[Congressional Record Volume 152, Number 133 (Wednesday, December 6, 2006)]
[Senate]
[Pages S11240-S11243]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




        RYAN WHITE HIV/AIDS TREATMENT MODERNIZATION ACT OF 2006

  Mr. ENSIGN. Mr. President, I ask unanimous consent that the Committee 
on Health, Education, Labor and Pensions be discharged from further 
consideration of H.R. 6143, and the Senate proceed to its immediate 
consideration.
  The ACTING PRESIDENT pro tempore. Without objection it is so ordered. 
The clerk will report the bill by title.
  The legislative clerk read as follows:

       A bill (H.R. 6143) to amend title XXVI of the Public Health 
     Service Act to revise and extend the program for providing 
     life-saving care for those with HIV/AIDS.

  There being no objection, the Senate proceeded to consider the bill.
  Mr. KENNEDY. Mr. President, today marks an important milestone in our 
ongoing national struggle with HIV and AIDS. Twenty-five years ago, the 
Centers for Disease Control and Prevention issued its first warning 
about the disease we now know as AIDS. Today, we approve the third 
extension of the Ryan White CARE Act, the comprehensive legislation 
first enacted in 1990, for the prevention and treatment of HIV and 
AIDS.
  In those early days, the Nation failed on all levels to recognize the 
danger posed by this disease. Its victims suffered in silence and 
stigma. Shamefully, those who had the power to help did nothing.
  Then, mid-eighties, a young boy's courage awakened the Nation to the 
very real tragedy of AIDS. A disease that had seemed distant was 
suddenly threatening us all, and we could no longer claim that it was 
someone else's problem. We realized it was a virus that knows no color, 
religion, political affiliation, or income status. And I think Ryan 
White would be proud of the effort we are putting forth today with this 
compromise we have worked hard on for the last few months.
  In 1987, Senator Hatch and I introduced bipartisan legislation 
calling for a comprehensive national strategy of education, prevention, 
and research to halt the spread of AIDS. We called on government, the 
public health community, and the media to all do their part in order to 
prevent the AIDS epidemic from continuing its rampage across America.
  We were optimistic that we were poised to handle this challenge more 
effectively than at any previous point in our history. We would not 
lose the battle, unless we failed to wage it with wisdom, reason, 
dignity, and common sense.
  Yet the battle continues. We mourn the 500,000 Americans we have lost 
to the AIDS virus. Each victim is a human tragedy--so much potential 
lost before its time. But we take heart in the fact that AIDS is no 
longer a death sentence. Through testing and treatment, people are 
living long and full lives with HIV. We are identifying victims earlier 
in the progression of the disease and keeping them healthier longer.
  But we still have a long way to go. Many who live with HIV and AIDS 
do not have insurance to pay for costly treatments. As a result, heavy 
demands are placed on community-based organizations and State and local 
governments. For these citizens, the Ryan White CARE Act continues to 
provide the only means to obtain the care and treatment they need. It 
doesn't matter where they live.
  Americans agree. Seventeen percent of our people name HIV as the most 
urgent health problem facing the country, just behind cancer and heart 
disease. Sixty-three percent say the Government is spending too little 
at home to fight HIV and AIDS. Six in ten believe more spending on 
prevention and testing will help slow the spread of this disease.
  Four in ten say they know someone with HIV. Eighty-one percent say 
discrimination against people living with HIV or AIDS is a fact of life 
in America today.
  We have far to go in educating people about the disease. Thirty-seven 
percent of Americans fear the spread of HIV through kissing, twenty-two 
percent by sharing a drinking glass, and sixteen percent by touching a 
toilet seat, none of which are true.
  We have not finished the job we started 25 years ago.
  The Ryan White Care Act began as an emergency response to the crisis 
in urban areas, but today it represents a national plan to provide care 
and support for persons living with HIV and AIDS anywhere in America--
urban or rural, coastal or inland.
  This bill represents a working agreement among States, cities, 
community-based organizations, hospitals and health providers, and 
persons living with HIV and AIDS their families and advocates.
  It responds to an evolving epidemic that continues to grow in the 
very cities and States that have long borne the greatest burden of 
disease. It is expanding into regions of the country that have been 
historically less affected.
  With this bill, we take a major step toward a more effective 
response. It preserves access to life-saving medications, quality 
health care, and support services for persons living with HIV and AIDS 
who have come to depend on publicly-funded systems. It extends this 
system of quality care to persons with HIV and AIDS who have faced long 
waiting lists for medications and severe limits on their access to 
specialty health care. It protects governmental and community-based 
institutions charged with providing this care, all of whom face growing 
case loads and the greater challenges of an evolving population of 
persons with HIV/AIDS. It balances the needs of high-prevalence cities 
and States with those facing rapidly growing epidemics. It ensures 
those who have been relying on their local system of care that it will 
continue to be there for them. It reassures persons seeking tests for 
HIV that comprehensive care and support will also be ready to serve 
them. And it authorizes the expenditure of $7 billion over the next 3 
years to carry out this mission.
  This legislation is good for Massachusetts.
  This bill recognizes the added burden facing States like 
Massachusetts that have increasing numbers of people with HIV and AIDS 
living in cities like Boston. It ensures sufficient resources to 
maintain a HIV/AIDS service system

[[Page S11241]]

strained by a rising case load. It stabilizes funding to the State and 
stabilizes funding to the city of Boston because a larger portion of 
their award will be based on a predictable formula.
  The bill continues to provide significant Federal support for the 
State medication assistance program, lessening the possibility of 
having to create cruel waiting lists for life-saving medications. It 
eliminates the uncertainty of an untried severity of need index.
  Both Massachusetts and Boston benefit from having the State's HIV 
cases counted for the first time, for next 3 to 4 years. This will 
allow my State of Massachusetts to continue to focus on providing 
quality care and support services to people living with HIV and AIDS.
  At its best, America has the finest HIV/AIDS care system--one we as a 
Nation should be proud to hold up as the gold standard of care 
throughout the world. Our goal in this legislation is to make it also 
the fairest system of care--with equal access for all, high standards 
for quality, and guaranteed continuity of care. At last, access to all 
the benefits of medical science will no longer be the result of 
geography.
  This bill is a product of effective advocacy, creative thinking, a 
sense of shared responsibility, and a common commitment to getting it 
done. The Nation is fulfilling the promise of the original Care Act, 
first created in an era of limited treatment options and uncertain 
prognosis, to bring hope to persons living with the infection that they 
may live healthy and productive lives.
  It is also complex legislation, and all our committee staff, both 
Democrat and Republican, deserve great credit for working long nights 
and weekends over the past several months. In particular, I thank 
Keysha Brooks-Coley, Lauren Brumsted, Ann Gavaghan, Lisa German, Ann 
Grady, Elizabeth Hoffman, Bruce Lesley, Tamar Magarik, and Michael 
Woody. And I give special thanks to Shana Christrup of Senator Enzi's 
staff for her diligence and desire to make the world a better place for 
people living with HIV and AIDS.
  This was a clear bipartisan effort, by the House and Senate, and I am 
grateful as well to staff from the House of Representatives, including 
Melissa Bartlett of Congressman Barton's staff and John Ford and 
William Garner of Congressman Dingell's staff.
  On my own staff, I especially commend several who worked so long and 
hard and well on this legislation--Alice Lam, Megan Gerson, Caya Lewis, 
Cody Keenan, Ches Garrison, Daniel Dawes and Michael Myers, and above 
all to Connie Garner, whose passion, counsel, and commitment I value so 
highly on this and many other issues. She never once let us forget what 
this debate is truly about.
  My hope is that as we continue to improve the Ryan White CARE Act to 
meet the needs of this disease, the remedies we adopt will continue to 
come from the bright lights of science, not the dark fears of bigotry. 
This is an important day for people living with HIV and AIDS and for 
all Americans. We must do more to provide care and support for those 
caught in the epidemic. This legislation will give us the time and 
support we need to accomplish that goal.
  Mr. HATCH. Mr. President, I am pleased that the Senate has been able 
to come to an agreement and adopt H.R. 6143, the Ryan White HIV/AIDS 
Treatment Modernization Act of 2006.
  With this agreement, we finally reauthorize the only Federal program 
that helps low-income individuals living with HIV/AIDS. We tried to 
pass this critical legislation earlier this year, and even though this 
effort has enjoyed large bipartisan support in both Chambers, just a 
few Members prevented its passage.
  We worked to address their concerns in this compromise, and I am very 
glad to see the success of that endeavor. I would like to thank HELP 
Committee Chairman Enzi and Ranking Minority Member Kennedy, and 
others, for their tireless efforts throughout the reauthorization 
process. It has taken quite a long time to get here, and I commend 
everyone for their hard work. No one knows this more than Senator 
Kennedy, with whom I authored the original Ryan White CARE Act back in 
1990, and I am very proud that our work has been able to help so many 
people.
  This bill may not be perfect, but it will continue a vital program 
that needs to be continued. Importantly, it will help stabilize the 
distribution of CARE Act funding in areas of the country where the AIDS 
epidemic is largest and also increase access to areas that have seen 
large numbers of new HIV infections.
  Many of us in the Senate recently received a letter from 99 AIDS 
organizations that endorse this reauthorization. These are national and 
local organizations that provide services to people living with HIV/
AIDS--they are the ones out there actually working with them, not 
sitting here in Washington, just talking about it. They have been 
involved throughout this entire reauthorization process--they have seen 
all the proposals and compromises--and they support this legislation.
  I thank these individuals for their participation in and contribution 
to the lengthy reauthorization process because the end product would 
not be effective without their input.
  I am especially thankful for the insight of Jennifer Brown, the State 
AIDS director in my home State of Utah, who helped me throughout 
negotiations to understand the possible effects of changes in the 
program.
  I would like to read a portion of the letter sent by the AIDS 
organizations, which I think reiterates a very important message:

       It is time to put aside regional differences and individual 
     jurisdictional concerns, and act on behalf of all Americans 
     who are living with this terrible disease. If Congress fails 
     to act before adjournment, many of our citizens will lose 
     life saving medical care, drug treatment and the support 
     services necessary for them to lead healthy, productive 
     lives.

  This message has been quite clear for some time. We received this 
message from the HIV/AIDS community, from our constituents, and from 
the President.
  Everyone has urged us here in the Senate to work in the best 
interests of the entire Nation and pass this reauthorization, and I am 
pleased that we have been able to do so.
  Mr. ENZI. Mr. President, today the Senate affirmed its commitment to 
ensuring access to quality care for all Americans living with HIV and 
AIDS no matter their race, gender, or where they live. Today we finally 
have unanimous consent to pass H.R. 6143, the Ryan White HIV/AIDS 
Treatment Modernization Act.
  Senator Kennedy and I and our counterparts in the House have worked 
for nearly 2 years to address the concerns from every State and the 
hundreds of stakeholders who participated in our outreach efforts. We 
have reached broad consensus that this is the right policy at the right 
time.
  In the past few weeks, we have received letters of support from more 
than 100 leading AIDS service organizations calling for us to pass this 
legislation now.
  The Ryan White law must reflect the principle that every American 
living with HIV/AIDS deserves access to quality care, and this 
reauthorization is a step toward our goal of just and equitable 
treatment under this law. Our action today will ensure a more equitable 
program to provide not only AIDS patients but also HIV-positive 
Americans with the treatment they desperately need.
  The HIV/AIDS epidemic of today affects more women, more minorities, 
and more people in rural areas and the South than ever before. While we 
have made significant progress in understanding and treating this 
disease, there is still much more we must do to ensure equitable 
treatment for all Americans living with this disease.
  The epidemic is shifting, and our Federal programs must shift to meet 
this need and fight the epidemic where it is today and will be 
tomorrow, not where it was 10 or 20 years ago. The legislation passed 
unanimously by the Senate today does just that.
  An alarming 1.1 million Americans are living with HIV/AIDS today and 
the face of the epidemic is rapidly changing. The Kaiser Family 
Foundation has reported that while the number of AIDS cases in the 
Nation rose by 1 percent between 2000 and 2001, it rose by 9 percent in 
the South and fell by 8 percent in the Northeast.
  Newly infected people are increasingly likely to be poor, have 
inadequate access to health care, and be members of a minority 
community.

[[Page S11242]]

For example, African Americans make up 19 percent of the South's 
population but accounted for over 60 percent of new cases in 2003. In 
addition, the growing number of rural Americans infected with HIV face 
already overburdened rural health care systems that have too few 
doctors, underdeveloped support systems, and long travel distances to 
care.
  Rural States and States in the South have a newer epidemic, with more 
HIV than AIDS cases, while urban areas with a longer history of the 
disease have a much higher percentage of AIDS cases. Because of old 
formulas that counted only AIDS cases, more than 100,000 Americans with 
HIV went uncounted, resulting in drastic funding disparities across the 
Nation. This has crippled the ability of health systems in rural and 
frontier States, like Wyoming, to confront this growing crisis.
  Today, with the unanimous passage of the compromise bill, the Senate 
has begun to correct these inequities and ensure that those 
traditionally overlooked by this program will receive the care and 
treatment they desperately need. The Ryan White program can now begin 
to address the epidemic of today, not yesterday, and treat the full 
spectrum of this disease.

  This legislation strengthens and modernizes the Ryan White program to 
ensure that all Americans with HIV and AIDS are counted, that 
appropriate funding is provided to those on the ground fighting this 
epidemic, and that State and city care systems are protected so they 
can continue providing quality care to their residents with HIV and 
AIDS.
  Senator Kennedy and I are committed to looking at the overall 
structure of this program beginning next year. We both want to ensure 
that when this reauthorization expires at the end of 2009, we have a 
comprehensive solution to the health disparities created by the current 
flawed formula for allocating Ryan White funding. This legislation is 
one step toward a more just and equitable program, and I look forward 
to continuing to strengthen and improve this program in the future.
  In whatever policy we have on Ryan White, I will insist on key 
principles first, that the money follows the epidemic so that our 
funding formulas can be responsive to the needs of Americans affected 
by the epidemic today and in the future. In addition, we need to ensure 
that we capture the need of an area better by going beyond simply 
including HIV in the formulas and develop other mechanisms to better 
account for the need on the ground.
  Ryan White is a safety net program, and we need to better understand 
how much of that safety net is being supported by local, State, and 
Federal dollars. Finally, I want to be clear to my colleagues that any 
new funding formula must ensure that we are providing care across the 
spectrum of the disease--from HIV to AIDS. In doing so, we provide the 
right incentives for providing lifesaving care as soon as possible.
  With that being said, I would like to close by thanking my colleagues 
and their staff both here in the Senate and in the House for their hard 
work in passing this critical legislation. I want to thank all the 
members of the Senate Committee on Health, Education, Labor, and 
Pensions, especially my friend and ranking member Senator Kennedy.
  I also thank our good colleagues on the House Committee on Energy and 
Commerce, Chairman Barton and Representative Dingell.
  This bill is yet another example of the good work that can be done 
when we put politics aside and work together to improve the lives of 
Americans. I am proud of the accomplishments I have achieved with 
Senator Kennedy in the 109th Congress, and I hope the 110th Congress is 
just as productive.
  I would like to offer special thanks to my colleagues who assisted me 
on the Senate floor in September when we previously tried to pass the 
bill. Senators Hatch, Burr, and Sessions were all instrumental in 
getting us to this great victory today. I want to mention their staff: 
Pattie DeLoatche and Karen LaMontagne with Senator Hatch, Liz Stillwell 
with Senator Sessions, and Jenny Ware with Senator Burr.
  I would like to offer a special thank you to Senator Coburn and 
Roland Foster, Stephanie Carlton, and Katy French of his staff. Senator 
Coburn helped educate our colleagues of the importance of getting this 
bill passed.
  Vince Vintimiglia, Marty McGeein, Laura Ott, Maury Huguley, Deborah 
Parham, and Adelle Simmons of the Department of Health and Human 
Services were crucial in guiding our efforts to help craft reforms to 
the Ryan White programs. Megan Hauck at the White House was also 
instrumental in helping us move this legislation forward.

  I would also like to thank Marcia Crosse, Martha Kelly, and Suzanne 
Worth of the Government Accountability Office for their tireless 
efforts to analyze different proposals and their effect on distribution 
of funding across the Nation.
  Through this entire process, Bill Baird of Senate Legislative Counsel 
and Pete Goodlowe of House Legislative Counsel have drafted countless 
legislative proposals and compromises and were invaluable in crafting 
the final language that reformed this program.
  Kathie Hiers of the Southern AIDS Coalition and Bill McColl of AIDS 
Action have provided critical support from the beginning of this 
process, without which much of our progress would not have been 
possible. In addition, there were numerous other individuals and 
organizations who helped us throughout the process. So as not to leave 
anyone out, I just want to express my appreciation to all of you who 
have continually labored with us to craft and pass this bill.

  As you can imagine, a process involving Republicans and Democrats in 
the House and the Senate over a year and a half involved many dedicated 
staffers and many late nights. I would like to specifically acknowledge 
Connie Garner and Alice Lam of Senator Kennedy's staff; Melissa 
Bartlett, Randy Pate, Ryan Long, and Katherine Martin of Chairman 
Barton's staff; and John Ford, William Garner, and Jessica McNiece of 
Congressman Dingell's staff for their diligence and determination as we 
worked together to craft this important and essential bill.
  Both the Republican and Democratic leadership in the Senate were 
incredibly helpful in helping us reach the final compromise. I would 
like to thank Majority Leader Frist and Elizabeth Hall of his staff and 
Minority Leader Reid and Kate Leone of his staff for their efforts.
  Finally, there are a number of individuals I would like to thank on 
my own staff for their dedication and determination to pass these 
critical reforms to the Ryan White CARE Act. First and foremost, I 
would like to commend Shana Christrup for her leadership, tireless 
efforts, determination, and unlimited patience. Without her knowledge 
of the policy and the process, this lifesaving legislation would not 
have been possible. I would also like to thank Katherine McGuire, my 
staff director on the HELP Committee. She keeps the trains running on 
time and keeps my team motivated to search for solutions when solutions 
seem to be exhausted. I also want to thank Stephen Northrup, my health 
policy director. He does a great job managing the health issues before 
the committee. I should also make special mention and thank Aaron 
Bishop for his expertise and incredible outreach with the stakeholders. 
He sat through countless listening sessions with stakeholders and staff 
to ensure their thoughts and concerns were incorporated in the 
legislation. Thank you also to Michelle Dirst, Brittany Moore, Keith 
Flanagan, Kori Forster, Todd Spangler, Amy Shank, Ilyse Schuman, Greg 
Dean, Lesley Stewart, and Megan O'Neil. All these Team Enzi members 
were instrumental in shepherding this legislation through the process.
  In addition, I want to thank chief of staff and anchorman, Flip 
McConnaughey, for his steady hand and helping us to stay the course.
  I urge the House to pass this final compromise this week to ensure 
justice and equitable treatment under the law for all Americans who 
struggle with the medical and financial burdens of HIV and AIDS.

  Mr. ENSIGN. I ask unanimous consent the Enzi-Kennedy substitute at 
the desk be agreed to, the bill as amended be read a third time and 
passed, and any statements relating to the measure be printed in the 
Record.

[[Page S11243]]

  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  (The amendment is printed in today's Record under ``Text of 
Amendments.'')
  The amendment (No. 5212) was agreed to.
  The amendment was ordered to be engrossed for a third reading and the 
bill to be read a third time.
  The bill (H.R. 6143), as amended, was read the third time and passed.

                          ____________________