[Congressional Record Volume 146, Number 69 (Wednesday, June 7, 2000)]
[Senate]
[Pages S4663-S4665]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                          RYAN WHITE CARE ACT

  Mr. KENNEDY. Mr. President, yesterday we passed the Ryan White CARE 
Reauthorization Act. I commend everyone in the Senate who has worked so 
effectively on the issue of HIV and AIDS, beginning with Senator 
Jeffords, who has been a champion on this issue since the CARE Act was 
first authorized in 1990. I also thank the sponsors of this bill and 
our colleagues on the Health Committee who have sounded the alarm about 
the HIV/AIDS crisis through their unwavering support of the CARE Act 
reauthorization.
  There is no stronger or more effective support than a full Senate 
unanimous vote today to show that, in each and every one of our states, 
we stand behind a bill that will enable so many citizens to receive the 
benefits of advances in therapies and support developed through our 
efforts over the past ten years.
  At times of great human suffering or great tragedies or epidemics, it 
has often been the leadership of the federal government that has helped 
our fellow citizens deal with difficulties. It is in that very 
important tradition that this legislation was originally enacted and I 
urge the Senate to approve this important reauthorization of it today.
  Ryan White, the young boy after whom the CARE Act was named, would 
have celebrated his twenty-eighth birthday this year. If we had we been 
as far along as we are now in providing life-prolonging and life-saving 
therapies, Ryan might well have been here with us, thanking each of us 
for the lifeline and the hope provided through the CARE Act.
  Since the beginning of this epidemic, AIDS has claimed over 400,000 
lives in the United States, and an estimated 900,000 Americans are 
living with HIV/AIDS today. AIDS continues to claim the most vulnerable 
among us. Like other epidemics before it, Aids is now hitting hardest 
in areas where knowledge about the disease is scarce and poverty is 
high. The epidemic has dealt a particularly severe blow to communities 
of color, which account for 73% of all new HIV infections. Women 
account for 30% of new infections. Over half of all new infections 
occur in persons under 25. This means that HIV infection of the 
nation's youth is a national crisis.
  AIDS continues to kill brothers and sisters, children and parents, 
friends and loved ones--all in the prime of their lives. From the 
30,000 AIDS orphans in New York City to the 21 year old gay man with 
HIV living in Iowa, this epidemic knows no geographic boundaries and 
has no mercy.
  An estimated 34% of AIDS cases in the U.S. are in rural areas, and 
this percentage is growing. We know the challenges faced in rural 
communities where pulling together in the face of adversity is 
commonplace in other case. But where too often today there is silence 
and isolation because of the fear of condemnation over AIDS.
  In addition, access to good medical care is often a significant 
barrier for many of our citizens with disabling diseases, who have to 
travel to urban centers to receive the care they need and deserve. As 
the AIDS crisis continues year after year, it has become more and more 
difficult for anyone to claim that AIDS is someone else's problem. In a 
very real way, we are all living with AIDS or are directly touched by 
AIDS.
  The epidemic still kills over 47,000 persons a year. But we have good 
reason today to feel encouraged by the extraordinary medical advances 
made over the past ten years. AIDS deaths declined by 20% between 1997 
and 1998. Many people with HIV and AIDS are leading longer and 
healthier lives today.
  In addition, we have witnessed the smallest increase in new AIDS 
cases--11% in 1998, compared to an 18% increase in 1997. More families 
are leading productive lives in our society, in spite of their HIV 
diagnosis. This is the good news. But unfortunately, the number of 
people living with AIDS who can't afford expensive medical treatment is 
growing which means that greater demands are being placed on community-
based organizations and state and local governments that serve them.
  The advances in the development of life-saving HIV/AIDS drugs has 
come with an enormous price tag and these advances have been costly. An 
estimated 30% of person living with AIDS do not have health care 
coverage to pay for costly treatments. For these Americans, the CARE 
Act continues to provide the only means to obtain the health care and 
the treatment they need.
  In Massachusetts we have seen an overall 77% decline in AIDS and HIV-
related deaths since 1995. At the same time, however, like many other 
states, the changing HIV/AIDS trends and profiles are serious problems. 
AIDS and HIV cases increased in women by 11% from 1997 to 1998. 55% of 
persons living with AIDS in the state are person of color. State 
budgets often provide funds for prevention, screening and primary care. 
But no state could provide the major financial resources needed to help 
person living with HIV disease to obtain the medical and support 
services they need, without the Ryan White CARE Act.
  By passing this legislation, we are making clear that the AIDS 
epidemic in the United States will receive the attention and public 
health response it deserves. The CARE Act reauthorization brings hope 
to over 600,000 persons each year in dealing with the devastating 
disease. It also brings hope and help to their families and their 
communities.
  The enactment of this legislation in 1990 was an emergency response 
to the devastating effects of HIV on individuals, families, 
communities, and state and local governments. The Act targets funds to 
respond to the specific needs of specific communities. Title I targets 
the hardest hit metropolitan areas in the country. Local planning and 
priority-setting requirements under Title I assure that each of the 
Eligible Metropolitan Area can respond effectively to the local HIV/
AIDS needs.
  Title II funds emergency relief to states. It helps them to develop 
HIV care infrastructure, and to provide effective and life-sustaining 
drug therapies through the AIDS Drug Assistance Program to over 61,000 
persons each month.
  Title III funds community health centers and other primary health 
care providers that serve areas with a significant and disproportionate 
need for HIV care. Many of these community health centers are located 
in the hardest hit areas, serving low income communities. Title IV of 
the CARE Act meets the specific needs of women, children, and families.
  This reauthorization builds on these past accomplishments, while 
recognizing the challenge of ensuring access to HIV drug treatments for 
all who need them. Our goal is to reduce health disparities in 
vulnerable communities, and improve the distribution and quality of 
services. Senator Jeffords and I have worked together to address new 
challenges we face in the battle against AIDS. This reauthorization 
will create additional funding for states that have had to limit access 
to new therapies due to lack of resources. The bill also targets new 
funds to smaller metropolitan areas and to rural and urban communities, 
where the epidemic is growing and adequate infrastructure is lacking.
  In addition, the bill funds early intervention services to promote 
early diagnosis of HIV disease, referral to health

[[Page S4664]]

care, and initiation of effective treatments to reduce the onset of the 
illness and its progression. Health disparities in communities of color 
will be reduced by requiring states and local communities funded by the 
Act to plan, set priorities, and fund initiatives to meet documented 
local needs in dealing with the epidemic. The reauthorization will also 
establish quality and accountability in HIV service delivery, by 
strengthening quality management activities to make them consistent 
with Public Health Service guidelines.
  Our action yesterday affirmed our long-standing commitment to 
citizens with HIV/AIDS and to sound public policy for all citizens, 
families and communities touched by this devastating disease. We have 
the resources to continue to battle AIDS. We must continue to deal with 
this disease with the same courage shown to us ten years ago by the 
valiant ten year old, Ryan White, who spoke out against the ignorance 
the discrimination faced by so many people living with AIDS. The lives 
saved by our efforts through the CARE Act will mean a chance for real 
hope as medical research comes closer and closer to finding a cure.
  Mr. SMITH of Oregon. Mr. President, I am delighted that last night 
the Senate voted to reauthorize the Ryan White CARE Act, S. 2311. I am 
proud to count myself as one of the cosponsors of this legislation in 
the Senate and strongly support its swift passage by the House.
  The HIV/AIDS epidemic continues to take a high toll on Americans 
infected with HIV and their families. HIV/AIDS has affected Oregon in 
many ways. Almost five thousand Oregonians have been diagnosed with 
AIDS--resulting in almost 3,000 deaths. In addition, those infected 
with HIV number up to 8,500 in Oregon. This epidemic has touched people 
in every part of my State--rural and urban, rich and poor, senior 
citizens and newborns.
  Although the story of each of these individuals living with HIV/AIDS 
is different, they all have one thing in common: they all benefit from 
the Ryan White CARE Act. Oregon received almost $8.5 million federal 
dollars last year to fund programs through the Ryan White CARE Act.
  Passage of the Ryan White CARE Act will allow Oregonians living with 
HIV to have timely access to life-prolonging medications and necessary 
health care and support services, regardless of income level or 
insurance status. The Ryan White CARE Act will also improve access for 
HIV positive Oregonians to clinical trials, with the potential for 
additional scientific breakthroughs in the treatment of HIV/AIDS.
  I call for the House to join the Senate in a similar quick passage of 
the Ryan White CARE Act that will allow hundreds of thousands of HIV 
positive Americans to remain healthy, productive members of their 
communities, while slowing the spread of the AIDS epidemic.
  I would like to thank my friend Terry Bean of Portland, Oregon for 
talking to me about the good things the Ryan White Act does for 
Oregonians living with HIV/AIDS. Terry is a long time board member of 
the Human Rights Campaign and has been a highly valued advisor on 
issues affecting the Gay and Lesbian community in Oregon.
  Terry's thoughts and wisdom on hate crimes, ENDA and fighting against 
all types of discrimination have provided me with an ethical marker for 
doing what is right on the Senate Floor for Oregonians. I do feel lucky 
that Terry's advice is dispensed on a golf course--though the only 
criticism I may have for Terry is that he lacks the political savvy to 
lose to a United States Senator. I thank him anyway for his strong 
support and good advice.
  Mrs. FEINSTEIN. Mr. President, yesterday the Senate reauthorized a 
very important piece of legislation: the Ryan White CARE Act. I want to 
thank Senators Kennedy and Jeffords for their work and commitment to 
reauthorizing the Ryan White CARE Act.
  The CARE Act provides access to health care for tens of thousands of 
low-income people living with HIV and AIDS. This vital Act is set to 
expire on September 30, 2000. We must move quickly to ensure that it is 
reauthorized. Without the CARE Act, access to important health-related 
services could be jeopardized for hundreds of thousands of people 
living with HIV/AIDS.
  Since 1990, the CARE Act has helped establish a comprehensive, 
community-based continuum of care for uninsured and under-insured 
people living with HIV and AIDS, including access to primary medical 
care, pharmaceuticals, and support services. The CARE Act provides 
services to people who would not otherwise have access to care.
  The CARE Act is particularly important to communities of color. The 
HIV epidemic is devastating communities of color. Currently, AIDS is 
the leading cause of death among African American men and the second 
leading cause of death among African American women between the ages of 
25 and 44. Comparably, AIDS is the fifth leading cause of death among 
all Americans in this age group. A disproportionate number of African 
Americans and Hispanic/Latinos are also living with AIDS. Whereas 
African Americans represent only 13 percent of the total U.S. 
population, they represent 36 percent of reported AIDS cases. Likewise, 
Latinos represent 9 percent of the population but 17 percent all of 
AIDS cases.
  The Ryan White CARE Act is important to thousands of Californians. 
Two of California's largest cities, Los Angeles and San Francisco, are 
among the top four metropolitan cites with the highest number of AIDS 
cases in the United States. California has the second highest number of 
AIDS cases, with over 40,000 Californians currently living with AIDS. 
Through the CARE Act, Los Angeles has provided services to over 43,160 
clients since 1996. San Francisco has provided services to 47,440 since 
1996. These numbers alone demonstrate the significant impact the CARE 
Act has had on California.
  A majority of newly diagnosed AIDS cases in California are among 
people of color. Through 1998, over half of all AIDS cases are reported 
among racial and ethnic minorities in California. In Los Angeles, and 
Oakland that number rises to over 60 percent, according to the Ryan 
White CARE Act state profiles.
  Los Angeles County and San Francisco County were among the first 
sixteen eligible metropolitan areas to receive Title I emergency Ryan 
White CARE Act funds in 1991. California has been significantly 
impacted by the HIV/AIDS since the beginning of the epidemic, and has 
greatly benefitted from the Ryan White CARE Act since 1990.
  The CARE Act has been very successful in the past decade. Over the 
last several years, the CARE Act has:

       Helped to reduce AIDS mortality by 70 percent. Due to 
     combination anti-retroviral therapies being made more widely 
     available through the CARE Act, the AIDS death rate in 1997 
     was the lowest in nearly a decade.
       Helped to reduce mother-to-child transmission by 75 
     percent.
       Helped to reduce the number and length of expensive 
     hospitalizations by 30 percent. It has also helped decrease 
     the use of medical speciality care.
       Helped 97,000 individuals access drugs through the AIDS 
     Drug Assistance Program in 1997.
       Helped 315,234 people receive HIV testing and counseling 
     services in 1997.
       Helped 66,000 people access dental care in 1998.
       Promoted health and well-being which has enabled many 
     people living with HIV to return to work and remain healthy, 
     and actively participate in society.

  The CARE Act is more important now than ever. HIV/AIDS remains a 
health emergency in the United States. The Centers for Disease Control 
estimates that 40,000 new cases are reported annually. According to the 
Centers for Disease Control, between 650,000 and 900,000 Americans are 
currently infected with HIV while the number of AIDS cases has nearly 
doubled over the past five years. According to Dr. Fauci at the 
National Institutes of Health, the worse is yet to come in the 21st 
century. The state of the epidemic points to the need for an increase, 
rather than a decrease, in health care and drug treatment for people 
living with HIV/AIDS. Communities of color and women will continue to 
be the most heavily impacted in the 21st century.
  We have made many advances in testing, treatment, and research since 
the early days of the disease and the beginnings of the Ryan White CARE 
Act. Drugs now exist that can prolong and improve the quality of life. 
These drugs are not a cure, but they enable

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many people to lead a more ``normal'' life. Our job is not done, 
however, until we have made certain that all people have access to 
these life-prolonging medications.
  The work we were able to accomplish in San Francisco for people 
living with HIV/AIDS is one of my proudest achievements as Mayor of the 
City and County of San Francisco. In 1981, when there were only 76 
diagnosed cases, we provided $180,000 for prevention and social 
services for people living with HIV/AIDS. These were some of the first 
public funds allocated for AIDS in the United States. In 1987, during 
my last full year as mayor, 20,000 AIDS deaths were reported in San 
Francisco and we increased funding to $20 million. There was no federal 
Ryan White program then; I struggled to find this money in the city 
budget. Fortunately, for cities and States across the country, we now 
have the Ryan White CARE Act.
  I pledge to do all I can to eliminate AIDS. As I have said time and 
time again: I was there in the beginning and I plan to be there in the 
end. In the meantime, we must make certain that the uninsured and 
under-insured have access to life-prolonging HIV treatments. The Ryan 
White CARE Act has proven to be an essential and effective Federal 
program for the uninsured and under-insured. We must ensure the 
continuation of the Ryan White CARE Act.

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