[Congressional Record (Bound Edition), Volume 151 (2005), Part 20]
[Extensions of Remarks]
[Page 27631]
[From the U.S. Government Publishing Office, www.gpo.gov]




                        HONORING WORLD AIDS DAY

                                 ______
                                 

                          HON. ELIOT L. ENGEL

                              of new york

                    in the house of representatives

                       Tuesday, December 6, 2005

  Mr. ENGEL. Mr. Speaker, last week, on December 1, communities across 
the world joined to commemorate the 18th annual World AIDS Day.
  World AIDS Day gives us a chance to evaluate what needs to be done to 
make substantial progress combating HIV/AIDS, both at home and abroad. 
Globally, 25 million people have already lost their lives to this 
disease, with another 40 million people currently living with HIV/AIDS. 
HIV/AIDS is the leading cause of death (age 15-59) and threatens the 
political, social and economic stability of nations worldwide.
  We must answer the call to action to fight the AIDS pandemic on the 
global, national and local levels. Globally, we must continue to fund 
programs that not only directly address the prevention and treatment of 
HIV/AIDS, but also those programs that promote the overall health, 
economic and social prosperity of developing nations.
  On the national level, we can start by reauthorizing the Ryan White 
CARE Act. This landmark program, which provides federal support to 
metropolitan areas and states to provide lifesaving health care and 
support services for individuals and families living with HIV/AIDS, 
expired on September 30, 2005. I strongly urge the Chairman of the 
Energy and Commerce Committee to commence with hearings on the 
reauthorization of the Ryan White CARE Act when Congress reconvenes in 
the new year.
  In my state of New York, significant time and money has been invested 
into HIV/AIDS care. No state spends more than New York to care for its 
residents with HIV/AIDS--over $3 billion last year. Sadly, New York's 
efforts still are not enough to sufficiently address the need. New York 
City comprises three percent of the nation's population, but more than 
16 percent of the nation's AIDS cases.
  Mr. Speaker, we must do better by CARE Act funding. This program has 
been virtually flat funded for years, and its AIDS Drug Assistance 
Programs (ADAP) only received a ten million dollar increase in this 
year's House Labor-HHS bill. Many very low-income people continue to be 
shut-out from ADAP programs due to states' varying income eligibility 
levels, which can range from 125 percent to 500 percent of the Federal 
Poverty Level. Without early, aggressive treatment people living with 
HIV/AIDS can experience rapid and often irreversible disease 
progression. Additionally, if care is interrupted drug resistance can 
develop, which compromises their ability to properly control their 
health.
  The President's Principles for Ryan White CARE Act Authorization, 
released this past summer, include some troubling provisions which 
could have devastating results for communities' ability to provide 
consistent, appropriate care for persons living with HIV/AIDs. The 
proposed Severity of Need for Core Services Index will change funding 
formulas to take into account the availability of other resources, like 
state and local funding streams. This is bad public policy as it 
punishes states that have taken responsibility for their local HIV care 
and creates a powerful disincentive for other states to prioritize 
funding for HIV funding in future years, if they think the federal 
government will just cover the gap. No state spends more than New York 
does to care for its residents with HIV and AIDS--over $3 billion last 
year. New York has always viewed this funding as a partnership between 
the state, cities and federal government and should not lose out on 
future federal funding for being at the forefront of providing 
progressive services and treatment.
  Secondly the President's proposal for a minimum of 75 percent of Ryan 
White CARE Act funding to be spent on core medical services should be 
seriously revisited. While there is no question that appropriate 
funding should be directed towards medical care, localities that 
benefit from comprehensive state funding for medical care, might better 
serve patients with using the funding for transportation to medical 
visits, emergency housing assistance for homeless patients, and other 
key services. This hard number fails to reflect the different resources 
that cities like New York utilize to care for their patients, and the 
changing needs of the HIV/AIDs patient population.
  New York City has always had a special respect for the opportunities 
the Ryan White CARE Act affords the city in serving the needs of our 
HIV/AIDs population. As of December 31, 2003, there were 142,085 
cumulative AIDS cases in NYC, and 88,479 City residents diagnosed as 
Persons Living With HIV/AIDs. Although Ryan White CARE Act is widely 
considered the payer of last resort for people with HIV/AIDs, it fills 
much of the void in providing treatment and support services for those 
who either are uninsured or underinsured, without the necessary 
resources to access desperately needed care.
  Mr. Speaker, it is shameful that Congress recently passed legislation 
with billions of dollars in cuts to Medicaid, all in the name of 
reform. Real reform would be to permit early treatment for those living 
with HIV in the Medicaid program. Under current Medicaid rules, most 
HIV positive people must meet both an income standard and be disabled--
by AIDS--before they can receive access to Medicaid provided care and 
treatment that could have prevented them from becoming ill so quickly. 
This policy runs counter to current Federal HIV treatment guidelines 
which call for early access to medical care and treatment including the 
use of combination antiretroviral therapy. Medical costs for those with 
advanced AIDS are significantly higher than costs for caring for HIV 
positive people, and this is a burden on the States' Medicaid budgets.
  I offered an amendment in the Energy and Commerce Committee markup 
for Medicaid reform to give States the OPTION of amending their 
Medicaid eligibility requirements to included uninsured, pre-disabled 
low-income people living with HIV. ETHA, which has been introduced by 
Leader Pelosi in prior Congresses and Senator Smith and Senator Clinton 
in the Senate, is modeled after the successful Breast and Cervical 
Cancer Prevention and Treatment Act, BCCA, that allows states to 
provide early access to Medicaid to women with cancer. Forty-nine 
States have implemented the BCCA, designed to preserve health and 
prevent unnecessary and high-cost medical interventions. As with the 
BCCA, ETHA includes an enhanced Federal match rate of 65 percent to 83 
percent to encourage States to participate in offering the services.
  Although my amendment failed, a demonstration project for ETHA, was 
successfully offered by Senator Clinton and Senator Smith in the Senate 
consideration of the reconciliation bill. Mr. Speaker, I strongly 
encourage the preservation of this important policy in the formal 
reconciliation bill.
  World AIDS Day is an opportunity to examine what progress we have 
made and to seriously consider what we must do to address this 
overwhelming problem. Working together, we can address both prevention 
and early treatment options, attacking HIV/AIDS head on.

                          ____________________