The Bush administration plans no increase in AIDS funding in the budget it will present to Congress this week, according to versions that are being leaked to the press. AIDS advocates see this as part of a larger political struggle that includes tax cuts. They believe that Congress will increase funding for AIDS and other health issues beyond what the administration has proposed but are unsure of the extent.
The budget proposes an increase of about a $2.8 billion for the Department of Health and Human Services (HHS), roughly equivalent to the increase being proposed for research at the National Institutes of Health.
To compensate for that and also fund some of the administration’s initiatives such as increased funding for community health centers, spending will be cut for popular programs that include disease prevention, aid to seniors, minority health, and training baby doctors. So AIDS got off better with flat funding than some other program areas.
“It sounds like all of this talk of compassionate conservatism is coming down to compassion for the wealthy with tax cuts” and not for those most in need, says Patricia Dunn, policy director of the Gay and Lesbian Medical Association.
Terje Anderson, executive director of the National Association of People With AIDS (NAPWA), says that flat funding “amounts to a cut” because it does not take into account the increased cost of living. Furthermore, the caseload of people living with HIV and dependent on government health assistance continues to grow.
“I’m alarmed, it is a very, very serious problem,” says Bill Arnold, director of the ADAP Working Group, a broad coalition of those supporting the drug assistance program. He projects a $50-60 million shortfall in ADAP for the operating year that began on April 1 and is seeking a supplemental appropriation.
Without the additional money, “ADAP is going to have to close its doors or reduce its current level of services by summer,” he says. The state-run AIDS drug assistance programs usually have responded by cutting benefits, creating waiting lists, or restricting the formulary of approved drugs that they cover.
Arnold says that deaths from AIDS are down, people are living longer, healthier lives because of combination therapy, and “that adds up to a legitimate demand for increased funding” as more people are brought under medical care. He argues that flat funding will only make current inadequacies more apparent.
Jim Driscoll, a lobbyist with the National AIDS Treatment Advocacy Project and the ADAP Working Group, says that the Bush health budget will result in “a free for all, a food fight in Congress, not just on AIDS but for everything.” It is like the administrations said, “Okay guys, fight it out and see who is strongest.”
He says, “The pharmaceutical industry is screwing the Republican Party” with the cost of AIDS drugs. He wouldn’t be surprised to see the administration push for larger rebates on the drugs that it purchases through programs such as Medicare and the Veteran’s Administration.
Steve Gunderson, a former Republican congressman from Wisconsin, believes the budget figure is not one of malice towards AIDS but rather one of ignorance of the issues. It is compounded by the fact that so few political appointees have been named or confirmed to policy-making positions in the administration.
Winnie Stachelberg concurs. The political director of the Human Rights Campaign (HRC) adds, this is a new administration and “we are back to the beginning” in having to educate it on issues. She calls the President’s budget just the beginning of the process, not the end.
“This is part of the reason why we have two branches of government,” says Gunderson. He is urging that people first try to educate the administration rather than confront it.
Anderson was expecting “something like a 4 percent increase” in the budget for HIV programs. He assumes that Congress will allow for some growth in them, but is unclear as to how much that might be.
Arnold predicts that the Bush budget numbers “will energize the AIDS community right off the bat.” ACT UP had already scheduled a demonstration in Washington for April 12 and many believe that the focus will expand from international issues to include the domestic budget.
The traditional AIDS lobby days will take place the first week of May. Anderson reports increased interest and participation from places such as Mississippi, and that was before the budget numbers became known.