[Congressional Record (Bound Edition), Volume 152 (2006), Part 16]
[Senate]
[Pages 21451-21453]
[From the U.S. Government Publishing Office, www.gpo.gov]




                          RYAN WHITE CARE ACT

  Mrs. CLINTON. In 1990, Congress enacted a law that has been a vital 
part of our national strategy to fight AIDS and HIV, the Ryan White 
CARE Act, which directs support and resources to the people and places 
most in need throughout our Nation.
  It was an incredible act of compassion, smart decisionmaking, and 
bipartisanship. Members in this Chamber put aside politics, recognized 
the seriousness of the crisis, and took action.
  How far we have come. Unfortunately, though, the recent debate around 
the Ryan White CARE Act has been marred by misconceptions and mired in 
politics. It is time to set the record straight.
  First, some of my colleagues have alleged that New York receives more 
funding per case than the national average, suggesting that New York is 
somehow getting more than its fair share. But the numbers I heard being 
used on the Senate floor yesterday only represented part of the funding 
under the Ryan White CARE Act, skewing the data to make a political 
point.
  When you look at the whole picture and see the funding under the 
whole bill, the story is very different.
  According to an analysis prepared by the Communities Advocating for 
Emergency AIDS Relief Coalition, the CAEAR Coalition--as seen on this 
chart--the national per case allocation for people with AIDS is $4,745.
  Here is the State-by-State breakdown. New York is by no means at the 
top. This analysis does not even account for the higher cost of living 
and treatment in my State.
  Some of my colleagues have cried foul saying they get far less per 
person with AIDS than New York. I heard my friends and colleagues from 
Wyoming and Alabama making that point. But here are the facts, and they 
say otherwise.
  When you look at all of the titles under the Ryan White CARE Act, 
Wyoming and Alabama actually receive more per person with AIDS than New 
York and more than the national average. The difference between 
Oklahoma and New York is about $100 per person living with AIDS. And, 
again, these numbers do not account for differences in costs.
  Second, there are those making misleading statements about my State, 
that we misuse funding, or do not use the funding we receive, claims 
that are simply not true. Some have even asserted that New York has 
allowed dog walking to count under the CARE Act.
  Well, let me set the record straight. New York is not using Federal 
dollars for such services. And to point fingers and make such 
outlandish assertions impugns my State and is profoundly unfair to the 
thousands of New Yorkers who rely each and every day on the CARE Act 
for treatment and needed services.
  New York has been audited by the HHS--the Health and Human Services--
inspector general. They said New York complies with all requirements 
and is not misspending or mismanaging its funds.
  Another specious claim is that New York is somehow not even using the 
funds we receive, that we retain surpluses every year. Well, being 
fiscally responsible is good management.
  In New York, a tiny percentage of unspent funds is carried from one 
year to the next. This year, New York carried about $3 million over, 
representing about 3 days' worth of expenses. That is exactly what I 
want States to do--manage resources wisely and avoid interruptions in 
care or create waiting lists. I don't believe sound fiscal management 
is something to denigrate.
  Third, we are having a debate now over a shrinking pot of funding, at 
a time when I absolutely agree that more and more States have greater 
and greater needs. But to argue about the formula instead of arguing 
about the program and what it needs to be funded appropriately seems 
like a diversion. We are having a formula fight when we should be 
focused on fixing our strategy and strengthening our funding to meet 
the growing challenge and crisis of HIV/AIDS in America. That is the 
real debate we should be having on the floor of the Senate.
  Here is a chart that shows the increase of people living with HIV/
AIDS

[[Page 21452]]

in the United States. That is this red line here. It shows the decline 
in funding for title I of the CARE Act. So you can see the disparity. I 
have a great deal of sympathy for my friends from States that are just 
realizing the full extent of the AIDS crisis in their communities, who 
are deeply concerned by the fast-growing number of such cases among 
poor women and among our African-American and Hispanic populations. But 
here is part of the reason we are in this dilemma. Here is the number 
of AIDS cases, and here is the amount of funding available to deal with 
them.
  Instead of honoring our moral obligation, instead of strengthening 
our efforts as the epidemic continues to grow, State and local agencies 
and community groups have been forced to do more with less. This is 
especially true in New York, the State that has been hardest hit by the 
AIDS epidemic. Back in the 1980s and 1990s, people were moving from 
other States to be able to come to New York, where they thought 
somebody would care enough to try to take care of them. And New York 
still leads the Nation in both the number of overall HIV/AIDS cases as 
well as the number of new HIV infections each year.
  What is this fight about? Well, I will tell you. New York stands to 
lose more than $78 million in funding over the next 5 years. We would 
see New York City alone lose $17 million next year. But we know who 
would really lose--the patients whose health and lives are on the line.
  With the exception of the AIDS Drug Assistance Program--which still 
doesn't go nearly far enough, given the long waiting list for the 
poorest and sickest of those who cannot afford the drugs they need to 
stay healthy and alive--the CARE Act has been cut over the past 3 
years, even as costs and the number of people with the virus have 
risen, adding to the pressure on New York, New Jersey, and other States 
with higher costs of living and the largest numbers of people living 
with HIV/AIDS.
  In addition, the Ryan White CARE Act is the payer of last resort; it 
is the safety net for the safety net. And this Congress and the 
administration have spent years trying to cut big holes in both. In 
fact, the CARE Act is only part of the strategy against this terrible 
disease. The Medicaid Program serves nearly half of those living with 
HIV/AIDS in America. This Republican Congress and the Republican 
administration have tried time and time again to cut Medicaid and have 
succeeded in passing drastic reductions.
  I have introduced bipartisan legislation with my colleague, Senator 
Gordon Smith, the Early Treatment for HIV Act. This legislation would 
provide Federal funding to extend Medicaid eligibility to low-income 
Americans living with HIV before they develop symptoms, allowing them 
to access life-extending medical services.
  There are those suggesting that somehow the epidemic has changed, 
trying to pit one part of the country against another, trying once 
again to divide us. My Republican colleagues have told me there is not 
enough money to prevent cutbacks for New York and other States that 
lose under this proposed formula. Nine States, plus Puerto Rico, lose, 
and every other State makes gains. So, in effect, you want to take 
money away from my 100,000 people living with HIV/AIDS and give it to 
worthy people in other parts of the country because this administration 
and this Congress won't put more money into funding treatment programs 
for HIV/AIDS.
  My colleagues on the other side still refuse to provide us with a 
guarantee--at a time when the epidemic continues to grow--that New York 
and other States facing losses will not lose out, a guarantee meant to 
make sure people dying with AIDS have the treatment they need.
  The White House and Republican leadership in the Congress are 
cynically pressuring many of my colleagues that if they don't 
reauthorize the bill this year, they will face cuts in funding next 
year. But approving a fundamentally flawed bill, under pressure, that 
will end up hurting people living with HIV/AIDS is the wrong thing to 
do. We should be working to strengthen the CARE Act for everyone.
  I will also address the question of the expanding epidemic. There is 
no doubt that it is growing--40,000 new HIV infections occur every year 
in the United States, and they have a disproportionate impact on people 
of color. In my State, African Americans account for 45 percent of the 
total population living with HIV/AIDS, while Hispanics account for an 
additional 29 percent of the cases. But this bill cuts funding for both 
of them. Groups such as the National Minority AIDS Council, the 
Hispanic Federation, and the Latino Commission on AIDS have expressed 
concern over these cuts which would limit access to care for far too 
many people of color and people of modest, limited means.
  We are also seeing the infection rate rising among women. In New York 
alone, over 30,000 women are living with HIV/AIDS. Women would also be 
shortchanged under the latest version of the CARE Act. Indeed, the 
version of the bill my colleagues want to bring up would flat-fund what 
is called title IV--the very program designed to address the needs of 
women, infants, and children, the populations so many have come to this 
floor and spoken about so eloquently.
  Let's put our money where our mouth is. Let's put money into this 
program so we are not picking between a poor African American in New 
York City and a poor African-American woman in Alabama.
  The epidemic is spreading. When people talk about the South, they are 
talking not only about Alabama and North Carolina but Washington, DC, 
Texas, Florida, and Maryland, which are the places that have been the 
hardest hit by this epidemic. Texas and Florida alone account for about 
20 percent of people living with AIDS. Yet Florida, too, would lose 
money under this proposal.
  If we decide to meet the growing AIDS epidemic in our Nation, I hope 
we can look at the facts about how the program works now and try to 
come to a bipartisan solution that covers the entire country's needs 
and leads to a real solution, not a political one. We know there are 
solutions. Those of us representing the States that are going to be 
giving up money so money can be shifted to take care of other people 
who are worthy and deserve help have proposed solutions.
  This is not about politics. This is about how we help people. My 
colleagues from New York, New Jersey, Illinois, and Florida have 
proposed a 1-year extension for the Ryan White CARE Act. So let's 
extends it for a year and figure out how we can fix it. I think we 
could raise the authorization levels across the titles by 3.7 percent 
and set up a grant program to address unmet needs of States that do not 
receive title I funding in order to address the challenge in rural 
areas where HIV incidence has also increased. Our proposal would delay 
penalties for those who cannot meet the HIV reporting requirements and 
give them time to come into compliance with the CDC.
  As a Senator from New York, which has experienced the heaviest burden 
of the AIDS epidemic, I don't think anyone cares more about this 
legislation. I understand completely the profound importance of the 
Ryan White CARE Act. I am committed to the reauthorization of a good 
bill that strengthens and improves the ability of all Americans to 
access HIV/AIDS care, support, and treatment. But a bill that 
destabilizes existing systems of care and devastates, even destroys, 
the ability of high-prevalence communities to address needs is 
unacceptable.
  I stand ready to work with my colleagues on a fair, openminded, 
nonpartisan, practical solution--in the spirit of the original bill 
that brought people together to develop a strategy to combat this 
horrible epidemic that has caused so much death and destruction, 
destroyed so many lives, created such a challenge to our health care 
system and our basic values.
  Mr. President, we can do this if we really want to. All it takes is 
narrowing the gap between these two lines on the chart--HIV/AIDS cases 
and the

[[Page 21453]]

amount of funding available. Some of the priorities on which we are 
asked to vote in this Chamber certainly don't reflect the pressing 
needs I have heard described in this Chamber. I hope we can come up 
with a real solution for the Ryan White CARE Act.
  The PRESIDING OFFICER. The Senator from Rhode Island is recognized.

                          ____________________