[Congressional Record Volume 151, Number 124 (Thursday, September 29, 2005)]
[Extensions of Remarks]
[Page E2000]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




             REMARKS ON RYAN WHITE CARE ACT REAUTHORIZATION

                                 ______
                                 

                          HON. ELIOT L. ENGEL

                              of new york

                    in the house of representatives

                      Thursday, September 29, 2005

  Mr. ENGEL. Mr. Speaker, tomorrow, Congress will stand by and allow 
the Ryan White CARE Act to expire. While this does not signify the end 
to the program, it does underscore our responsibility to conduct 
hearings and vote on its soon overdue reauthorization. We must act 
swiftly to ensure that this landmark program, which provides lifesaving 
treatment to more than half a million persons living with HIV/AIDS each 
year, be strengthened to meet the changing needs of their care.
  New York City has always had a special respect for the opportunities 
the Ryan White CARE Act affords the city in serving the needs of our 
HIV/AIDS population. New York City comprises three percent of the 
nation's population, but more than 16 percent of the nation's AIDS 
cases. As of December 31, 2003, there were 142,085 cumulative AIDS 
cases in NYC, and 88,479 City residents diagnosed as Persons Living 
With HIV/AIDS. Although Ryan White CARE Act is widely considered the 
payer of last resort for people with HIV/AIDS, it fills much of the 
void in providing treatment and support services for those who either 
are uninsured or underinsured, without the necessary resources to 
access desperately needed care.
  We must do better by CARE Act funding. This program has been 
virtually flat funded for years, and its AIDS Drug Assistance Programs 
(ADAP) only received a ten million dollar increase in this year's House 
Labor-HHS bill. Many very low-income people continue to be shut-out 
from ADAP programs due to states' varying income eligibility levels, 
which can range from 125 percent to 500 percent of the Federal Poverty 
Level. Without early, aggressive treatment people living with HIV/AIDS 
can experience rapid and often irreversible disease progression. 
Additionally, if care is interrupted drug resistance can develop, which 
compromises their ability to properly control their health. Now, more 
than ever, the President should release emergency ADAP funding to help 
host states care for the estimated 8,000 victims of Hurricane Katrina, 
who have been displaced from their homes and networks of care.
  The President's Principles for Ryan White CARE Act Authorization 
include some troubling provisions which could have devastating results 
for communities' ability to provide consistent, appropriate care for 
persons living with HIV/AIDs. The proposed Severity of Need for Core 
Services Index will change funding formulas to take into account the 
availability of other resources, like state and local funding streams. 
This is bad public policy as it punishes states that have taken 
responsibility for their local HIV care and creates a powerful 
disincentive for other states to prioritize funding for HIV funding in 
future years, if they think the federal government will just cover the 
gap. No state spends more than New York does to care for its residents 
with HIV and AIDS--over $3 billion last year. New York has always 
viewed this funding as a partnership between the state, cities and 
federal government and should not lose out on future federal funding 
for being at the forefront of providing progressive services and 
treatment.
  Secondly the President's proposal for a minimum of 75 percent of Ryan 
White CARE Act funding to be spent on core medical services should be 
seriously revisited. While there is no question that appropriate 
funding should be directed towards medical care, localities that 
benefit from comprehensive state funding for medical care, might better 
serve patients with using the funding for transportation to medical 
visits, emergency housing assistance for homeless patients, and other 
key services. This hard number fails to reflect the different resources 
that cities like New York utilize to care for their patients, and the 
changing needs of the HIV/AIDS patient population.
  As a member of the Energy and Commerce Committee, I look forward to 
holding hearings on the reauthorization of the Ryan White CARE Act. We 
must work together with the Senate to strengthen and preserve the 
foundation of the Ryan White CARE Act program with the compassion and 
thoughtful consideration it deserves.

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