[Congressional Record Volume 152, Number 122 (Tuesday, September 26, 2006)]
[Senate]
[Pages S10190-S10192]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. LAUTENBERG (for himself, Mr. Menendez, Mrs. Clinton, Mr. 
        Schumer, Mr. Obama, Mr. Durbin, and Mr. Nelson of Florida):
  S. 3944. A bill to provide for a one year extension of programs under 
title XXVI of the Public Health Service Act; to the Committee on 
Health, Education, Labor, and Pensions.
  Mr. LAUTENBERG. Mr. President, I rise to talk about my bill to 
provide a temporary reauthorization of the Ryan White Care Act.
  I want to thank my colleagues, Senators Menendez, Clinton, Schumer, 
Obama, Durbin, and Bill Nelson, for cosponsoring this important and 
life-saving measure.
  I was an original cosponsor of the Ryan White CARE Act and I have 
been an active supporter of this legislation for many years now. Never 
have I been as concerned about the future as I am right now.
  The Ryan White CARE Act Reauthorization legislation that has been 
proposed in both the House and the Senate actually attempts to shift 
already inadequate Ryan White money away from States like New Jersey, 
where the epidemic first appeared and the need is still growing, to 
States where the epidemic is emerging.
  The Committee bill pits cities against cities, States against States, 
women against men, and urban areas against rural. This is not the way 
to go. We need to fully fund the Ryan White CARE Act to realize the 
promise of its original intentions.
  Today I am introducing an alternative bill to reauthorize Ryan White. 
My bill has something for everyone in it. This legislation to 
reauthorize the Ryan White Care Act includes provisions that would help 
remedy funding disparities and permit a temporary extension to allow 
negotiations to continue.

  My bill would simply extend current law through Fiscal Year 2007. 
Additionally it would provide for a 3.7 percent increase in 
authorizations over the 2006 amounts to account for inflation. 
Importantly, my bill also protects States

[[Page S10191]]

that have not yet transitioned to ``names based'' reporting for HIV 
cases by giving them an extra year to make that change. Without this 
protection these States would lose significant money.
  Finally, I recognize the need of those States who have a growing 
incidence of HIV, which is why I include a one-time emergency 
authorization of $30 million to be distributed to those States who have 
unmet need and no Title I entities.
  The original Ryan White CARE Act provides critical funding to help 
provide health care and support services for low-income individuals and 
families affected by HIV or AIDS. Since its enactment in 1990, Ryan 
White funds have helped millions of HIV/AIDS patients receive the care 
and treatment services they need to live healthy and productive lives.
  The Senate and House bills to reauthorize the Ryan White Care Act are 
named the ``Ryan White HIV/AIDS Treatment Modernization Act.'' 
Ironically, it does not modernize the care of folks living with HIV/
AIDS in our communities. Rather, it will bring us back to the early 
1990s when the disease was spreading even more rampantly than it is 
now, and people were dying quickly.
  I know firsthand that many of the stakeholder groups, those people 
who are on the ground providing and receiving services funded by the 
Ryan White CARE Act, are terrified of what will happen to our system of 
care should this reauthorization move forward.
  In my home State of New Jersey, we have the highest proportion of 
cumulative AIDS cases in women, and we rank third in cumulative 
pediatric AIDS cases. Furthermore, we have consistently ranked fifth in 
overall cumulative AIDS cases since the beginning of this epidemic. And 
yet, under the reauthorization proposal we stand to lose millions of 
dollars.
  That is unacceptable. It is not acceptable for us simply to say that 
this is a formula fight and there will undoubtedly be winners and 
losers. With the Ryan White CARE Act, when we talk about losers, we are 
talking about lives being lost. I, for one, am not willing to settle 
for such an outcome.
  It's not just my State that stands to lose money, either. New York, 
Florida, and Illinois all stand to lose millions of dollars under this 
proposal. All those states that have substantial need.
  My bill is clearly not meant to be a permanent substitute for 
reauthorizing Ryan White. It is meant to give us all more time to 
continue our negotiations and try to work out a compromise that may 
keep all of our systems of care in tact.
  I urge my colleagues to support it.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 3944

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. ONE-YEAR EXTENSION OF PROGRAMS.

       (a) Authorizations of Appropriations for Fiscal Year 
     2007.--Notwithstanding any provision of title XXVI of the 
     Public Health Service Act:
       (1) For the purpose of carrying out part A of such title, 
     there is authorized to be appropriated $634,209,704 for 
     fiscal year 2007.
       (2) For the purpose of carrying out part B of such title, 
     there is authorized to be appropriated $1,247,000,000 for 
     fiscal year 2007.
       (3) For the purpose of grants to States that demonstrate 
     unmet needs with respect to HIV/AIDS and that do not have any 
     areas that receive grants under part A of such title for 
     fiscal year 2007, there is authorized to be appropriated 
     $30,000,000 for fiscal year 2007.
       (4) For the purpose of carrying out part C of such title, 
     there is authorized to be appropriated $218,600,000 for 
     fiscal year 2007.
       (5) For the purpose of carrying out part D of such title, 
     there is authorized to be appropriated $75,385,648 for fiscal 
     year 2007.
       (6) For purposes of AIDS Education and Training Centers 
     under section 2692 of part F of such title, there is 
     authorized to be appropriated $35,983,900 for fiscal year 
     2007.
       (7) For purposes of dental programs under section 2692 of 
     part F of such title, there is authorized to be appropriated 
     $13,570,182 for fiscal year 2007.

     Amounts appropriated under this subsection are available to 
     the Secretary until the end of fiscal year 2009.
       (b) Names-Based Reporting of Cases; Other Changes Regarding 
     Methodology for Counting Cases.--Notwithstanding any 
     provision of title XXVI of the Public Health Service Act, the 
     Secretary may not, in determining the amounts of formula 
     grants under such title for fiscal year 2007, use a 
     methodology for counting the number of cases of acquired 
     immune deficiency syndrome, or the number of cases of HIV, 
     that is different than the methodology used by the Secretary 
     for such purposes for fiscal year 2006.
       (c) Definitions.--For purposes of this section, the terms 
     ``HIV'' and ``Secretary'' have the meanings that apply to 
     such terms under title XXVI of the Public Health Service Act.

  Mr. MENENDEZ. Mr. President, I rise today to join Senator Lautenberg, 
and Senators from New York, Illinois and Florida, in support of a one 
year reauthorization of the Ryan White CARE Act, and to raise my 
serious reservations about the current committee proposal. I recognize 
and respect the dedication and hard work of Senators Enzi and Kennedy, 
Congressmen Barton and Dingell and their staff to reauthorization this 
vital program. But unfortunately, their proposal, as it currently 
stands, threatens lives by destroying networks of care in New Jersey 
and in other States across the country.
  In reviewing the committee's proposal, I cannot help but wonder why 
we are not doing more and providing additional resources to address a 
growing need in our communities. More people are getting infected and 
more communities are having to provide care for individuals with HIV/
AIDS, which means we need more resources, not less. We need to address 
the growing need for care. Unfortunately, this legislation doesn't 
address the spread of the disease; it simply spreads already limited 
funding even thinner.
  In New Jersey, we are still struggling with the HIV/AIDS battle and 
unfortunately, at this point, we are not winning the war. It is a sad 
reality, but New Jersey continues to rank fifth in the country for 
overall AIDS cases. We have the highest proportion of AIDS cases in 
women, and rank third in pediatric AIDS cases. We have not yet won the 
battle--we are still fighting. And we need weapons, in terms of 
funding, to win.
  New Jersey has stepped-up to the plate to develop a comprehensive 
array of medical services, which are funded in part by the CARE Act. 
People infected with HIV/AIDS living in New Jersey have access to one 
of the most effective ADAP programs in the nation, as well as primary 
medical care, mental health service, substance abuse services, oral 
health, case management, and nutritional services. I'm proud of our 
State's networks of care, and recognize how important they are to the 
well-being of countless New Jerseyans. But in order to help this 
program to grow and be effective, we must maintain our Federal support.
  During the debate surrounding the reauthorization some are saying we 
should cut funding for certain States and their HIV/AIDS services. I 
disagree and so do New Jerseyans. I am proud of the strong voice of New 
Jersey's advocates. Beneficiaries from across the State, members of our 
HIV Health Services Planning Councils from our eligible metropolitan 
areas or EMAs, representatives from all counties that are part of the 
Philadelphia EMA, and individuals from the consortiums of the remaining 
counties have been fully engaged in this reauthorization process.
  Our elected officials, the Governor's office, and our entire New 
Jersey delegation have all been supportive of making sure New Jersey 
has the resources to continue fighting this battle. Our State--but 
apparently not this Congress--is united in providing care, saving lives 
and ending this epidemic once and for all.
  Unfortunately, the committee's proposed reauthorization threatens to 
destroy and dismantle critical networks of care that are keeping people 
alive and healthy in New Jersey. With our current network of care, our 
healthcare providers have been instrumental in helping prevent people 
with HIV from developing full-blown AIDS. Without these services, the 
impact will be devastating for patients, their ability to work and 
provide for their families and most importantly, their lives.
  My concerns continue to grow. Most recently, the U.S. Centers for 
Disease Control and Prevention recommended routine HIV testing for all 
Americans ages 13 to 64, saying that an HIV test should be as common as 
a cholesterol check. The CDC estimates 250,000 Americans are infected 
and don't even

[[Page S10192]]

know it. At a time when we are identifying more and more individuals 
with HIV, our country is destroying the very networks of care that will 
help educate and care for these individuals. We need testing, but we 
also need so much more.
  That is why I propose that we try again--and this time, get it right. 
That we try to find a way to build on our networks of care, and provide 
the services that our entire Nation needs to win the war on HIV/AIDS.
  Today, I join Senator Lautenberg in offering a proposal that would 
provide a 1-year reauthorization of the Ryan White CARE Act under 
current law. It would provide a 3.7 percent increase in authorization 
levels through 2007, while preventing funding from reverting back to 
the Treasury. This bill would provide a 1-year extension of the names-
based reporting requirement set to go into effect beginning October 1, 
2006. In addition, it would provide $30 million under Title II for 
States who have an ``unmet need'' and ``no title I entities.'' This 
proposal would help all States across the country without doing any 
harm. Instead of 5 years of a detrimental reauthorization, I support 
another year to get it right.
  I believe America can do better, and today I am standing up for the 
HIV/AIDS community across the country. Today is a day to make our 
country's budget reflect our values by expanding funding for this 
important program. I call on my colleagues to save the Ryan White CARE 
Act. Wait to implement formula changes that could destroy existing 
networks of care, and instead, work out a solution that addresses the 
needs of the entire country. Please join me in supporting this 
legislation.
  Mrs. CLINTON. Mr. President, I rise today to express my strong 
support for the Ryan White CARE Act. The programs funded through this 
law have, for more than 15 years, enabled hundreds of thousands of 
people living with HIV and AIDS to access essential care and treatment 
services.
  Yet the reauthorization proposals currently under consideration by 
both the House and the Senate would unfairly shift funding from the 
hardest-hit areas of the epidemic, devastating the ability of providers 
and organizations to offer life-extending services. The more than 
100,000 people living with HIV and AIDS in New York would be adversely 
affected by the millions of dollars in cuts they would face if these 
reauthorizations were to go through.
  I understand that the White House and the Republican leadership are 
pressuring many of my colleagues, particularly those from code-based 
States, that if they don't reauthorize the bill this year, they will 
face cuts in funding next year. But approving a fundamentally flawed 
bill under pressure is not the right thing to do. We should be working 
to strengthen the CARE Act for everyone, not decimate it.
  Today, I, along with my colleagues from New Jersey, Illinois, and 
Florida, will be introducing legislation that provides for a 1-year 
extension of programs funded by the Ryan White CARE Act, to give us 
more time to address the concerns of many that were raised during this 
reauthorization process. It will increase authorization levels across 
titles by 3.7 percent, and will set up a grant program to address unmet 
need in States that do not receive title I funding, in order to address 
the need in rural areas where HIV incidence has increased. It will also 
delay the switch from code-based to names-based reporting for 1 year, 
in order to give us time to address many of the issues that these 
States are facing in making this switch.
  I believe in the reauthorization of the CARE Act, but I believe in 
reauthorizing the CARE Act the right way--in a way that will help, not 
hurt, all of the people living with HIV and AIDS in this country. Our 
bill will help that process, and I would urge all of my colleagues to 
support it.
                                 ______