[Congressional Record Volume 152, Number 125 (Friday, September 29, 2006)]
[Senate]
[Pages S10601-S10604]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                    RYAN WHITE CARE REAUTHORIZATION

  Mr. MENENDEZ. Mr. President, I rise tonight to speak about the Ryan 
White CARE reauthorization.
  We have heard a number of speakers on the Senate floor over the past 
few days claiming to be experts on New Jersey's HIV/AIDS community and 
our Ryan White Program. Now, some might choose to listen to them, but I 
choose to listen to the real New Jersey experts. Governor Corzine says 
the bill will have ``an enormous negative impact for individuals and 
families with HIV in New Jersey.''
  New Jersey stands to lose millions of dollars in the first year alone 
with these losses increasing over time. The losses will disrupt and 
destabilize the comprehensive continuum of care that has been 
established. And New Jersey's HIV/AIDS providers and advocates are 
unified against the proposed bill and know the real impact these cuts 
have on real lives.
  The medical director from the Monmouth Medical Center and HIV Clinic 
in Long Branch, NJ, a clinic funded by Ryan White funds, says:

       Since our inception in 2001, we have doubled our size. 
     Fifty-two percent of our clients are women. Forty-eight 
     percent are African Americans. The majority of our clients 
     have no insurance and no access to medications, except to the 
     State ADAP program. Our patients are living longer and having 
     a better quality of life. In fact, this past year we have had 
     8 babies born to HIV-infected women. None of these infants 
     are infected with the virus. To ensure that we will not lose 
     ground in the fight against this epidemic, the Ryan White 
     program must be reauthorized so that existing clinics and 
     programs continue to provide medical access for care and 
     treatment. Please do not dismantle the system at the expense 
     of another, they tell us.

  Now, I really had to bite my lip earlier because some came to the 
floor of the Senate and had the audacity to say that New Jersey is a 
privileged State. To them I say: I would gladly give up the privilege 
of being No. 1 in the Nation in the proportion of women living with 
AIDS. I would gladly give up the privilege of having the third largest 
proportion of children living with HIV/AIDS. I would gladly give up the 
privilege of having the fourth highest number of people living with 
HIV/AIDS. I would gladly give up the privilege of having the fifth 
largest number of new AIDS cases each year--each year--despite the fact 
that we are only the ninth largest in total population. I would gladly 
give up the privilege of having the fifth highest rate in reported 
deaths due to AIDS.
  I am sure that the 32,000 people living with HIV or AIDS in New 
Jersey would love nothing more than to be able to

[[Page S10602]]

give up that privilege, or the people of color who account for 75 
percent of all HIV/AIDS cases, or the women who make up more than a 
third of all people living with HIV/AIDS. I am sure they would gladly 
give up that privilege as well.
  These same experts have argued that New Jersey is receiving more than 
its fair share of Ryan White funding. But what we are hearing is just 
another numbers game to try to avoid the real issue, which is the 
completely inadequate funding in this reauthorization bill.
  When you look at the full picture, without just zooming in on the 
piece that happens to fit your argument, New Jersey is one of the most 
expensive States in which to live in this country. Yet it spends less 
per person--less per person--than 15 other States, including Alabama, 
Wyoming, South Dakota, Montana, Alaska, Idaho, Massachusetts, Vermont, 
the District of Columbia, Arizona, Pennsylvania, Louisiana, and 
Michigan.
  So just to put things in perspective, according to the Care 
Coalition, Alabama spends about $5,778 per HIV/AIDS patient, and 
Wyoming spends $5,984 per patient. In contrast, New Jersey spends $800 
less than Alabama and $1,000 less than Wyoming per patient on HIV/AIDS 
care. So I cannot accept the numbers as those would have it constructed 
for the purposes of pursuing their argument.
  There are more than 2,130 new HIV/AIDS infections each year in New 
Jersey, and in 2004 New Jersey reported almost 2,400 new HIV and AIDS 
cases, more than all but 4 other States. Ryan White funding is being 
put to good use saving lives and helping individuals avoid disability 
and lead productive, successful lives. In New Jersey, we are giving 
32,000 people with HIV/AIDS a new lease on life. We have one of the 
most effective ADAP programs in the Nation, as well as comprehensive 
services, including primary medical care, mental health service, 
substance abuse services, oral health, case management, nutritional 
services.
  So thanks to the success of New Jersey's network of care, we have 
seen a sustained drop in the number of HIV/AIDS deaths each year. 
However, with this growing population, there is a growing need for 
services. It is blatantly clear that any cut to our State is a 
destructive blow to the very network of care that countless men, women, 
children, and babies are counting on.
  Now, I would be happy to have a straight, one-year reauthorization in 
which all would be made whole if the majority is willing to accept it. 
I am also willing to find a solution to the real problem, which is a 
severe shortage of funding--a severe shortage of funding. As I said, I 
am happy to give up the privilege--I would be happy, as would the lives 
of those individuals who find themselves struggling day in and day out, 
they would be happy to give up the privilege that we heard about on the 
floor. But I cannot stand by and watch the hopes and dreams of New 
Jerseyans living with HIV/AIDS be extinguished by this misguided 
proposal.
  How can I go back to constituents in New Jersey living with HIV or 
AIDS and tell them it is a fair deal to have them put their lives at 
risk? I can't and I won't, and we can't have an appropriate 
reauthorization.
  Mr. President, I yield back the remainder of my time and yield the 
floor.
  Mr. ENZI. Mr. President, it is my understanding that the Republicans 
have an extra 15-minute slot.
  The PRESIDING OFFICER. That is correct.
  Mr. ENZI. I have been allocated in that slot.
  The PRESIDING OFFICER. The Senator is recognized for 15 minutes.
  Mr. ENZI. I would assume that the Senator from New Jersey has had 
adequate time to look at the unanimous consent request that I presented 
earlier, and I will be making that unanimous consent request again. He 
must be ready to debate the AIDS bill that New York and New Jersey have 
proposed, and I am ready to grant time to have a vote on that bill as 
well as the bipartisan, bicameral bill passed by the House last night. 
I have no fear of that. This Nation has a lot of problems with HIV and 
AIDS that need to be taken care of. There is one bill that does that 
fairly--a bill that the House overwhemingly passed. A bill with a 
comprehensive, fair and equitable solution. There is another one that 
merely extends the time where we keep doing the same thing that we have 
been doing. A quick fix that would give us the same results that we 
have been getting--people across the country are dying because of not 
getting treatment, because of unfair, inequitable funding formulas that 
ignore the new, emerging epidemic of HIV in rural areas and the 
Southeast.
  Mr. SALAZAR. Mr. President, parliamentary inquiry: Mr. President, 
would the Senator from Wyoming yield for a question?
  The PRESIDENT pro tempore. Will the Senator yield for a question?
  Mr. ENZI. I am happy to yield for a question.
  Mr. SALAZAR. Mr. President, just a parliamentary inquiry as to the 
order of speakers and where we are, based on the last unanimous consent 
order.
  The PRESIDENT pro tempore. Senator Enzi has 15 minutes, then Senator 
Landrieu has 15 minutes, and then another Republican has 15 minutes, 
and then the Senator from Colorado, Mr. Salazar, has the fourth 15 
minutes.
  Mr. SALAZAR. I thank the Presiding Officer, and I thank my friend 
from Wyoming.
  Mr. ENZI. I thank my neighbor from Colorado. As we set it up earlier, 
we have been alternating times. I am glad that I have the opportunity 
to speak right after the Senator from New Jersey. I know he turned down 
the unanimous consent request earlier. I am hoping that he will accept 
the unanimous consent this time.
  Tomorrow is a very critical time for people in the United States. 
These States, the red states in this chart in particular, will start 
losing significant funds at midnight tomorrow night if the current 
failed formula is not fixed. California loses $18.78 million; 
Connecticut, $3.2 million; the District of Columbia, $6.93 million; 
Delaware, $1.52 million; Georgia, $9.68 million; Illinois, $12.48 
million; Oregon, $1.38 million; Pennsylvania, $9.25 million; 
Washington, $2.42 million; Maryland, $11.64 million. We can fix this 
formula tonight. A solution, passed overwhelmingly in the House, is 
before us now.
  I appreciate the letter that I got from the Senator from Maryland, 
Ms. Mikulski, reminding me that this goes into effect tomorrow and 
asking me to get the Ryan White bill done.
  Now, when we reauthorize this program by using the bill that came out 
of my committee and passed overwhelmingly in the House, there will be 
some changes to the formula--saving many States from significant and 
critical losses. Instead of California losing $18.78 million, they will 
gain $15.38 million because the money is going to follow the cases, and 
they are not going to get the penalty that they would have under 
current law. I have the chart that shows the gains for a number of 
States. All the ones that I mentioned would have gains instead of 
losses. So this is a critical piece of legislation to all of these 
States.
  We are talking about unfairness and inequity. This isn't the only 
bill on which we are changing formulas so they more accurately address 
the problems they were meant to address. The reason we have 
reauthorizations is so that on a regular basis we can review the monies 
going to States, see how it is allocated, see if it needs to be 
allocated on a different basis so that it is more fair. Our committee 
ran several hundred evaluations to see different kinds of formulas at 
the suggestion of members of the committee and Members of the Senate to 
see what the fairest way would be to do this bill.
  Now, not only did we pick the fairest way to transition, by holding 
those States harmless for 3 years, but we chose the fairest formula in 
the long-term that ensures that Americans with HIV/AIDS get the 
treatment they need on an equitable basis no matter their race, gender, 
or where they live. I have to tell my colleagues, there is not another 
bill we have done that allows this kind of inequity--under current 
law--to continue to give those States time to prepare for the formula 
shift. Of course the States that do not obtain equality for 3 years are 
usually pretty upset. They think that the equality ought to come in 
much earlier in the process.

  So we had a number of States that said, How come it gets to be unfair 
for

[[Page S10603]]

that long? We said we are going to try to protect these States so they 
have a time to transition, so they prepare their systems for the change 
in the funding.
  One of the things that was raised earlier this afternoon was that it 
is more expensive to live in New Jersey. It is more expensive to live 
in New York.
  It is pretty expensive to live in DC, too, and DC is going to lose 
$6.93 million, if we don't pass this legislation. If we pass this bill, 
they are going to gain $4.35 million. It is a change for a lot of 
States, but it is a change to fairness based on the number of people 
with HIV/AIDS, not the number of institutions that we have been funding 
in these States. This program is not for economic development. It is 
not a way to keep jobs. It is a program to keep patients alive.
  On these other bills I have been working on--the Older Americans 
Act--includes a 5-year transition. Some of the States said, By golly, 
we have been cheated for years. We ought to get our money faster, but 
they have agreed to a 5-year transition.
  The ones who are losing money have said: Okay, we understand, that is 
fair. You gave us a time to transition.
  We have 9 or 10 bills that my committee has to do that deal with 
formulas. I can tell you the first reaction of every Senator, including 
myself, is to say: Print the chart out, see what happens to my State. 
Naturally, you get upset if your State is not going to get as much 
money as they got before. But, fortunately, the majority of the Members 
around here look and say, Is the amount I am getting fair?
  Higher costs--I want to go back to that again. What we are providing 
are the AIDS drugs, and the AIDS drugs cost the same all over this 
country. It doesn't cost more for an AIDS drug in New York than it does 
in Wyoming. As for expenses, we only have a couple of big cities in 
Wyoming--Cheyenne is 52,700-and-some people, that is our biggest city; 
Casper is next with a little over 50,000, and then it drops off 
significantly.
  If a third of your towns have less than 250 people in them, how many 
of those do you think have a hospital? How many of those even have a 
doctor to look at somebody with HIV/AIDS? They have to travel a long 
way at great inconvenience and great cost. We don't cover that. We 
cover the treatment.
  When we crafted the current funding proposal, we ran dozens of these 
various formula options to see which was the fairest way to do it, 
which one created the least amount of disruption. That is how we came 
up with the current funding formulas in this bill. We are being asked, 
of course, to consider another bill, introduced on Tuesday of this week 
by the Senators from New York, New Jersey, and Florida. I believe we 
should debate this bill. However, I have problems with this bill 
because what that other bill does is delay this argument over funding 
formulas for 1 year. It doesn't do the equity for sure at any time. So 
in our bipartisan, bicameral bill, what we said is we will delay equity 
for 3 years. Three years is better than 1 year, so I really don't 
understand why anybody is holding this bill up.
  I understand that they lose money. I understand that. However, they 
are grossly overpaid. As I have shown before, under the current law, 
the State of New York gets $504 more than the average per patient 
across the rest of the Nation. New Jersey gets $310 more per person 
than the average across the rest of the Nation.
  Under the reauthorization, New York will still get $304 per person 
more; New Jersey will still get $88 per person more. As I have 
mentioned, all of the funds have not been spent every year. So we are 
saying New York does not want to share even what did not spend.
  I can understand Senators being concerned over losing the money. What 
I am just asking is we take a look at the whole national picture, just 
like we are taking the whole national picture in some other bills 
pending before the HELP Committee. For all of those bills, I pledge 
that during this next year we will have hearings where we look at the 
formulas in these other bills and see how we can transition more 
quickly than we have been doing, to move toward equity.
  If you have people who are dying of AIDS and you have people who 
cannot be treated for HIV, you have a real problem. We are not talking 
about parks or things that might be considered luxuries. We are talking 
about life and death. The earlier we start treating people, the more 
chance they have for survival.
  Fortunately, very fortunately, there have been a lot of drugs that 
have been developed for the market that make a difference, now, for 
those infected with HIV; these drugs will extend their lives. We don't 
have to wait until they are in the AIDS category to do that. We don't 
have to do that to give them as good a life as possible. We can start 
providing life-saving treatment when we know they have HIV. We can 
positively extend their lives.
  That is what we are trying to do with this bill. Under the other 
bill, introduced on Tuesday of this week, the supporters are 
eliminating, again, the count of HIV, the ability to treat those with 
HIV. As far as fairness, don't you think we ought to treat as early as 
we can with the capability that we have instead of just waiting until 
they have AIDS and then counting them and pay for them?
  The other bill doesn't take into account the HIV folks at all. If I 
were one of the Senators from those two States, and I have been holding 
out this long, I would be here yelling too, I guess, because I would 
have to explain why I was doing what I'm doing--and not just to the 
people in my State. I would have to be explaining why I was being an 
obstructionist for life-saving care to the whole Nation. Of course, 
those outside my State don't get to vote for me, but we do have an 
obligation to all of those folks across the Nation.
  When we have equitable funding formulas, if States come up with a 
higher HIV/AIDS population than we thought they would have, we may have 
to put more money into it. But the additional money ought to come with 
the additional cases. We ought to have some numbers to back up what is 
happening, and not everyone has the numbers to back up their current 
funding. We have some waiting lists, waiting lists of people who are 
waiting for life-saving treatment. But if they look at the waiting list 
they may say, I am not going to gain treatment anyway, so why would I 
even get on a waiting list? Thus, there may be thousands more, not 
seeking treatment because, where they live, we are not treating them 
equitably. I do know there are some difficulties out there.
  I know the time to vote on Ryan White is now or never because as soon 
as the clock strikes midnight tomorrow night thousands of Americans 
will start losing access to the life-sparing treatment unless we pass 
the bill now. I can't understand why four Senators are denying people 
suffering from HIV/AIDS to vote on this critical legislation to create 
a more equitable program.
  Earlier today, the Senators from New Jersey and New York suggested 
that the answer to the inequities in Ryan White is more money. I say we 
can talk about more money in Ryan White as soon as the States that are 
hoarding funds allow current dollars to focus on those in need, 
individuals on waiting lists throughout the country. We have to address 
the current inequities, not compound them by just adding more dollars 
to a failed funding formula. We don't want to continue to have the rich 
States get richer while the poor States get poorer.
  The Senator from New Jersey also suggested this bipartisan bicameral 
bill was not supported by minorities because the National Minority AIDS 
Council did not support the bill. One council does not capture all the 
minorities. In fact, over seven minority organizations, including the 
Alaska Native Tribal Health Consortium, Brother 2 Brother, Latino 
Coalition, League of United Latin American Citizens, the National Black 
Chamber of Commerce, the National Minority Health Month Foundation, and 
the New Black Leadership Coalition support this bipartisan bicameral 
product.
  In addition, 34 other organizations support this key legislation, 
including key national advocate organizations such as AIDS Action, AIDS 
Healthcare Foundation and the Southern AIDS Coalition.
  I ask unanimous consent the full list of supporting organizations be 
printed in the Record.

[[Page S10604]]

  There being no objection, the material was ordered to be printed in 
the Record, as follows:

    Organizations That Support Final Passage of Ryan White HIV/AIDS 
                      Treatment Modernization Act


                               H.R. 6143

       AbsoluteCare Medical Center; ADAP Coalition; AIDS Action; 
     AIDS Action Coalition; Huntsville, AL; AIDS Action Ohio; AIDS 
     Alabama, Inc.; AIDS Healthcare Foundation; AIDS Outreach of 
     East Alabama Medical Center; AIDS Resource Center Ohio; 
     Alaska Native Tribal Health Consortium; American Academy of 
     HIV Medicine; American Dietetic Association; Am I My 
     Brother's Keeper, Inc.; Birmingham AIDS Outreach; Brother 2 
     Brother.
       Carepoint Adult, Child and Family Center; Catholic 
     Charities Diocese of Fort Worth; Columbus AIDS Task Force; 
     County of Los Angeles; County of Riverside; County of San 
     Diego; First Ladies Summit; Governor Robert L. Ehrlich 
     (Maryland); Harabee Empowerment Center; HIV Medicine 
     Association; Latino Coalition; League of United Latin 
     American Citizens (LULAC); Life Linc; Log Cabin Republicans; 
     Lowcountry Infectious Diseases.
       Montgomery AIDS Outreach; National Black Chamber of 
     Commerce; National Coalition of Pastors Spouses; National 
     Minority Health Month Foundation; New Black Leadership 
     Coalition; Ohio AIDS Coalition; President's Advisory Council 
     on HIV/AIDS; Rep. Linda Upmeyer (Iowa State Rep, District 
     12); Rocky Mountain Opportunities Industrialization Center; 
     South Alabama Cares; Southern AIDS Coalition.

  Mr. ENZI. May I ask my time?
  The PRESIDENT pro tempore. The Senator has 5 seconds left.
  Mr. ENZI. I would like to propound a unanimous consent request and 
ask unanimous consent to be able to propound the request.


                  Unanimous Consent Request H.R. 6143

  I ask unanimous consent 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 or one of the Senators from New Jersey or New York, 
which is the text of S. 3944, with 30 minutes of debate equally 
divided. I ask unanimous consent that following the disposition of the 
amendment, the bill as amended, if amended, be read the third time and 
passed, the motion to reconsider be laid upon the table, and that any 
statements relating to the bill be printed in the Record.
  The PRESIDENT pro tempore. Is there objection?
  Mr. MENENDEZ. Mr. President, we do have an obligation to all the 
people of this country and that includes the people of New Jersey. This 
is not just simply about money.
  The PRESIDENT pro tempore. The question is, does the Senator object?
  Mr. MENENDEZ. I do object based on that and much more.
  The PRESIDENT pro tempore. Objection is heard. The time of the 
Senator has expired.
  Under the previous agreement, the Senator from Louisiana is 
recognized for 15 minutes.

                          ____________________