs directed toward prevention of HIV infection and 
AIDS. In total, this legislation represents a successful and very 
important comprehensive approach to HIV and AIDS, and its 
reauthorization is surely among the most significant legislative 
accomplishments of this Congress.
  I think from the very beginning of this reauthorization, Members on 
both sides of the aisle and on both sides of the Capitol have 
completely agreed on one point: that we should reauthorize these 
important programs. We did, however, have several areas of difference 
which needed to be resolved and have been resolved in the conference. 
One of these related to the matter of HIV testing of women and 
newborns. This is a difficult and contentious issue, and I am extremely 
pleased that we were able to reach agreement.
  Under this agreement, we have broadened the grant program included in 
the House bill so that grants can be used to assist States to implement 
the CDC guidelines relating to counseling and voluntary HIV testing of 
pregnant women, as well as to determine the HIV status of newborns. I 
am especially pleased with this change because I think it places 
emphasis where we can do the most good--preventing the perinatal 
transmission of HIV infection. The legislation then asks the Secretary 
to make a determination, in consultation with appropriate medical 
organizations, about whether it is the standard of practice in medicine 
to test newborns for HIV. If the Secretary makes this determination, 
then, in order to continue to receive Title II funding under Ryan 
White,

[[Page H4359]]

States would need to meet one of two performance standards. The State 
could demonstrate that, through voluntary counseling and testing 
programs, it is determining the HIV status of 95 percent of women who 
are in prenatal care. Alternatively, the State can demonstrate that it 
has reduced pediatric AIDS, contracted through perinatal transmission, 
by 50 percent, compared to the 1993 level. This date is important in 
that it reflects the time at which we learned that treatment of HIV-
positive pregnant women with AT can prevent perinatal transmission.
  Only if States cannot demonstrate the achievement of one of these 
specified goals would they be required to put in place either 
legislative or regulatory requirements relating to the mandatory HIV 
testing of newborns, as a condition of their continuing to receive 
title II funding under the Ryan White Act.
  Further, any State that did choose this route would be required to 
have in place important protections such as requirements that health 
insurance could not be denied or canceled, based on the fact that an 
individual has been tested or is HIV-positive. These provisions are 
over and above the protections already provided in the Americans with 
Disabilities Act and under applicable State law.
  The ADA requires that all persons with disabilities--including those 
with HIV or AIDS--be protected from arbitrary insurance discrimination. 
In other words, under the ADA, an employer or insurance company cannot 
treat people with HIV or AIDS differently from people with other 
serious conditions that pose equal financial risk. That is clear.
  Many State laws also provide a State remedy already for such 
discrimination. That is also clear.
  The Coburn-Waxman amendment as included in this bill would go further 
and provide protection to people who have simply undergone testing for 
HIV, whether or not they are perceived by the insurance company as 
having HIV. The goal of this amendment is clear. We are all trying to 
reduce any disincentives for anyone to be tested. The Coburn/Waxman 
amendment also provides a different enforcement device to assure that 
such discrimination is prohibited, that is, that States could lose 
their Ryan White money.
  With all three of these protections in place--ADA, State law, and 
Ryan White, the conferees feel that we will make significant public 
health strides in getting people who may be afraid of being tested less 
afraid.
  I am pleased with this result, because I think we have placed the 
emphasis where it should be--not on testing as an end in itself, but on 
reducing the number of babies born with HIV. Reaching pregnant women, 
and educating them about the importance, both to them and to their 
babies, of knowing their HIV status at a time when it will do the most 
good and actually prevent perinatal HIV transmission, is what we should 
be doing. After all, our goal here is to stop the transmission of HIV 
to babies. I think this compromise emphasizes and also helps us achieve 
that goal.
  A second issue that has proven difficult to resolve is how funding 
under this act is distributed to cities and States. The conference 
report deals with these issues in three ways. First, the conferees 
agreed that, particularly in light of the increases in funding for both 
titles I and II under the fiscal year 1996 appropriations bill, it made 
sense to continue authorizing two separate appropriations for these two 
titles. Second, we agreed that although changes in the formulas were 
designed were needed, in light of new information and the changing 
nature of the AIDS epidemic, we did not want to allow such large shifts 
in funding that cities and States severely affected by the epidemic 
could not absorb them. Thus, while we have agreed to make significant 
changes in the way funds are allocated to cities and States, we have 
placed tight limits on losses.
  In addition, we have tailored the funding formulas appropriately to 
take account of the continuing enormous need for funding in States and 
cities, like my home State of California, and my Los Angeles district, 
as well as the State and city of New York, and the States of Florida 
and Texas, and others where the AIDS epidemic began and where it always 
will remain a significant problem.
  On a personal note, I am pleased that the formulas we adopted do 
result in significant increases of funds for Los Angeles, and for the 
State of California, where the need for services for people with HIV 
and AIDS and for access to drug therapies for the very large number of 
affected people remains a severe problem.
  Mr. Speaker, in conclusion let me say that I am extremely proud to 
have been an original author of the Ryan White CARE Act and to have 
been a part of its reauthorization. This is a law that has worked and 
will continue to be an integral and essential part of this country's 
response to the AIDS epidemic.
  And finally, I want to express my appreciation to the chairman of the 
Commerce Committee, Mr. Bliley, and the chairman of the Health 
Subcommittee, Mr. Bilirakis, for the cooperative and truly bipartisan 
way in which this legislation has proceeded. I want to acknowledge the 
hard work of the GAO staff, who helped us with the title I and II 
formula calculations. I particularly want to thank the committee 
staff--Melody Harned of the majority and Kay Holcombe of the minority--
for their significant contributions to the process.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BILIRAKIS. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
Maryland [Mrs. Morella].
  Mrs. MORELLA. I thank the gentleman for yielding me the time.
  Mr. Speaker, I rise in support of the passage of the Ryan White CARE 
Act, and I congratulate the conferees on their persistence in reaching 
agreement on several difficult issues. A final agreement on this 
reauthorization bill has been a long time in coming, and it is critical 
that we pass this bill today.
  The CARE Act provides medical care to more than 350,000 people living 
with HIV/AIDS. Under the Act, local communities make the decisions as 
to how funding should be allocated, in a manner consistent with this 
Congress' efforts to give States and localities greater control.
  In regard to the issue of HIV testing for infants and pregnant women, 
I commend the conferees for choosing to focus on the voluntary testing 
of pregnant women, instead of the mandatory testing of infants. This 
approach is supported by the medical and public health community as the 
most effective way of preventing perinatal transmission of HIV. The 
final provisions include funding to assist States to implement the CDC 
guidelines which call for voluntary HIV counseling, testing, and 
treatment for pregnant women.
  Mr. Speaker, every Member here agrees that we must do everything 
possible to reduce perinatal transmission of HIV. The CDC guidelines 
will provide access to early interventions that will actually prevent 
perinatal transmission, and link them to HIV care and services.
  Preserving a patient-provider relationship of trust is essential to 
keeping women in the health care system. Many voluntary counseling and 
testing programs exist, at Harlem Hospital and others; the physicians 
who run these programs will tell you that it is because the testing is 
voluntary that they are successful. In these programs, almost all 
women, after talking with their provider, will choose testing and the 
treatment recommended by their provider. We should devote our resources 
to replicating these models, rather than to efforts that will do 
nothing to prevent perinatal transmission.
  Mr. Speaker, this bill is not perfect, but is the best agreement that 
could be reached.
  Mr. Speaker, I congratulate the chairman of the subcommittee, the 
full committee, the ranking member of the full committee, the 
subcommittee, and the conferees. We should all vote for this bill.
  Mr. WAXMAN. Mr. Speaker, I yield 2 minutes to the gentleman from 
Massachusetts [Mr. Studds], who played such a very important role in 
the work on the Ryan White bill and our approach to the full AIDS 
epidemic.
  (Mr. STUDDS asked and was given permission to revise and extend his 
remarks.)
  Mr. STUDDS. Mr. Speaker, as an original cosponsor of this 
legislation, I rise to express my strong support for the conference 
report. This agreement is a welcome one which was far too long in 
coming.
  Nearly 6 years ago, I joined with colleagues on both sides of the 
aisle in passing the Ryan White Care Act. Since then, this legislation 
has been a lifeline for hundreds of thousands of people in States and 
communities across the land.
  We could not know then that AIDS would become the primary killer of 
American men and women in the prime of their lives. Nearly half a 
million cases have been reported to the Centers for Disease Control and 
Prevention, and nearly half that number have died. Included in those 
sobering statistics are two former Members of this House and many 
members of our families and our official family.
  As the AIDS epidemic has expanded, it has placed an enormous burden 
on the public health system, including both the communities in which 
the early cases were concentrated and

[[Page H4360]]

those in which significant case loads are a more recent development. 
The public health burden has also increased with the emergence of 
promising but costly new drugs for treating the disease. The conference 
report attempts to reconcile these competing demands in a way that will 
help ensure continuity of care for every person living with HIV/AIDS.
  I would also like to say a word about one provision that has 
attracted a good deal of attention and concern--the portion of the bill 
dealing with the HIV testing of newborns. The compromise that has been 
reached is precisely that--a compromise. On the one hand, it affirms 
explicitly what I think we are believe: That every pregnant woman 
should be tested for the AIDS virus, that those who test positive 
should be offered the best treatments currently available, and that the 
soundest and surest way of ensuring that both of these things will 
happen is to provide the woman with counseling and voluntary testing.
  On the other hand, a State that fails to meet specified targets 
through these voluntary measures could conceivably find its title II 
funding curtailed unless it agrees to institute mandatory testing of 
newborn infants. While I respect the convictions of those who favor 
such a result, the simple fact is that mandatory newborn testing cannot 
prevent HIV transmission from mother to child and is not supported by 
the responsible medical community.
  Under the conference agreement, no State would be required to 
institute mandatory testing of newborns unless the Secretary finds that 
the medical community has changed its mind and such testing has become 
routine practice. In essence, it could not be required unless it is 
already taking place--a logic which Yogi Berra would surely appreciate. 
Nevertheless, I think it would have been wiser to give State health 
authorities the resources they need to implement voluntary testing 
without holding a gun to their heads and threatening the very funds on 
which so many vulnerable people depend.
  Fortunately, the agreement we have reached virtually assures that no 
State will ever be put in that position. I believe the provision will 
allow every State to reduce its rate of perinatal transmission by 
voluntary means to a level and within a time frame that is both 
achievable and desirable, in a manner that is respectful of the 
critical relationship between the woman and her physician.
  The effort to reauthorize this legislation has been a long and 
tortuous process. It has been, from first to last, a bipartisan effort. 
This is as it should be, for the AIDS virus does not discriminate by 
race or creed or sexual orientation--or even by party affiliation. This 
is a crisis that compels us to put aside such differences, and I 
commend Chairman Biliey, Mr. Bilirakis, Mr. Waxman, and our fellow 
conferees for doing so.
  I urge my colleagues to join together in that spirit to pass the 
conference report without delay.
  Mr. BILIRAKIS. Mr. Speaker, I yield 3 minutes to the gentleman from 
California [Mr. Bilbray], a member of the subcommittee.
  Mr. BILBRAY. Mr. Speaker, I would like to commend Chairman Bilirakis 
and the ranking member of our Health Subcommittee, Mr. Waxman, for the 
cooperative effort that we see here today. I hate to say it is too bad, 
that you watch, you will not see this on the front page of the papers 
or you are not going to see this on national television, the 
cooperative effort on something that is a major, health issue. I hope 
we see more of this kind of cooperation and I hope that the American 
people take notice of this success.
  I am pleased to see the conference report, Mr. speaker, that 
adequately funds the communities that are in desperate need of these 
funds to be able to address the heavy impacts of AIDS and HIV. I am 
also very pleased to see that this legislative piece actually directs 
and corrects some of the mistakes that were made from the past.
  Both Republicans and Democrats have worked together at developing a 
formula that is fair and equitable and truly applies to the need. The 
old formula actually had misconstrued numbers in it, Mr. Speaker, where 
there were actually communities getting funds based on numbers of 
people that had already passed away.

                              {time}  1845

  I do not think anybody meant that to happen. What I am very proud of 
is this body, bipartisanly, has been able to work together to 
straighten out the mistakes of the past and make the Ryan White CARE 
Act not only stronger and better, but also fairer.
  I would like to take a moment to address one item, and that is an 
item brought up, and that is the issue of testing. I have an AIDS 
Advisory Committee member in my district that consists of health care 
experts and also advocates in San Diego for the AIDS community. They 
express major concerns about the mandatory testing component that was 
originally included. But by trying to work together and find a good 
compromise, this bill, through the conference process, has been able to 
work it out and actually present an alternative.
  I think the conference report addressed the concerns that allow the 
time in the States of this Union to be able to work with the Centers 
for Disease Control and their regulations to make a voluntary system 
that will work out, to counsel pregnant women, make sure there is the 
money, up to $10 million, to help not only to test, but also to counsel 
in the case of high risk women who fall in this category.
  With this compromise, we are able to get the job done. We are going 
to be able to break new ground, enter into new territory, and try to be 
more proactive in the first truly aggressive prevention strategy. I 
think that we should be very proud of that, Mr. Chairman.
  I understand that my advisory committee looked at this compromise, 
and though they had major concerns about the original proposal, feel 
that this is a very sound and humane way to approach this. I think it 
is one of those issues that will show that we not only can be humane, 
but we can also be smart and intelligent. With a crisis like the AIDS 
crisis we are confronted with, this is going to be something we need to 
do more of.
  Again, I thank Chairman Bilirakis and also my colleague from 
California for a job well done, and let us begin with this as an 
example of what we need to do more of, and not allow it to end here.
  Mr. WAXMAN. Mr. Speaker, I yield 2 minutes to the gentleman from New 
York [Mr. Towns], a very important member of the subcommittee who 
played an active role in the reauthorization of this legislation.
  Mr. TOWNS. Mr. Speaker, I am very pleased that we finally have the 
opportunity to vote on a conference concerning the reauthorization of 
the Ryan White CARE Act. I want to particularly commend the Chairman of 
the committee, the gentleman from Florida [Mr. Bilirakis], for his 
tireless efforts to reauthorize this legislation. I want to also thank 
the ranking minority member, the gentleman from California [Mr. 
Waxman], for his work not only on this bill but also for the tremendous 
role he has played in the past in working on the Ryan White Act. And, I 
am certain the majority and minority staff are to be equally commended 
for their efforts.
  There is no more critical issue than funding for health care services 
to combat the AIDS virus. Those of us from New York State continue to 
have the unfortunate distinction of the highest number of AIDS and HIV 
infection cases in the Nation. In fact, the Ft. Greene community in my 
congressional district, has the highest incidence of new AIDS cases of 
any area in New York City.
  Mr. Speaker, Ryan White programs have been critical to New York's 
ability to provide a continuum of care which has greatly improved the 
quality of life for people with AIDS and HIV infection. For example, as 
a result of Ryan White dollars, the HIV/AIDS dental program was able to 
provide over $300,000 to Brooklyn Hospital in my district for oral 
health services to AIDS patients who had little or no dental insurance.
  The changing nature of the AIDS epidemic and its impact on minority 
communities is recognized in this legislation. The average person would 
assume that the leading cause of death for African-American men is 
homicide. They would be wrong, however. AIDS now kills more black men 
than gunshot wounds. Eighty-four percent of the

[[Page H4361]]

AIDS cases involving children, age 12 and under, can be found in the 
Black community. And, AIDS has now become the second leading cause of 
death for black women. I.V. drug use and T.B. have exacerbated these 
mortality statistics in minority communities.
  It is my hope, Mr. Speaker, that with today's action we can move 
quickly to provide the funds that our cities and small towns so 
desperately need to address the AIDS crisis in communities across this 
Nation. I believe that this reauthorization of the Ryan White CARE Act 
meets the needs of rural and suburban areas without devastating our 
metropolitan areas, which still have the burden of treating the largest 
number of AIDS and HIV infected patients.
  This bill has been a long time coming, and I am happy we were able to 
get through the conference process and where we are today. I would like 
to encourage my colleagues to vote for the passage of this legislation.
  There is a need for this legislation to pass and to pass very 
quickly. I am not totally pleased with the formula, but I am happy that 
some sensitivity was shown to those large areas, those metropolitan 
areas, that have a severe crisis.
  So I would like to again salute the leadership on both sides, the 
minority and the majority, for taking these factors into consideration. 
It is not perfect and a lot still needs to be done, but I am happy we 
are moving in the right direction.
  Mr. BILIRAKIS. Mr. Speaker, I yield 2 minutes to the gentleman from 
Wisconsin [Mr. Klug], a member of the subcommittee and full committee.
  Mr. KLUG. Mr. Speaker, to my colleagues on the Health Subcommittee on 
Commerce, this is a nice way to end the day after fairly contentious 
hearings on trying to figure out a way to reform the Food and Drug 
Administration, so that we can get pharmaceutical products and medical 
devices to the market faster, but at the same time not compromising 
public safety.
  This is a fitting end for the day, because we end occasionally, as 
this subcommittee can, and I hope will more often in the future, in a 
strong spirit of bipartisan cooperation to move forward a very 
important piece of legislation.
  This is an interesting kind of coming together of the minds, not only 
from both sides of the aisle, but, frankly, an interesting 
collaboration from people who represent very different parts of the 
country.
  I represent Madison, WI, which, like most other smaller cities in the 
United States, also has AIDS problems. But in the past we feel that we 
have been shortchanged because so many of the resources were plowed 
into New York and San Francisco, which obviously just based on current 
numbers had a much more serious problem. But in the future communities 
like Madison and Milwaukee will be just as dramatically impacted. I am 
glad to see the gentleman from California [Mr. Waxman] and the 
gentleman from Florida [Mr. Bilirakis], as well as the gentleman from 
Michigan [Mr. Dingell] and the gentleman from Virginia [Mr. Bliley], 
were able to move closer to Senate spending levels, which at the end of 
the day frankly will take funding in Wisconsin that was just a little 
bit over $1 million and, with the different kind of grant programs, 
push it to nearly $2 million.

  I think we have all learned over the last decades that AIDS affects 
every part of the country, and, obviously, given the name of the bill 
itself, affects very different demographic groups, whether it is a 
young boy who has been victimized by the AIDS virus as a result of 
being exposed to hemophilia in a blood transfusion, or somebody who 
contracts AIDS from intravenous drug users, or whatever the case may 
be. The bottom line is all of those people need compassion and at the 
end all of those people need money.
  Again, I congratulate the gentleman from Florida [Mr. Bilirakis] for 
his leadership, and the gentleman from California [Mr. Waxman] for all 
of his help on this bill as well.
  Mr. WAXMAN. Mr. Speaker, I am pleased to yield 2 minutes to the 
gentleman from New York [Mr. Ackerman].
  (Mr. ACKERMAN asked and was given permission to revise and extend his 
remarks.)
  Mr. ACKERMAN. Mr. Speaker, I rise in full support of the conference 
report and want to take a moment to thank the chairman and the ranking 
member of the subcommittee and the full committee as well for the hard 
work and dynamic leadership that they have exhibited in bringing all 
parties and points of view together in this very, very important 
legislation.
  I want to especially take a moment to acknowledge the hard work and 
important work that has been done in what has been called the AIDS baby 
part of this legislation. This is a very, very important and creative 
first step that we are taking, first emphasizing as strongly as we can 
the voluntary aspects, to try to get as many pregnant women counseled 
and tested for the HIV virus and then absent that, or after that, to 
whatever extent that does or does not work, and we all hope that will 
be as effective a method as possible, to then take those neonates whose 
mothers' HIV status is unknown, and to mandatorily test them so as to 
be able to save additional lives and to put off the onset of so much 
tragedy and emotion in so many people's lives.
  I want to thank the members of the conference committee and urge 
everybody to support the report.
  Mr. BILIRAKIS. Mr. Speaker, I yield 3 minutes to the gentleman from 
Wisconsin [Mr. Gunderson].
  (Mr. GUNDERSON asked and was given permission to revise and extend 
his remarks.)
  Mr. GUNDERSON. Mr. Speaker, first I rise in support of the conference 
report; to the commitment tonight continues. Second, I rise to extend 
my deep and sincere appreciation to the gentleman from Florida [Mr. 
Bilirakis], the chairman of the subcommittee, to the gentleman from 
Virginia [Mr. Bliley], chairman of the full committee, certainly to the 
gentleman from California [Mr. Waxman], to the gentleman from Oklahoma, 
[Mr. Coburn], and others who have worked so hard to bring this day to 
its reality.
  The fact is that this is a difficult process and there were some 
issues that were obviously very difficult, the infant testing issue, 
the formula for title II. But both of those issues have been resolved 
in, I think, a very positive and constructive way.
  I can tell you from a Wisconsin perspective, because we now have some 
reforms in the title II program, we can look toward an increase in our 
funding in 1996 over 1995 of from $1 million to $1.5 million. In 
addition, because we now have a drug assistance program, we can look at 
the potential because it has been funded under the appropriation 
process, of literally $254,000 in that regard.
  I would hope that we would send a message tonight, a message that has 
been developed over the last 2 weeks, that shows that this Congress on 
a bipartisan basis, and, yes, that includes the Republican majority, 
has sent the word that we understand and we care and we want to help. 
We did it first and foremost last week when we repealed the DOD-HIV 
provisions. We did it second last week when we included money for the 
AIDS drug assistance program, because we recognize that the new 
protocols are there but the funding is going to be one of the emerging 
challenges in the next few years to deal with in this area. We did it, 
third, because we increased the overall funding for Ryan White. Whoever 
thought under a Republican-controlled Congress that we would stand here 
tonight and tell you that Ryan White funding is up 17 percent over what 
it was last year? And now, tonight, we bring you a reauthorization of 
the Ryan White program.
  It has been a good two weeks and it is important. Many of you recall, 
certainly those of you who attended that hearing that began this 
reauthorization process a few months ago when Mr. Bilirakis gave me the 
honor of being the lead witness, I brought a former Republican staff 
member who had retired November a year ago with AIDS with me to that 
witness table and said ``Hear from one of our own on Capitol Hill who 
has AIDS.''
  Tonight as we pass this reauthorization, some 8 months later, his 
partner died of AIDS in November, and he lies in Sibley Hospital 
himself tonight as the ravage of this disease continues. I think it is 
important as those among the 300,000-plus in this country who have lost 
their life to AIDS, and the over 1 million who continue to battle the 
fight continue, that they know as

[[Page H4362]]

their battle goes on they do it with the support of the U.S. Congress.
   Mr. Speaker, I am happy to speak in favor of the Ryan White CARE 
Reauthorization Act conference report. To say that this reauthorization 
has been a long time in coming may be an understatement. Certainly, we 
all had hoped that this reauthorization could have been completed 
sooner, but the issues this conference committee grappled with were 
delicate and complex. Importantly, their deliberations were careful and 
fair, and I think that their final product is one of which they can be 
proud and which we should all support. I congratulate the conference 
committee on their work. I plan to vote in favor of this conference 
report, in favor of reauthorization, and I urge my colleagues to do the 
same.
  HIV disease, including AIDS, is devastating and has already wreaked a 
tremendous toll on this country and its citizens. The Centers for 
Disease Control and Prevention [CDC] reports that over a half million 
Americans have been diagnosed with AIDS, and that already over 300,000 
have died. It is estimated that approximately 650,000 to 1 million more 
Americans are infected with HIV, and that roughly 40,000 new infections 
occur in the United States each year. The costs, financially, 
emotionally, socially, and legally, that HIV has extracted from this 
country have been great, but what these projections indicate is that 
they will only increase in the years ahead. The Ryan White CARE Act 
programs represent the most visible and significant response the 
Federal Government has made to the HIV epidemic. It has provided 
services and support for thousands of people affected by this disease, 
and through this reauthorization, we can insure that such programs will 
continue to be available for the next 5 years.
  I would like to offer a few comments on some of the specific 
successes that I see in the reauthorization conference report. I view 
these as successes because workable and bipartisan compromises were 
reached, compromises that will allow us to move forward in effectively 
meeting the challenges HIV poses to this country.
  First, funds for emergency assistance programs, those programs that 
serve metropolitan areas hit hardest, and for comprehensive care 
programs, will be linked and appropriated based on a plan devised by 
the Health and Human Service Secretary. This linkage will help prevent 
needless fighting for funds within the AIDS community and between 
different organizations and advocates that all have the common goal of 
improving the lives of people affected by HIV. In addition, the big 
picture of the HIV epidemic will most likely determine the disbursement 
of funds rather than narrowly circumscribed geographic regions or 
special interests.

  In addition, the formula that was adopted for the distribution of 
title II, or part B, funds moves toward greater fairness. Previously, 
all funds were distributed based on all AIDS cases in a State. AIDS 
cases are not distributed equally across States, however, so there was 
great disparity in the funding levels for different States. But, the 
suffering caused by AIDS knows no State boundaries and is not limited 
to the States with the highest case counts. The new formula recognizes 
this important fact and disburses funds based on total AIDS case counts 
in a State as well as AIDS case counts that occur outside of hard-hit 
metropolitan areas.
  My home State of Wisconsin, for example, has reported 3,239 cases for 
AIDS through March 1996. This total may not sound like much to my 
colleagues from New York, California, Florida, or Texas. But, the fact 
remains that for each of these cases, there is an individual whose life 
has been irrevocably changed, who faces new challenges everyday, and 
whose family and friends have been affected. Many of us know firsthand 
the pain of HIV and AIDS, including the pain of losing a loved one too 
early, and this pain is not diminished simply because we live in a low 
incidence area or State.
  In addition, the CDC recently reported that the rate of proportionate 
increases in AIDS cases was high in the Midwest, and higher than the 
rates in the Northeast and West. In fact, during the period between 
1993 and October 1995, higher proportions of cases among adolescent and 
young adults occurred in small metropolitan and rural areas in the 
Midwest and the South. Total case counts do not reveal the depth of 
suffering inflicted by AIDS, nor do they reveal where changes in 
transmission patterns are occurring. The new formulas for distributing 
funds move us forward in being responsive to these changes and to 
alleviating the suffering of all Americans affected by HIV.
  Also in the name of fairness, this reauthorization stipulates that 
money to support AIDS drug programs, appropriated at $52 million in 
fiscal year 1996, will be based on total case counts. The committee has 
adopted the simple and compelling logic that these drugs and drug 
programs are intended to benefit anyone and everyone in a State with 
HIV disease. As long as funds for drugs and treatments remain a 
separate provision in appropriations, they will continue to be 
distributed based on the numbers of people who are affected in a State.
  Lastly, there is a provision in the reauthorization that insures that 
cities that receive funds under title I will not lose money. For the 
first 2 years, these cities are held harmless and the funds that could 
be lost are capped at 5 percent in fiscal year 2000. Thus, there is 
relative insulation from dramatic changes in funding levels, even if 
there are substantial changes in AIDS case counts.
  These formulas for distributing funds, complicated as they may be, 
insure that there are no losers. The States with relatively large case 
counts are protected from losing money, yet the new formulas benefit 
States with relatively few cases, too. It is a delicate balance to 
divide funds to combat a truly national epidemic; this conference 
report has successfully accomplished this difficult task.

  Another issue on which a delicate compromise has been crafted has to 
do with perinatal testing for HIV. HIV testing, and whether it should 
be anonymous or confidential, mandatory or voluntary, has long been a 
controversial topic. I believe that testing today is a critical part of 
good public health. Recent advances in the treatment of HIV disease 
have been developed and are becoming increasingly available. To test 
HIV positive is no longer the death sentence that many perceived it to 
be previously. For individuals to access these new and effective 
treatments, however, they must know that they are HIV positive. Testing 
should be encouraged and should take place in a supportive and 
sensitive context. With respect to pediatric HIV, scientific research 
also has indicated that early treatment of a mother can reduce the 
risks that her baby will be born with HIV.
  An important piece of this reauthorization is the way in which 
perinatal testing has been addressed. Rather than imposing a strict and 
perhaps impossible testing standard on all States, the reauthorization 
is flexible in its treatment of different States. In addition, critical 
goals or guideposts are laid out by which States can gauge their 
progress toward eliminating needless and tragic infant HIV infection. 
The conference committee has succeeded in providing carrots and not 
just sticks for implementing effective HIV testing programs as well as 
evaluation criteria by which success can be judged.
  To conclude, I urge a vote in favor of this conference report. Let 
all of us demonstrate our compassion, concern, and commitment to 
fighting the HIV epidemic in this country and to ensuring the high 
quality of life of Americans affected by HIV disease.
  Mr. WAXMAN. Mr. Speaker, I am pleased to yield 2 minutes to the 
gentlewoman from Texas [Ms. Jackson-Lee].
  (Ms. JACKSON-LEE of Texas asked and was given permission to revise 
and extend her remarks.)
  Ms. JACKSON-LEE of Texas. Mr. Speaker, may I take a moment of 
personal privilege to offer my gratitude to the conference committee, 
to the leadership, the Republican leadership, and chairman and ranking 
member, and as well to the ranking member and subcommittee chairs that 
have worked so actively. In particular, let me add my applause and 
appreciation to the gentleman from California [Mr. Waxman] who has 
visited the 18th Congressional District in Texas and noted in fact that 
my district has one of the highest rates of HIV cases in this Nation.
  So I humbly come to applaud the work, primarily because we should 
recognize that HIV is not a respecter of sex or race. High numbers of 
Hispanics and African-Americans in my community are now suffering from 
HIV.
  This effort, the Ryan White CARE Act, also brings groups together, 
those who are in a different lifestyle, along with other members of the 
community. It is important to know that this HIV, which results in 
AIDS, affects people of all ages, genders, races, social and economic 
status and sexual orientations.
  In the years following the disease's discovery, nearly half a million 
Americans have been diagnosed with AIDS and more than a quarter of a 
million men and women and children have died of AIDS. In Texas, the 
cumulative number of reported AIDS cases from the beginning of the 
epidemic in 1981 through 1994 is 30,712. The cumulative number of 
reported AIDS deaths for this time period is 18,435.
  When I visited the Thomas Street Clinic that works not only with 
adults between the ages of 25 to 44, but senior citizens and children, 
I see the grip of AIDS. More importantly, I think it is important that 
this conference committee has come together to allow for voluntary 
testing of pregnant women

[[Page H4363]]

and as well counseling. That helps the unborn child, the innocent 
child. That will help as we look toward the total elimination of the 
HIV virus and its devastation.
  Again let me add through the Ryan White program, over 300,000 
Americans living with HIV receive community-based care and support that 
allows them to live in their homes and neighborhoods. I join and hope 
my colleagues will give this an enormous vote of confidence by voting 
for the Ryan White CARE Act of 1996.
  Mr. Speaker, let me again applaud my colleagues so that we can work 
together to ensure that people will live and not die from HIV.
  Mr. Speaker, I rise today in support of the conference report for the 
Ryan White CARE Act Amendments of 1996. Next to the Medicaid Program, 
the Ryan White CARE Act represents the single largest Federal 
investment in the care and treatment of people living with HIV/AIDS in 
the United States.
  This act authorizes a set of Federal grant programs to provide 
assistance to localities disproportionately affected by the HIV 
epidemic. Grants are made to States, to certain metropolitan areas, and 
to other public or private nonprofit entities both for the direct 
delivery of treatment services and for the development, organization, 
coordination, and operation of more effective service delivery systems 
for individuals and families with the HIV disease. The CARE Act 
supports a wide range of community based services, including primary 
and home health care, case management, substance abuse treatment and 
mental health services, nutritional and housing services. Through Ryan 
White programs, over 300,000 Americans living with HIV/AIDS receive 
community-based care and support that allows them to live in their 
homes and neighborhoods and avoid costly in-hospital care, care that is 
currently the most expensive kind of health care in America. 
Particularly in the urban AIDS epicenters, Ryan White funds form a 
safety net holding communities that have been devastated by the 
epidemic together.

  The CARE Act promotes cost effective systems of care for people 
living with HIV/AIDS. The use of case management services and community 
based alternatives ensures that the federal government is using its 
resources most effectively. Similarly, antibody testing and early 
intervention services provided through title III(B) allow individuals 
to monitor their health status on a regular basis and receive early, 
preventative care, rather than waiting until an acute episode requires 
more costly hospitalization.
  The CARE Act provides maximum flexibility to cities and States, 
allowing them to develop local systems of care based on the specific 
service needs of people living with HIV/AIDS in their area. Title I of 
the CARE Act requires that each local HIV services planning council--
comprised of local public health, community-based service providers and 
people living with HIV/AIDS assess local needs and make recommendations 
as to which services are needed. Similarly, through title II, each 
State is given maximum flexibility to craft a service mix that is 
responsive to the specific service needs in that State.
  One of the most important programs funded by the Care Act in Texas is 
the AIDS Drug Assistance Program [ADAP]. Texas' ADAP is administered by 
the HIV/STD Medication Program at the Texas Department of Health and it 
provides free or low-cost HIV prescription drugs to individuals who 
would otherwise have no access to basic HIV treatments. The program 
currently has 4,775 clients enrolled and so far in fiscal year 1996 
3,437 have been provided with medications they might not have otherwise 
received. Approximately 35 to 40 percent of the clients are Medicaid 
eligible at some time. Funds from the ADAP are only used to pay for 
drugs the clients cannot receive with Medicaid benefits. All clients 
have incomes below 200 percent of the poverty line.

  Mr. Speaker, the AIDS epidemic is one that cries out for immediate 
and forceful action. The human immunodeficiency virus [HIV], which 
causes AIDS, does not discriminate. It affects people of all ages, 
genders, races, socioeconomic statuses, and sexual orientations. In the 
years following the disease's discovery, nearly half a million 
Americans have been diagnosed with AIDS, and more than a quarter of a 
million men, women, and children have died of AIDS. In Texas, the 
cumulative number of reported AIDS cases from the beginning of the 
epidemic in 1981 through 1994 is 30,712. The cumulative number of 
reported AIDS deaths for this time period is 18,435.
  Mr. Speaker, AIDS is the leading killer of Americans between the ages 
25 and 44. AIDS is killing the youngest and most vital part of our 
workforce and our whole Nation suffers as a result. The Centers for 
Disease Control and Prevention estimated that in 1992 the indirect cost 
of the AIDS epidemic to the U.S. economy was $23.3 billion, primarily 
due to wages lost by workers. Clearly, we must invest in HIV 
prevention, education and treatment. I support the conference report 
and I urge my colleagues to do so as well.
  Mr. BILIRAKIS. Mr. Speaker, I yield 3 minutes to the gentleman from 
Florida [Mr. Foley].

                              {time}  1900

  Mr. FOLEY. Mr. Speaker, let me thank the gentlewoman from Texas for 
her acknowledgment. That was very gracious and very kind, and I hope I 
hear more of that tonight from the other side because this truly is a 
bipartisan effort in helping people that have been stricken by a very 
deadly and tragic disease.
  With the passage of the conference report on the Ryan White CARE 
amendment today we have a valuable opportunity to continue our 
commitment in the fight against AIDS. This legislation secures vital 
medical care and treatment for Americans suffering with this tragic 
disease and gives States more flexibility to provide them with a wider 
range of support services.
  Since 1981, over 250,000 Americans have died from AIDS and more than 
a million others are expected to be infected. Sadly, the number of 
women, children, and teenagers infected with HIV continues to grow 
dramatically.
  In my home district in Florida, the city of West Palm Beach has the 
single second highest rate of HIV infections in females. The 
legislation recognizes these concerns and sets up special grants to 
provide health services to women, infants, and children.
  As more and more of our Nation's communities are affected by the AIDS 
epidemic, preserving the partnerships we have developed between the 
Federal, State and local governments to meet these health care needs is 
critical.
  I want to single out the gentleman from Florida [Mr. Bilirakis] for 
his leadership on this important legislative initiative, but I also 
want to take a moment to thank some people that are often derided by 
both the media and the other side of the aisle as the radical extreme 
of this party. I want to say, thank you, Mr. Newt Gingrich. He first 
brought the Ryan White Act onto this House floor under a suspended 
calendar to prevent it from being intruded on by harmful amendments.
  Let me thank the gentleman from Louisiana, Bob Livingston, chairman 
of the Committee on Appropriations, for working so closely with Mr. 
Bilirakis to secure $105 million additional for the funding of the Ryan 
White Act this year alone.
  Let me thank my Republican colleagues for recognizing the severity of 
AIDS; that it affects Republicans, that it affects Democrats, that it 
affects Independents, that it affects men, it affects women, it affects 
blacks, whites, and Hispanics, that it affects heterosexuals as well as 
homosexuals. It affects America, our families, our children.
  This legislation brings us to the point where we are fighting a 
dreaded disease and we are fighting it in a bipartisan spirit, caring 
for the soul of the human being rather than their ethnicity, their 
race, their gender, their preference or their voting status.
  I think we embark today on a day of bipartisan spirit, and I hope the 
media genuinely reflects that it is a Republican majority that brings a 
bill to this floor to show care and compassion for human beings; it is 
a Republican majority, in concert with the gentleman from California 
[Mr. Waxman], and the minority who brings a bill together that funds a 
tragic, tragic thing in American life. It fights AIDS, it fights the 
battle, and it provides for human suffering when they need help the 
most.
  Again my commendations to the gentleman from Florida [Mr. Bilirakis] 
for his excellent leadership, and I urge the floor to vote solidly for 
the reenactment of the Ryan White Act.
  Mr. WAXMAN. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
Connecticut [Mrs. Kennelly].
  Mrs. KENNELLY. Mr. Speaker, I thank the gentleman from California 
[Mr. Waxman] for yielding the time, and I rise in strong support of the 
conference report for the Ryan White CARE Reauthorization Act.
  My State knows all too well the pain and agony that HIV and AIDS 
bring. Connecticut has the fifth highest number of AIDS cases per 
capita in the Nation. In my district, the city of Hartford has been 
particularly hard hit.

[[Page H4364]]

AIDS is clearly a health crisis we must address now.
  Last fall, Hartford and two adjoining counties were, for the first 
time, awarded title I Ryan White funding. This money will enable people 
living with AIDS to receive services so important to those ill--from 
housing to child care to respite care.
  The formula under this conference report ensures that communities, 
like Hartford, with growing caseloads get the emergency funds they need 
to respond to this crisis. More importantly, it ensures the thousands 
of men, women, and children affected by the disease get the support 
they need to live their lives with dignity.
  I urge a ``yes'' vote on this conference report.
  Mr. BILIRAKIS. Mr. Speaker, I yield 2 minutes to the gentleman from 
California [Mr. Horn].
  Mr. HORN. Mr. Speaker, I join others in commending the gentleman from 
Florida, Chairman Bilirakis, for bringing the Ryan White Act to the 
floor for reauthorization.
  Mr. Speaker, I rise today in strong support of S. 641, the Ryan White 
Comprehensive AIDS Resources Emergency Reauthorization Act of 1995. 
Thousands of men and women and children with HIV and AIDS depend on the 
continuation of these vital services and this vital program.
  Ryan White services include outpatient health and medical services, 
pharmaceuticals, funding for the continuation of private health 
insurance and home care, which is essential. Without such assistance, 
tens of thousands of people will be adversely affected. Without such 
assistance increased suffering will ensue.
  I have been an early active supporter of the Ryan White program since 
coming to Congress in 1993, and in the 103d and the 104th Congresses 
this bipartisan act and appropriate funds and increases have been 
allocated by the Members with overwhelming majorities. Sufficient 
funding for AIDS research, care, and prevention must be the consistent 
goal of all future Congresses until this horror is eradicated from the 
Earth.
  Mr. WAXMAN. Mr. Speaker, I yield 1 minute to the gentleman from New 
Jersey [Mr. Payne].
  Mr. PAYNE of New Jersey. Mr. Speaker, I would like to commend my 
colleagues for their work in the fight against AIDS in our community. 
By producing this very important document, we here, in the spirit of 
bipartisanship, have taken another step to deal with the devastation 
and the threat that this disease poses to our society.
  AIDS is growing fastest among women and children in our society. By 
early 1993, 253,448 people in the United States had been diagnosed with 
AIDS.
  In my district in Newark, we have one of the highest reported 
percentages of women with AIDS. In fact, I held the first congressional 
hearing in my district on the AIDS issue.
  Later, we held a hearing on the problem of abandoned infants, where 
women infected with AIDS testified about the problems they encounter 
and their personal plight.
  As an original cosponsor of the Ryan White bill, I know the real 
travesty of this disease and we can prevent it. If this document is any 
indication, I believe there is some hope that we turn this tragedy into 
a triumph.
  I look forward to working very closely with my colleagues to 
eliminate the threat to our community and our society.
  Mr. BILIRAKIS. Mr. Speaker, I yield 2 minutes to the gentleman from 
Oklahoma [Mr. Coburn] who has added an awful lot of grassroots and 
personal experience to the subcommittee and to the full committee and, 
obviously, to this particular piece of legislation, and we are very 
grateful for his work on Ryan White.
  (Mr. COBURN asked and was given permission to revise and extend his 
remarks.)
  Mr. COBURN. Mr. Speaker, I thank the chairman of the committee. We 
come here tonight happy that we have accomplished some things that are 
new, some things that are important, but, most of all, to provide 
support for those that need our support in terms of facing HIV 
infection.
  Some things have been added to this bill, which needed to be added a 
long time ago, and the first of those is a prohibition on 
discrimination based on either HIV status or the seeking of an HIV 
test. It is long overdue and I am glad to see it included.
  Spousal notification is something that is needed. It is right. It is 
proper. It is a part of this bill as well.
  And then, finally, putting in perspective where we have seen the best 
AIDS research come forward; that in terms of treating newborn infants 
and infants conceived to women who are HIV positive. The science is 
great, the science is very promising, and, hopefully, this science will 
lead to further discoveries and further breakthroughs that will treat 
those that are so ravaged by this disease.
  Mr. Speaker, I want to thank the gentleman from California [Mr. 
Waxman] and those of the other side of the aisle who worked to help us 
forge out a compromise. I believe we have forged out a good one and I 
am hopeful we can get this money going straight away to help those who 
need it.
  Mr. WAXMAN. Mr. Speaker, I yield myself 2 minutes for the purpose of 
engaging in a colloquy with the gentleman from Florida.
  (Mr. WAXMAN asked and was given permission to revise and extend his 
remarks.)
  Mr. WAXMAN. Mr. Speaker, this bill provides that funds appropriated 
solely for the drug assistance program be allocated based on statewide 
case counts. I ask the gentleman from Florida; is that correct?
  Mr. BILIRAKIS. Mr. Speaker, will the gentleman yield?
  Mr. WAXMAN. I yield to the gentleman from Florida.
  Mr. BILIRAKIS. Mr. Speaker, I would say to the gentleman that that is 
correct.
  Mr. WAXMAN. The bill also specifies that 3 percent of the 
appropriations for each title of the Ryan White program be set aside 
for the special projects of national significance; that 1 percent be 
set aside for technical assistance; and 1 percent for the Public Health 
Service evaluation funds.
  It was my understanding that the $52 million for the drug assistance 
program would not be subject to these set-asides nor would this sum be 
included in calculating the set-aside taken from the formula grant. Was 
that the gentleman's understanding as well?
  Mr. BILIRAKIS. Mr. Speaker, if the gentleman will continue to yield, 
yes, it was my understanding, Mr. Waxman, and I hope this colloquy and 
conversations with the Health Resources and Services Administration 
will help to clarify this point prior to funds being distributed to 
States.
  Mr. WAXMAN. Mr. Speaker, I thank the gentleman for entering into this 
colloquy so we can clarify this.
  Mr. BILIRAKIS. Mr. Speaker, I yield 2 minutes to the gentleman from 
Connecticut [Mr. Shays].
  Mr. SHAYS. Mr. Speaker, I just really want to express my gratitude to 
the gentleman from Florida [Mr. Bilirakis] and the ranking member, the 
gentleman from California [Mr. Waxman], for working so well together, 
and the full chairman of the committee as well as the gentleman from 
Oklahoma [Mr. Coburn], in particular, a new member who has helped bring 
together and help forge some very important elements to this bill.
  Mr. Speaker, I am grateful that we are seeing a 17 percent increase 
in the Ryan White funding over last year. I am particularly grateful 
that we are seeing for the first time the prohibiting of health 
insurance discrimination against someone who suspects or in fact is HIV 
positive.
  We have a million people in our country who are HIV positive, we have 
300,000 who have died of AIDS. This country needs to come together to 
heal the wounds and to help them, and I am just extraordinarily 
grateful for the leaders on both sides of the aisle who have 
depoliticized this and made a significant step forward in helping the 
people in our country who need the help the most.
  Mr. GILMAN. Mr. Speaker, over 250,000 Americans have died from AIDS, 
the dreaded equal opportunity killer which first became known to 
Americans in 1981. It is a health crisis which must be addressed now. 
This legislation accomplishes many of our most important goals--to 
modify the eligibility requirements and allocation formulas for grants 
to State and local governments; to give States increased flexibility to 
provide a wider range of treatments and support services; to emphasize 
the provision of services for women, infants, and children by 
instituting special grant set- 

[[Page H4365]]

asides; to cap administrative and evaluation expenses for grant 
programs, and; to require states to implement center for disease 
control guidelines regarding HIV testing and counseling for pregnant 
women.
  In short, this legislation not only demonstrates bipartisan 
humanitarian spirit of this Congress, but by working together in areas 
of mutual concern we can accomplish worthy goals. Accordingly, I am in 
strong support of the Ryan White CARE Act amendments conference support 
and urge its immediate passage.
  Mr. BLILEY. Mr. Speaker, I am pleased that we are bringing to the 
floor the reauthorization of the Ryan White CARE Act.
  I am particularly pleased that we were able to work on a bipartisan 
basis to develop this legislation. I believe that we have developed a 
bill that responds to changes in the HIV and AIDS epidemic, addresses 
some concerns with the current implementation of the Ryan White 
program, includes provisions regarding the perinatal transmission of 
HIV, and attempts to reach a compromise on funding formulas.
  As is always the case, the funding formulas proved to be the most 
difficult issue to resolve. It was further complicated by the fact that 
States have not adopted the new definition of AIDS in a uniform 
fashion, which without a reauthorization would have resulted in large 
shifts of money this year. In addition, there have been some very 
exciting therapeutic breakthroughs over the past several months. While 
these breakthroughs represent tremendous hope in the treatment of HIV/
AIDS, they result in additional financial strains on States. For these 
reasons, I believe it was very important, in agreeing on the title II 
formula, that we kept in mind both the disruptions caused by large 
shifts in money and the need to provide the non-EMA States with greater 
funds.
  We believe we have achieved a fair compromise between the original 
House and Senate positions. We significantly increase funding for non-
EMA States while limiting the losses to large States with title I 
cities. The formula we have agreed upon is a modified version of the 
Senate formula. I do want to point out however, that in the fiscal year 
1996 appropriations bill, which just passed, an additional $52 million 
was provided solely for the drug assistance program. The conference 
agreement provides that these funds will be allocated based on the 
statewide case count rather than the Senate formula. I believe this is 
important because the States provide drugs to all individuals with HIV/
AIDS regardless of where they live through the drug assistance program.
  The other key issue was that of perinatal transmission of HIV. All 
the conferees, and I am certain all Members of the House and Senate, 
share the same goal--reducing the transmission of HIV to infants, and 
in those cases where transmission is not prevented, identifying and 
treating those babies as soon as possible. It is our sincere hope that 
the provisions included in the conference agreement will achieve that 
goal.
  I also want to point out that we have received a letter from CBO 
stating that the bill does not invoice the Unfunded mandates Reform Act 
of 1995. And I ask that the letter from CBO follow my statement.
  I want to thank all the conferees and their staffs for their 
perseverance and hard work on this conference agreement. I also want to 
thank the staff at the General Accounting Office who spent many long 
hours running iterations of the formulas.
  I urge my colleagues to join me in supporting the conference 
agreement.
                                                    U.S. Congress,


                                  Congressional Budget Office,

                                      Washington, DC, May 1, 1996.
     Hon. Thomas J. Bliley, Jr.
     Chairman, Committee on Commerce, House of Representatives, 
         Washington, DC.
       Dear Mr. Chairman: At the request of your staff, the 
     Congressional Budget Office has reviewed the conference 
     committee's discussion draft of S. 641, the Ryan White CARE 
     Act Amendments of 1996, for intergovernmental and private 
     sector mandates. The bill contains two intergovernmental 
     mandates and no private sector mandates. The cost of the 
     intergovernmental mandates would not exceed the $50 million 
     threshold established in Public Law 104-4, the Unfunded 
     Mandates Reform Act of 1995.
       S. 641 would require states to determine annually the 
     number of AIDS cases reported within their boundaries that 
     result from perinatal transmission. The cost associated with 
     this requirement would be insignificant because most states 
     are already gathering this type of information.
       The bill would also require states to adopt the Center for 
     Disease Control's (CDC's) guidelines concerning HIV 
     counseling and voluntary testing for pregnant women. In order 
     to offset the costs associated with adopting these 
     guidelines, the bill would authorize the appropriation of $10 
     million in each of fiscal years 1996 through 2000. Any state 
     that does not adopt the guidelines would not be eligible for 
     this funding, but the bill does not clearly relieve states of 
     responsibility for adopting the CDC guidelines if they choose 
     not to take any of the grant money. While CBO does not expect 
     the costs of promulgating the CDC guidelines to be 
     significant, public hospitals and clinics could face 
     additional costs in implementing the guidelines. However, 
     many hospitals and clinics are already carrying out these 
     AIDS-related activities on their own or because their states 
     have already adopted the CDC guidelines. In the time 
     available, CBO has not been able to estimate the additional 
     costs with precision, but we believe that the costs to public 
     facilities would be well below the $50 million threshold. 
     Furthermore, the bill authorizes funds that would at least 
     partially offset these costs.
       Finally, as a condition of receiving their Ryan White grant 
     money, states may have to require all newborns to be tested 
     for HIV. This requirement would not be a mandate as defined 
     by Public Law 104-4, because it is clearly a condition for 
     receiving federal financial assistance.
       If you wish further details on this estimate, we will be 
     pleased to provide them. The analyst for intergovernmental 
     mandates is John Patterson, and the analyst for private 
     sector mandates is Linda Bilheimer.
           Sincerely,
                                        June E. O'Neill, Director.
  Mr. LAZIO of New York. Mr. Speaker, I rise today to support S. 641, 
the Ryan White CARE Act amendments conference Report. I am a cosponsor 
of the House bill. It is long overdue and I am glad that Congress is 
finally completing its work on this measure.
  New York has been hit especially hard by the AIDS epidemic as close 
to 20 percent of all AIDS cases are in my home State.
  Since its enactment, the Ryan White CARE Act has provided a wider 
range of services for people of all racial, ethnic, and social-economic 
classes throughout the United States who are struggling with HIV 
disease. These funds provide a coordinated continuum of care for these 
individuals. Some of the services supported by the CARE Act include 
outpatient health and medical serrices, pharmaceuticals, funding for 
continuation of private health insurance, and some health care.
  As a society we have a responsibility to provide for those who are 
truly needy. Since its original enactment the Ryan White program has 
helped tens of thousands of AIDS victims in my home State of New York 
State as well as those throughout the country.
  We need to reauthorize the Ryan CARE Act without any further delay 
and I urge all my colleagues to vote for its passage.
  Mrs. MINK of Hawaii. Mr. Speaker, I rise in strong support of the 
conference report on the Ryan White CARE Reauthorization Act of 1995. 
The importance of this act cannot be overstated; in the 6 years since 
its enactment, it has been a lifeline of support to hundreds of 
thousands of AIDS and HIV victims throughout the country.
  The challenges of our fight against AIDS are not unfamiliar to us. 
Since the onset of this epidemic over 15 years ago, we have struggled 
to contain this virus via surveillance and prevention efforts, as 
researchers worldwide scrambled for a cure. Meanwhile, numbers of 
people affected with the AIDS has spiraled upward. According to the 
Centers for Disease Control, more than 440,000 cases of AIDS have been 
reported in this country, and over 1 million are HIV-infected. Over 100 
Americans die each day from the disease. Health care costs for treating 
the virus have risen astronomically, taking an unwieldy economical toll 
on its victims. Discrimination rising out of fear and lack of awareness 
about the AIDS and HIV has exacerbated the sense of emotional isolation 
faced by its victims. This is all in addition to the physical agony the 
disease wreaks on the body.
  The scope of this crisis clearly commands the attention and resources 
of the American people. The Ryan White CARE Act of 1990 made available 
much needed Federal money to help ease the physical, emotional, and 
economic toll of the disease on its victims. Our Nation was caught so 
unprepared for the advent and explosion of AIDS and HIV in the last two 
decades, that this legislation provided needed relief for our reeling 
health services delivery system. In the 6 years since the law 
authorized grants to States and cities for AIDS treatment and support 
programs as alternatives to inpatient care, much of the burden that 
urban and rural hospitals face has been alleviated and the quality of 
life for those suffering with the virus has greatly improved. National 
AIDS organizations and Federal, State, and local public health 
officials have testified to the success of the program, while 
underscoring that the urgency of the AIDS epidemic has not subsided and 
that there exists a continued need for the CARE Act.

[[Page H4366]]

  We are entering a new phase in our battle against the virus. A recent 
article in the New York Times discussed the arrival of a new class of 
drugs known as protease inhibitors, which, taken in combination with 
standard older drugs, provide the most potent therapy against HIV to 
date. These new treatments are unfortunately very expensive. Where 
Medicare and private insurance defer some of the cost, many patients 
are depending on the AIDS drug reimbursement program of the CARE Act as 
a means of easing their suffering. I strongly believe that it is 
especially critical as we are on the brink of medically treating this 
disease, that we do not withdraw our funding support.
  Fighting against this killer virus is the universal charge of all 
Americans. AIDS is no longer a disease of a select few, but instead 
touches the lives of more and more people in our society. The epidemic 
has spread into suburban and rural areas in every State of this country 
and entered the ranks of sports heroes and movie stars. AIDS is 
currently the No. 1 killer of all Americans between the ages of 25 and 
44. It does not discriminate between gender or sexual orientation. It 
cuts across all races and socio-economic classes. As of July 1994, 
5,000 children had received an AIDS diagnosis. It is our collective 
social responsibility to provide for our most vulnerable citizens the 
best that we can, and I urge my colleagues to support this conference 
report.
  Mr. WAXMAN. Mr. Speaker, I have no further requests for time, and I 
yield back the balance of my time.
  Mr. BILIRAKIS. Mr. Speaker, I yield back the balance of my time, and 
I move the previous question on the conference report.
  The previous question was ordered.
  The SPEAKER pro tempore (Mr. Ewing). The question is on the 
conference report.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. GUNDERSON. Mr. Speaker, I object to the vote on the ground that a 
quorum is not present and make the point of order that a quorum is not 
present.
  The SPEAKER pro tempore. Evidently a quorum is not present.
  The Sergeant at Arms will notify absent Members.
  The vote was taken by electronic device, and there were--yeas 402, 
nays 4, not voting 27, as follows:

                             [Roll No. 145]

                               YEAS--402

     Abercrombie
     Ackerman
     Allard
     Andrews
     Archer
     Armey
     Bachus
     Baesler
     Baker (CA)
     Baker (LA)
     Baldacci
     Barcia
     Barr
     Barrett (NE)
     Barrett (WI)
     Bartlett
     Bass
     Bateman
     Becerra
     Bentsen
     Bereuter
     Bevill
     Bilbray
     Bilirakis
     Bishop
     Blute
     Boehlert
     Boehner
     Bonior
     Bono
     Borski
     Brewster
     Browder
     Brown (CA)
     Brown (FL)
     Brown (OH)
     Brownback
     Bryant (TN)
     Bunn
     Bunning
     Burr
     Burton
     Buyer
     Callahan
     Calvert
     Camp
     Campbell
     Canady
     Cardin
     Castle
     Chabot
     Chambliss
     Chapman
     Chenoweth
     Christensen
     Chrysler
     Clayton
     Clement
     Clinger
     Clyburn
     Coble
     Coburn
     Coleman
     Collins (GA)
     Collins (IL)
     Collins (MI)
     Combest
     Condit
     Conyers
     Cooley
     Costello
     Cox
     Coyne
     Cramer
     Crane
     Crapo
     Cremeans
     Cubin
     Cummings
     Cunningham
     Danner
     Davis
     Deal
     DeFazio
     DeLauro
     DeLay
     Dellums
     Deutsch
     Diaz-Balart
     Dickey
     Dixon
     Doggett
     Dooley
     Doolittle
     Dornan
     Doyle
     Dreier
     Duncan
     Dunn
     Durbin
     Edwards
     Ehlers
     Ehrlich
     Emerson
     English
     Ensign
     Eshoo
     Evans
     Everett
     Ewing
     Farr
     Fattah
     Fawell
     Fazio
     Fields (LA)
     Fields (TX)
     Filner
     Flake
     Flanagan
     Foglietta
     Foley
     Forbes
     Ford
     Fowler
     Fox
     Frank (MA)
     Franks (CT)
     Franks (NJ)
     Frelinghuysen
     Frisa
     Frost
     Furse
     Gallegly
     Ganske
     Gejdenson
     Gekas
     Gephardt
     Geren
     Gilchrest
     Gillmor
     Gilman
     Gonzalez
     Goodlatte
     Goodling
     Gordon
     Graham
     Green (TX)
     Greene (UT)
     Greenwood
     Gunderson
     Gutierrez
     Gutknecht
     Hall (OH)
     Hall (TX)
     Hamilton
     Hancock
     Hansen
     Harman
     Hastert
     Hastings (FL)
     Hastings (WA)
     Hayworth
     Hefley
     Hefner
     Heineman
     Herger
     Hilleary
     Hilliard
     Hinchey
     Hoekstra
     Hoke
     Holden
     Horn
     Hostettler
     Hoyer
     Hunter
     Hutchinson
     Hyde
     Inglis
     Jackson (IL)
     Jackson-Lee (TX)
     Jacobs
     Jefferson
     Johnson (CT)
     Johnson (SD)
     Johnson, E. B.
     Johnson, Sam
     Johnston
     Jones
     Kanjorski
     Kasich
     Kelly
     Kennedy (MA)
     Kennedy (RI)
     Kennelly
     Kildee
     Kim
     King
     Kingston
     Kleczka
     Klink
     Klug
     Knollenberg
     Kolbe
     LaFalce
     LaHood
     Lantos
     Largent
     Latham
     LaTourette
     Laughlin
     Lazio
     Leach
     Levin
     Lewis (CA)
     Lewis (GA)
     Lewis (KY)
     Lightfoot
     Lincoln
     Linder
     Lipinski
     LoBiondo
     Lofgren
     Longley
     Lowey
     Lucas
     Luther
     Maloney
     Manton
     Manzullo
     Markey
     Martinez
     Martini
     Mascara
     Matsui
     McCarthy
     McCollum
     McCrery
     McDermott
     McHale
     McHugh
     McInnis
     McIntosh
     McKeon
     McKinney
     McNulty
     Meehan
     Meek
     Menendez
     Metcalf
     Meyers
     Mica
     Millender-McDonald
     Miller (CA)
     Minge
     Mink
     Moakley
     Mollohan
     Montgomery
     Moorhead
     Moran
     Morella
     Murtha
     Myers
     Myrick
     Nadler
     Neal
     Nethercutt
     Neumann
     Ney
     Norwood
     Nussle
     Oberstar
     Obey
     Olver
     Ortiz
     Orton
     Owens
     Oxley
     Packard
     Pallone
     Parker
     Pastor
     Paxon
     Payne (NJ)
     Payne (VA)
     Pelosi
     Peterson (FL)
     Peterson (MN)
     Petri
     Pickett
     Pombo
     Pomeroy
     Porter
     Portman
     Poshard
     Pryce
     Quillen
     Quinn
     Radanovich
     Rahall
     Ramstad
     Rangel
     Reed
     Regula
     Richardson
     Riggs
     Rivers
     Roberts
     Roemer
     Rogers
     Rohrabacher
     Ros-Lehtinen
     Rose
     Roth
     Roukema
     Roybal-Allard
     Royce
     Rush
     Sabo
     Salmon
     Sanders
     Sanford
     Sawyer
     Saxton
     Schaefer
     Schiff
     Schroeder
     Schumer
     Scott
     Seastrand
     Sensenbrenner
     Serrano
     Shadegg
     Shays
     Shuster
     Sisisky
     Skaggs
     Skeen
     Skelton
     Slaughter
     Smith (MI)
     Smith (NJ)
     Smith (TX)
     Smith (WA)
     Solomon
     Souder
     Spence
     Spratt
     Stark
     Stearns
     Stenholm
     Stockman
     Stokes
     Studds
     Stupak
     Talent
     Tanner
     Tate
     Tauzin
     Taylor (MS)
     Taylor (NC)
     Tejeda
     Thomas
     Thompson
     Thornberry
     Thornton
     Thurman
     Tiahrt
     Torkildsen
     Torres
     Towns
     Traficant
     Upton
     Velazquez
     Vento
     Visclosky
     Volkmer
     Vucanovich
     Walker
     Walsh
     Wamp
     Ward
     Waters
     Watt (NC)
     Watts (OK)
     Waxman
     Weldon (PA)
     Weller
     White
     Whitfield
     Wicker
     Williams
     Wise
     Wolf
     Woolsey
     Wynn
     Yates
     Young (AK)
     Young (FL)
     Zeliff
     Zimmer

                                NAYS--4

     Funderburk
     Istook
     Scarborough
     Stump

                             NOT VOTING--27

     Ballenger
     Barton
     Beilenson
     Berman
     Bliley
     Bonilla
     Boucher
     Bryant (TX)
     Clay
     de la Garza
     Dicks
     Dingell
     Engel
     Gibbons
     Goss
     Hayes
     Hobson
     Houghton
     Kaptur
     Livingston
     McDade
     Miller (FL)
     Molinari
     Shaw
     Torricelli
     Weldon (FL)
     Wilson

                              {time}  1933

  Messrs. MARKEY, DIXON, and COBLE changed their votes from ``nay'' to 
``yea.''
  So the conference report was agreed to.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.

                          ____________________