[Congressional Record Volume 152, Number 125 (Friday, September 29, 2006)]
[Senate]
[Pages S10584-S10590]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HIV/AIDS TREATMENT

  Mr. ENZI. Earlier this afternoon, there were comments made in the 
Senate by the Senator from New York, Mrs. Clinton. Some of those 
comments distressed me a little bit. We have been trying to get the 
Ryan White Care Act, which passed out of committee and passed on the 
House floor, to pass in the Senate. This is one of those rare 
bipartisan, bicameral bills. We worked it out in advance with the House 
so the bill the House passed is essentially the bill we passed out of 
committee. It is a modernization act that would ensure equitable 
distribution of funds for HIV/AIDS treatment in the United States.
  I am compelled to discuss some of the points that the Senator from 
New York made today about the Ryan White Care Act and our bipartisan 
bicameral legislation. I will talk about each of her claims in turn.
  Senator Clinton claimed that when you look at the funding for the 
whole bill, New York is not receiving the most funds per case. I don't 
doubt those figures. However, those are deceptive numbers. As an 
accountant, I have to point that out. They are deceptive for two 
reasons. First, her statement dealt only with funds per AIDS case. We 
have been talking about including HIV cases as well. Why would she 
neglect to include HIV? I assume it is because 25 States have 50 
percent of their HIV/AIDS cases not being counted today because those 
individuals have HIV, which has not progressed to AIDS.
  Please note that all of my numbers have included both HIV and AIDS. 
We must include HIV in the funding formulas. Before, including only 
AIDS made sense because we were just waiting for people to die. Now, we 
have lifesaving treatment for those with HIV; therefore, we must count 
each person who can receive lifesaving care.

  Additionally, Senator Clinton is looking at more than just the 
formula funding. Her figures include funding for community health 
centers, health care providers, providers who reach out to women and 
children. Thus, her figures include a lot of extra funding that is not 
at the heart of the debate.
  If Senator Clinton wants to rely on these numbers, numbers outside of 
the formulas, then she can do so under the current bill. She can trust 
that the other portions of the CARE Act will assist those who she is 
saying are being harmed by the bill.
  As for her claim that her State has not spent Ryan White funds for 
things such as dog-walking, I will note that the Senator from Oklahoma 
provided information for the record regarding that.
  Now, Senator Clinton further claims that New York only carried over 
$3 million. Well, I find that surprising, given that New York, on the 
average, has carried over $29 million.
  Mr. President, I ask unanimous consent to have printed in the Record 
a document from the Health Resources and Services Administration 
documenting the funds carried over for New York.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

[[Page S10585]]

[GRAPHIC] [TIFF OMITTED] TS29SE06.001



[[Page S10586]]

  Mr. ENZI. Now, the Senator from New York mentions her 1-year 
extension bill. I will also discuss the Senator's 1-year extension, her 
resolution for Ryan White, her solution that would simply delay the 
reauthorization for another year. It simply says to those States that 
have not been getting adequate funds: We do not care about you, and you 
are not going to get adequate funds. We are going to re-debate all of 
this again next year. We are not even going to move toward making it 
fair.
  The underlying bipartisan, bicameral bill has a provision providing 3 
years of hold harmless funds for New York. For 3 years, New York will 
not have to follow the formula. They would like to have 5 years. The 3 
years already in the bill is at the expense of the other States. The 5 
years would be at the expense of the other States, although I will 
cover a question that was asked yesterday in a little while.
  This is not a time to delay. This is a time to act. We absolutely 
cannot delay the much needed updates to current formulas that ensure 
that all Americans with HIV and AIDS are treated fairly and have access 
to life-sparing treatments no matter their race, their gender, or where 
they live.
  We have a chart that shows the losses that would occur under current 
law versus the gains that would occur after this reauthorization. The 
red States here are going to lose significant funding under the current 
law, beginning on October 1. One hundred thousand Americans are going 
to be left out. The chart on the right, the blue chart, shows the gains 
under the Ryan White authorization. All States gain except five, who 
lose less funds under the reauthorization than they would under current 
law. Only two of the five are asking for a difference.
  The time is now or never. As soon as the clock strikes midnight 
tomorrow, thousands of Americans will begin losing access to life-
sparing treatment unless we pass this bill now. This amendment does not 
address this fact. This amendment would extend a formula that will 
cause dramatic reductions in funding to many States and thousands of 
Americans.
  The House has passed this critical legislation, and now five Senators 
must decide if they will stand in the way of bipartisan legislation 
with broad support--a bill that will ensure equitable treatment for all 
Americans living with HIV and AIDS. I would say, I believe that is down 
to four Senators now.
  Now, my second problem with the bill of the Senator from New York is 
that it shuts out Americans infected with HIV and does not provide them 
with equal access to treatment. Rather, it focuses on outdated funding 
formulas that only examine AIDS, not the full spectrum of the disease.
  Just like her numbers on funding per person, the Senator from New 
York refuses to acknowledge those with HIV. This chart shows that 
today, in over 25 States, half of the cases in those States are not 
counted because those Americans only have HIV, not AIDS. These States 
receive funding for less than half their total HIV/AIDS cases because 
of the current, outdated, failed formula. Half the Nation does not 
receive enough funds to provide the most basic care to their residents. 
Now, my third problem with the bill of the Senator from New York or the 
Senator from New Jersey is that it ducks the key issue. Rather than 
more equitable distribution for funding and more equitable access to 
treatment for all Americans, my colleagues supporting this bill are 
simply throwing more money at the problem, assuming it will ensure more 
equitable access to lifesaving treatments. We know this is simply not 
the case because it does not solve the inherent flaws in the funding 
formulas.
  Now, this chart shows that under the current law, more than 3 percent 
of Ryan White funding is returned to the Treasury each year. That is 
more than 3 percent--much of this coming from New York and New Jersey, 
the very States that objected to the passage of the bill that would 
more equitably distribute funding across the Nation.
  Again, you will see here that under the current law, New York is 
receiving $509 per case more than the national average. Under the new 
bill, they would still get $304 more than the average case per person 
across the United States. And they have an average $29 million unspent. 
New Jersey, the other State, is receiving $310 above the national 
average. They would still get $88 above the national average. This bill 
does not get to equity. This bill moves toward equity. And it does not 
move there until 3 years from now. Other bills we have done start 
transitioning immediately.
  Now, I am surprised that the Senator from New York or New Jersey 
would offer a bill to increase funding, ignoring the outdated formula 
issues, only to increase the inequity of the program and allow more 
funds that could save lives to be returned to the Treasury each year. 
Why would we offer more money to States that are already grossly 
overpaid and unable to spend their money and increase the disparities 
of outdated funding formulas, further harming those States with an 
emerging crisis?
  This amendment would have us give a few States even more money than 
they are receiving now, while the majority of the States will receive 
significantly less funding over the next year. The Senators from New 
York and New Jersey want to extend this inequity rather than fixing the 
formula, fixing the formula now, fixing it before the tomorrow-night 
deadline, to allow fair and equitable treatment and access to care for 
Americans who have none now.
  I can tell you that the HIV/AIDS community and families want this 
bill now. Now, perhaps my colleague can explain why she wants to give 
more money to States that cannot spend what they already have, while 
taking money away from States that are struggling, as we speak, to 
provide the basic life-sparing treatments to their residents. We are 
talking about life and death here. It seems they want to throw money at 
States where the epidemic started and ignore the areas where the 
epidemic has spread, underfunding areas in a growing crisis.

  When you look at the money being spent, what we are talking about in 
this amendment is saving institutions, not saving people, not saving 
lives. This is not an economic development bill. This is not meant to 
assure that institutions that might be interested in providing these 
services still get the same amount of funds to do so even though they 
do not have as many people to provide the services to as they are being 
paid for.
  I wish putting more money into the program could fix these inequities 
but, unfortunately, these inequities stem from outdated funding 
formulas and a lack of accountability. We must address the problem at 
its core and ensure that we are not denying the growing number of 
minorities and women living with HIV and AIDS equal protection under 
the Ryan White CARE Act.
  Now, another comment by the Senator from New York was that she needs 
more money because it is more expensive to provide care in New York. 
The big cost driver is HIV/AIDS medication, costs that are similar in 
every State. Therefore, I do not understand that claim, unless it is 
protection of the institutions rather than the people.
  I have another unanimous consent request that I intend to propound, 
and I, again, am hoping that someone will be here to object who is 
actually objecting to the bill instead of sending a surrogate who has 
had to go through this ritual several times already, even though he 
supports the bill, because the request earlier, of course, was to have 
a chance to vote on the bill of the Senator from New York and the 
Senator from New Jersey. And I am going to offer that. I am going to 
offer a short time for debate and a vote on that and then a vote on the 
bipartisan, bicameral bill that has already passed the House.
  I am hoping that somebody actually involved in the substitute bill 
will come to the floor to either agree or object. That should be fair. 
They can have a vote. It seems reasonable to me. But it really ought to 
be the people offering the amendment who say they have the better idea, 
even though it leaves out the HIV folks, hundreds of thousands of 
Americans. This amendment doesn't even provide a quick fix for 1 more 
year, because it keeps the flawed formulas that will cause tremendous 
funding shortfalls in place. They will come back in another year then 
and ask for 5 more years of being held harmless.
  I want to get a vote on the bill that includes HIV and follows the 
patient.

[[Page S10587]]

We need to do that. We need to do it today, not tomorrow, not next 
month. Tomorrow night, a bunch of States will be in crisis--and their 
residents with HIV/AIDS will begin losing access to care. I would 
imagine in their amendment they have slipped in a little thing to 
protect the States that will fall into a trap tomorrow. But let's not 
just throw money at the problem, let's do the right thing for the long-
term, for the entire Nation. Let's solve the formula. Let's do what we 
have done on a number of other bills that have gone through my 
committee, which is to look at the formula and say: What is fair to all 
the States?
  I have to say, there are some people on my committee and others in 
this body who have said: If I look at the charts and I see what is 
happening to my State, yes, I may lose some money, but we are trying to 
come up with a solution that solves a problem across this country. And 
that is what we are here for, to solve problems across the country. I 
can tell you that the HIV/AIDS families and community want it to be 
fair and want the bill we have been asking unanimous consent on for 
several days now.
  So I will be asking for unanimous consent. I will throw in this 
opportunity to have a vote on the other bill, to see if people want to 
do more of the same or if they want to fix this over a period of time, 
again, holding all States harmless for 3 years before we move into a 
transition to full fairness.
  Just last night the House passed this critical, bipartisan, bicameral 
legislation by an overwhelming bipartisan vote, 325 to 98, and sent it 
to us to act upon it immediately. The House understood the critical, 
time-sensitive nature of this legislation. Now the Senate must act 
quickly to reauthorize this critical program by September 30; 
otherwise, hundreds of thousands of individuals in States and the 
District of Columbia will lose access to lifesaving services. The only 
thing standing between us and the President's signature to enact this 
bill is a Senate vote on the House bill--or perhaps a Senate vote on 
the possible substitute amendment and then a vote on the House bill.
  Now, I have asked the Senate to move this critical legislation two 
other times. Currently, four Senators from two States are blocking a 
vote and thus may prevent many individuals and families from receiving 
critical AIDS and HIV treatment under a more equitable program.
  I appreciate the number of my colleagues who have been on the floor 
to talk about the people in their States who are dying because they are 
on a waiting list and cannot get the treatment, because they have had 
huge influxes of population, huge increases in the number of people who 
have been infected by HIV and AIDS. We cannot let that happen. We 
cannot continue that. We cannot continue to say: Well, if we have been 
shipping money to one part of the country, we are going to continue to 
ship money to that part of the country even though the problem has 
shifted. So four Senators are blocking us.
  Mr. President, I would like to take this opportunity to recognize the 
hard work of the Senators from California on this legislation. I 
appreciate their willingness to continue to talk to us to address their 
concerns. They have indicated they are no longer objecting to this 
legislation. I thank them. However, this bill, due to other objections, 
is still not moving forward.
  This legislation ensures that Federal moneys are distributed more 
fairly and the dollars will follow the person. This is something our 
outdated funding formula failed to do. Hundreds of thousands of people 
living with HIV and AIDS, who live in these States, will be needlessly 
harmed if a few Senators continue obstructing good policy.
  What is more, these four Senators will not come to the floor to 
defend their objection to this critical legislation at a time when we 
are talking about it. So today I will ask again for the Senators from 
New York and New Jersey to come to the floor themselves, lodge their 
objections, listen to the unanimous consent request, where I am going 
to offer them the right to have a vote on their bill, in exchange for 
the right to vote on the bill that came out of committee--the bill that 
is bicameral and bipartisan.

  Now, as part of the unanimous consent request, I am also allowing 
those Senators to offer that amendment, of course, the opportunity for 
them to put forward their best solution for dealing with the concerns 
they have. We have run hundreds of programs trying to come up with the 
most equitable way to do this. The one we are presenting is the one we 
found that had the most people to support it. I was told this is 
identical to the bill introduced by the New York and New Jersey 
delegations this week. That is the amendment we would be voting on. 
This bill and/or amendment is not a solution; rather, it is a harmful 
delay, putting off what we should and must do today.
  These States simply raise objections about what funds are received 
this year compared to last year. These States were grossly overpaid 
last year and will continue to be overpaid next year. However, they 
will no longer be grossly overpaid under the bill I am proposing. These 
few Senators keep saying they will lose money under the 
reauthorization. No matter the dollar formula they say they may lose on 
a given day, it doesn't add up to the amount of dollars they would 
stand to carry over from the current flawed formula. The State of New 
York would carry over an average of $150 million over 5 years.
  According to GAO data, even with the formula adjustment that will 
allow for more equitable treatment, save lives in more places, New York 
would still carry over about $115 million based on their past spending. 
In the past, New York and New Jersey have been able to under-spend 
hundreds of millions of leftover dollars. At the same time, 25 other 
States are struggling to provide even the most basic life-sparing 
medications to their residents living with HIV/AIDS. Because of the 
current flawed formula, this amendment doesn't even count Americans 
living with HIV. New York can afford to generously offer more than 495 
different medications to their residents. That is 23 times the number 
of medications that Louisiana is able to offer their HIV/AIDS residents 
because of a lack of appropriate funding. While New York offers a range 
of elective drugs, many other States are unable to provide the basic 
life-sparing treatments that every American should have access to. This 
is indefensible. New York carries over an average of $30 million each 
year; yet, 25 other States are having significant difficulty providing 
the basic drugs to all of its eligible residents. Eleven States have 
waiting lists--that is right, residents in 11 States are unable to 
receive life-sparing treatments because their States do not receive 
appropriate funds.
  New York, in 2005, spent an astonishing $25 million on administration 
costs for just two titles of this law. That is more than the entire 
amount of money received by 38 States in 2005 for those two titles to 
provide care to their residents with HIV/AIDS. This inequity must be 
addressed, and it is addressed in this reauthorization. Stalling now 
because a couple States stand to lose a fraction of the money they 
already cannot spend is indefensible. Lives are at risk and a solution 
is on the table today. A solution has been passed by the House and is 
before us now.
  I hope those four Senators will defend their objection and allow a 
vote on their amendment. The continued expansion of the AIDS epidemic 
in this country is a certainty. While the epidemic continues in the 
urban areas in the country, the number of new cases not diagnosed in 
small urban, suburban, and rural areas are reaching alarming levels. As 
the epidemic expands in all these areas, local health care systems have 
often been unable to meet the growing demands for medical and support 
services.
  The problems created in rural areas are often similar to those 
experienced in large cities. However, these problems are exacerbated by 
poor health care infrastructure and limited experience with HIV/AIDS 
care. The lack of trained primary care providers, the absence of long-
term care facilities, the scarcity of resources, and a scattered 
population are additional obstacles that may be faced in a developing, 
coordinated outpatient service program.
  If New York thinks it is more expensive to handle a new problem, they 
ought to deal with the distances these people have to travel in some of 
the rural areas to get care for some of the most basic ailments. Small 
areas are

[[Page S10588]]

also often not able to provide the specialized services required by 
some persons with HIV. When primary services are unavailable, 
individuals and families must travel long distances to receive the 
necessary care. Furthermore, rural health care systems must address not 
only the epidemic but also other conditions, including substance abuse, 
mental illness, and sexually transmitted diseases which they may be 
poorly equipped to deal with.
  Thus, as we think of the problem today in its expansion into rural 
areas, we must provide the same effort to those areas we did for urban 
areas in the early 1990s. We must target resources to those in need and 
assure that those infected with HIV and living with AIDS will receive 
our support and our compassion, regardless of their race, gender or 
where they live.
  Finally, I want to answer the question posed by the Senator from 
Minnesota last night. Senator Dayton asked what it would cost to give 
these States, over the next 5 years, the same amount of money as they 
receive presently. Alarmingly, to keep those States whole, it would 
cost $614 million a year. That is over half a billion for the next 5 
years.
  It is not possible just to provide increases to New York and New 
Jersey due to the funding distribution; therefore, to ensure that 
everybody receives as much money per person with HIV that New York is 
currently receiving, it would cost over $3 billion--if we went to 
equity, it would cost $3 billion, or a 30 percent increase in Ryan 
White funding to maintain States' funding level that are grossly 
overpaid and unable to spend the money they do receive.
  Our obligation as Senators is to the people of the United States. We 
still have four Senators who continue to obstruct the Senate from 
passing a bill because of the September 30 deadline--a bill which 
passed the House 325-to-98, a bill that can save more than 100,000 
lives, including the lives of the growing number of women and 
minorities who are afflicted by this devastating disease, and provides 
the money to where it is needed most.
  As I said last night, this is not an economic development project. 
The bottom line is simply, where States have more people with HIV/AIDS, 
they should get more money. Where States have less people with HIV/
AIDS, they should get less money. As we all know, the Ryan White 
program provides critical health care services for people infected with 
HIV and AIDS. These individuals rely on this vital program for drugs 
and other services. We need to pass this legislation so we can provide 
them with the treatment they desperately need.
  I urge the Senators who are holding up the bill to stop playing the 
numbers game so the Ryan White CARE Act funding can address the 
epidemic of today, not yesterday.
  I ask the Chair how much time remains.
  The PRESIDING OFFICER. The Senator has 20 minutes remaining.
  Mr. ENZI. Mr. President, I will yield 5 minutes to the Senator from 
Alabama, Mr. Sessions.
  The PRESIDING OFFICER. The Senator from Alabama is recognized.
  Mr. SESSIONS. Mr. President, I thank the Senator. Chairman Enzi has 
done a fine job, and he is known for his fairness and his hard work. 
Under his leadership, State after State has agreed to this new and 
fairer formula. Unfortunately, we have a few privileged States who want 
to maintain an extraordinary funding stream and are denying funding to 
the other States that are in crisis today.
  I have spoken with Kathie Hiers, the director of AIDS Alabama, who is 
very articulate on these issues, Mary Elizabeth Marr, who runs the AIDS 
center in Huntsville, and Jane Cheeks, the State AIDS director, and 
they have explained to me how unfair the current system is.
  Mr. President, I could not be prouder to serve on the committee with 
Senator Enzi, and I greatly appreciate his leadership to help those of 
us whose States are facing a national crisis.
  I would like to briefly show this chart and make a few points. 
Senator Hatch, who wrote the Ryan White Act, is here. Ryan White was 
from Indiana. He was not from a large city. But Senator Hatch 
considered the AIDS challenges facing America, and at the time, this 
disease appeared to be a greater problem in bigger cities. The whole 
Nation contributed money to fight this epidemic in the crisis area 
cities.
  The money that was spent fighting AIDS in these cities had a 
tremendous impact. However, the geography of the disease has changed. 
Where is the growth of AIDS today? Where are the surging numbers? HIV 
and AIDS are increasing at a greater rate in the South. Seventy percent 
of the new HIV cases in my State are African Americans, and the 
greatest growth rate by far is among African American women. My State 
is not receiving adequate funding to treat the greater numbers of 
people in our State that are living with HIV/AIDS.
  I would like to again point out that the formula used to determine 
funding has a number of serious flaws. One of these flaws is that we 
count AIDS cases for funding, but we do not count HIV positive cases, 
despite the fact that HIV is the precursor to fully-developed AIDS. In 
contrast to the early years of this disease, we have medicines that can 
be given to people who have HIV before it has developed into AIDS. 
These drugs have been proven to delay the onset of AIDS so that the 
people that have access to them can live a more healthy life.
  How is it possible that we are not including the people who have HIV 
in the funding formula?
  These are the people that need to be put on medicines at once. We now 
know that a pregnant women who has HIV will give birth to a child 
without AIDS if she is given the right medicines. However, if she is 
not given these drugs, she faces a greater probability that her child 
could be born with AIDS. This clearly is a very serious, life-and-death 
issue, and one that we must confront. We have continued to be generous 
with AIDS funding, but that generosity certainly would require that we 
shift the money to follow the disease. The money should not follow 
bureaucracies and established systems where it cannot be spent. For 
example, New York was not able to spend $29 million last year, yet 
under the same formula, Alabama receives only $11 million for the whole 
State for the entire year. The money that they had and were unable to 
spend is nearly 3 times more than our complete funding, yet Alabama has 
waiting lists for people who are in desperate need of these drugs. The 
people on our waiting lists must wait before they can become eligible 
for these drugs because we don't have enough money to pay for them. We 
cannot afford to pay for more than 40 drugs in Alabama, but New York is 
able to provide nearly 500 drugs to their AIDS patients. This is just 
not right.

  To conclude, I find it unfortunate that we have seen such partisan, 
parochial interest in protecting those who receive excessive federal 
benefits when these benefits are no longer justified. The U.S. 
Government and the American people were generous to New York, San 
Francisco, and other big cities. We saw that these cities were in a 
crisis with this disease, and so we gave them a disproportionate 
amount. These cities are not entitled to keep forever the benefits we 
have been giving, and now we are experiencing crises in other States. I 
think it is a sad day indeed that there are Senators blocking this 
reform and blocking the re-authorization of the act.
  The PRESIDING OFFICER. The Senator's time has expired.
  Mr. SESSIONS. I thank the Chair and yield the floor. I would like to 
note my appreciation for Senator Hatch and his leadership on this 
issue.
  Mr. ENZI. Mr. President, I yield 10 minutes to the Senator from Utah, 
Senator Hatch, who has been actively involved in the HIV/AIDS 
discussion for years. In fact, he selected the Ryan White name for this 
bill many years ago when he chaired this committee.
  Mr. HATCH. Mr. President, I thank my chairman. I am grateful to be 
with him on this bill. I am one of the prime authors of the Ryan White 
Act. I stood here on the floor, with Mrs. White sitting up in the 
gallery, and recognized it and named it the Ryan White bill.
  I rise again to support the effort to call up and immediately adopt 
S. 2823, the Ryan White HIV/AIDS Treatment Modernization Act. I thank 
our chairman and others who worked so hard on this bill to bring it 
here.
  It makes no sense that this product of bipartisan, bicameral effort 
should

[[Page S10589]]

be held up at the eleventh hour by Members representing only two 
States--three at one time, but at least the two Senators from 
California backed off and now realize that they are not doing what is 
right here.
  Given that the theme of this bipartisan, bicameral effort was to 
craft something that would help even out the playing field for all U.S. 
States and territories, it makes even less sense for these holds to be 
placed on behalf of States that currently enjoy substantially generous 
funding. In some areas of these States, the funding is so generous that 
we have heard reports of Ryan White dollars being spent on dog-walking 
services, haircuts, candlelight dinners, and four-star hotels. I, for 
one, am pretty fed up with it, and to have four liberal Senators on 
this floor holding this up is just outrageous.
  Furthermore, some States carry over millions of unspent dollars every 
year, and some continue to receive funding for people who are no longer 
living. This is happening while people die in areas where the epidemic 
is newer because under the current Ryan White structure, their location 
dictates that they should receive less money for care. This 
reauthorization bill would fix that broken program structure.
  Let me make it clear that my home State of Utah does not stand to 
gain large increases in funding. Our State AIDS director understands 
and supports the need for equity within the program. Due to efficient 
administration of the Ryan White program, Utah is able to manage its 
funding so that it can--just barely--avoid an ADAP waiting list for 
pharmaceuticals. Utah can do this even though it receives an average of 
$1,315 less per patient in Ryan White funding than does New York, 
$1,330 per patient less than New Jersey, and $843 per patient less than 
California, just to mention three States. The New York and New Jersey 
Senators are holding up this bill.
  I could go on and on about this because there are really only about 
five States that receive less funding per patient than Utah. But I am 
not going to do that, and that is precisely my point. My point is that 
this should not be about who gets the most money. I find it 
disconcerting that I have to point out, once again, that this program 
assists people who could die if it is not reauthorized this week. It is 
as simple as that. I have received numerous letters from the HIV/AIDS 
community urging that the Senate reauthorize this program before it 
adjourns this week. I also remind my colleagues that President Bush has 
charged Congress with reauthorizing this program.
  Last night, the House passed H.R. 6143, the Ryan White HIV/AIDS 
Treatment Modernization Act of 2006, by a vote of 325 to 98. The vote 
total includes over half of the House Democrats voting for this bill. 
What happened to the other half? They are always out here talking about 
compassion and talking about reason and talking about how good they are 
to the poor. Here is a chance to do some good for the poor. We worked 
hard to get everything together on this bill, and we have four liberal 
Senators holding it up. It is ridiculous.
  I am the coauthor of three of the AIDS bills. I remember when we 
brought the first one to the floor. It was a big battle. I was the 
conservative who stood up for it. We finally won, and we won on all 
three of them. Like I say, I named this bill the Ryan White bill right 
here on the floor of the Senate.
  As I mentioned, the House passed its bill last night with 
overwhelming bipartisan support. I implore my colleagues in the Senate 
to do the same, to work in the best interest of the entire Nation and 
pass this reauthorization.
  I am really upset about it, and I think everybody ought to be upset 
about it. Sometimes we get extreme worrying about who gets the money 
and who gets this and who gets that. New York and New Jersey are not 
being mistreated here. Some States will always think they are not 
getting enough money no matter what we do here. We have to work on 
this.
  Mr. President, I yield the floor, and I thank my colleagues for their 
forbearance.
  Mr. ENZI. Mr. President, it is my understanding that I have 9 minutes 
remaining?
  The PRESIDING OFFICER (Mr. Ensign). The Senator is correct.
  Mr. ENZI. I thank the Chair, and since there is a Senator now here 
from one of the two states objecting to us moving on with the Ryan 
White HIV/AIDS Treatment Modernization Act, I would like to propound 
the unanimous consent.
  Mr. President, I ask unanimous consent that the Senate proceed to the 
immediate consideration of H.R. 6143, which was received from the 
House. I ask unanimous consent that the only amendment in order be an 
amendment by Senator Lautenberg, which is the text of S. 3944, with 30 
minutes of debate equally divided. I ask consent that following the 
disposition of that amendment, the bill, as amended, if amended, be 
read the third time and passed, a motion to reconsider be laid upon the 
table, and that any statements relating to the bill be printed in the 
Record.
  The PRESIDING OFFICER. Is there objection?
  Mr. MENENDEZ. Mr. President, we just received this proposal about 15 
minutes ago. This is a monumental issue, very important to my State and 
others. Therefore, I must object at this time.
  The PRESIDING OFFICER. Objection is heard.
  Mr. ENZI. Mr. President, I am sorry to hear the objection. We have 
been trying to find a way, any way, to be able to move on to a vote on 
this bill that is bipartisan, bicameral. It has already passed the 
House and I am sure it would pass here. So I am really disappointed.
  Mr. President, I allocate 5 minutes of time to the Senator from North 
Carolina, Mr. Burr.
  The PRESIDING OFFICER. The Senator from North Carolina is recognized.
  Mr. BURR. Mr. President, I thank the Chair. I am amazed to hear that 
some have just become familiar with this bill. It has been negotiated 
in a bicameral, bipartisan way. It is the same bill that we have moved 
out of the committee and now the House has passed it without 
opposition, and we thought it just right to pick up the House bill.
  But let me back up, if I can. Currently, New York offers over 500 
Medicaid options to their HIV/AIDS patients. West Virginia has less 
than 50 options for medication. Now, this disparity is not because West 
Virginia doesn't care about people with HIV and AIDS; this disparity is 
because New York and New Jersey and other States with Title I cities 
receive more money per person than the other States. This just is not 
fair.
  Why do some States offer 400 drugs to their residents with HIV/AIDS 
when other States keep waiting lists for individuals who need the most 
basic lifesaving drugs? Well, in 2005 North Carolina contributed 40 
percent of the cost for every individual who qualified for ADAP. ADAP 
qualification in North Carolina is 125 percent of poverty, $9,200. In 
contrast, the same year, New York contributed 16 percent of the total 
ADAP funds, and New Yorkers, under 460 percent of poverty were eligible 
for Federal ADAP funds. New Jersey contributed only 14 percent of their 
total ADAP funds used, and residents of New Jersey, under 500 percent 
of poverty, are eligible for Federal funds. Why? Because the Federal 
funds that we supply under this formula are so rich to New Jersey and 
to New York that a person with an income of $47,000 a year is eligible 
for Federal medication on ADAP, but not in North Carolina. If they 
exceed the $9,500 income mark, because of our limited amount of 
dollars, they are no longer eligible.
  In 2004, in a clinic in Charlotte, NC, there were 547 patients who 
made 2,362 clinic visits. That is a little over 4 times a year. But we 
are told by individuals from these States that have more money than 
they can use that they couldn't possibly tell us how many real HIV/AIDS 
patients they have in their State in a 3 or 5-year period.
  The suggestion was made today that we delay this for another year so 
that we would have an opportunity to work out some of this and they 
could see if they could count patients. Let me suggest to my colleagues 
that if individuals are going into a clinic and receiving Federal aid 
under the Ryan White CARE Act, then you would be able to count them. If 
they weren't going in to receive care under the Ryan White

[[Page S10590]]

CARE Act, then they shouldn't be eligible and the State doesn't need 
the money. The fact is we are counting the people who are getting 
services. They don't exceed the amount of money that they get, but they 
would like to keep the extra. In fact, today, the reason that they 
would like another year is they would like to keep on counting to see 
if they can get their numbers up to match the amount of money that they 
get.
  The Senators from New York don't care about the fact that in 2006 the 
national funding per AIDS case was $1,613. Yet in New York, the average 
was $2,122 per case. In North Carolina, it is a little over $1,200 a 
year. The other States that get a disproportionate share of money per 
case exist, but they acknowledge that that disproportionate share is 
unfair. They realize it is unequal, and so they are willing to support 
this bill. Let me tell my colleagues that Connecticut gets $2,887 per 
AIDS patient, while South Carolina gets $1,364; Minnesota, $2,903, 
while Arkansas gets $1,239; Louisiana, $2069, while North Carolina gets 
$1,166.
  Mr. President, I thank those Members who are willing to support this 
legislation, who are willing to let their numbers help others who will 
die without this funding.
  I yield the floor.
  Mr. ENZI. Mr. President, for the last few seconds I am going to just 
mention that the bill by the Senators from New York and New Jersey was 
introduced on Tuesday. Surely they have had time to think about having 
that amendment debated and voted on in that amount of time. I am really 
disappointed that they won't give some kind of an answer that will 
allow a vote on that amendment. If that is what they need for cover, 
that is OK with me. I just need to get this done.
  New York and New Jersey are stealing the future from those with HIV, 
and that just cannot happen in the U.S. Senate. We have to worry about 
all the people from all of the United States, and that is what the 
reauthorization would do. That is why it is important to do it. I have 
asked those questions numerous times now trying to find a way to bring 
this bill up for a vote, and am being denied in every way--I am not 
being denied--those with HIV, those with AIDS, their families are being 
denied the right to have a vote on this bill in the U.S. Senate.

  The PRESIDING OFFICER. The order is for the Senator from Minnesota to 
be recognized for 20 minutes.
  Mr. BAUCUS. Mr. President, will the Senator from Minnesota yield to 
me?
  Mr. DAYTON. For the purpose of asking a question.
  Mr. BAUCUS. Mr. President, under regular order, after the Senator 
from Minnesota speaks, are there other speakers lined up?
  The PRESIDING OFFICER. The Senator from Texas then has 15 minutes.
  Mr. BAUCUS. Mr. President, I ask unanimous consent that following the 
statement by the Senator from Texas, the Senator from Iowa, Mr. 
Grassley, be allowed to speak for 20 minutes; following Senator 
Grassley, myself for 15 minutes, and following Senator Grassley, 
Senator Murray for 15, Senator Harkin for 10, and Senator Menendez for 
15.
  The PRESIDING OFFICER. Is there objection?
  Mr. GREGG. Reserving the right to object, with the understanding, Mr. 
President, that if a Republican Member wishes to speak, his time would 
be allotted in between the times of the Democratic Members.
  The PRESIDING OFFICER. Does the Senator from Montana so modify his 
request?
  Mr. BAUCUS. First of all, I would like that not to be the case--well, 
that automatically would be the case because Senator Grassley and 
myself would follow Senator Hutchison. Following the Senator from 
Texas, then the Senator from Iowa, and then myself, and then I am 
asking following myself, that Senator Murray and Senator Harkin be 
recognized. There will be three Republicans right in a row there 
already, at least two, so I am just suggesting that at least Senators 
Murray and Harkin be able to follow myself.
  Mr. GREGG. Maybe we can reserve this and discuss it for a second.
  Mr. BAUCUS. I would like to lock in Senator Grassley and myself 
because we have been seeking this for some time.
  Mr. GREGG. I would like to have the opportunity to make sure the 
Republicans would have an equal amount of time.
  The PRESIDING OFFICER. Is there objection?
  Mrs. MURRAY. Mr. President, I would modify the request to suggest 
that following myself and a Republican Senator to be recognized, and a 
Republican Senator between Senator Harkin and Senator Menendez if they 
so request.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from Minnesota is recognized for 20 minutes.

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