August 28, 2013

August 28, 2013
Is it time to Reauthorize the Ryan White CARE Act?

Welcome to another day in my life. Today is Wednesday and we have almost made it through the middle of another work week. I hope you are having a beary safe and great week so far. It is another busy week for Dab the AIDS Bear and me.

From reading my blogs, you know I have my own opinion on reauthorization of the Ryan White CARE Act. So I decided to blog on the issue today since another organization has been pushing for Congress to reauthorize Ryan White this year.

On September 30th, some HIV/AIDS advocates have pontificated that the world will end with respect to supports and services afforded to people living with HIV/AIDS...but that simply isn't true. That is the date when the current Ryan White CARE Act -- which was reauthorized by Congress in 2009 as the "Ryan White HIV/AIDS Treatment Extension Act" -- is set to expire. Maybe federal lawmakers anticipated four years ago that the partisan gridlock would only worsen by today, but interestingly enough the law doesn't include language that is fairly common in reauthorizing legislation: a sunset provision.

What does that mean? In legislative terms, it means that the current law is likely (as in, very likely) to continue under the current law's framework and structure -- including appropriation levels. Putting the hysteria aside, it is nonetheless important for Ryan White stakeholders remain engaged to ensure that the "payor of last resort" safety net that the law provides remains intact, and robust funding accompanies it. Fortunately, coalitions such as the Ryan White Work Group, ADAP Coalition and the National ADAP Working Group (all of which the ADAP Advocacy Association is a member organization), are working to monitor this situation and propose meaningful advocacy strategies.

Of particular interest to most Ryan White stakeholders is the fate of the current law's "Hold Harmless" provision, which was added during a previous reauthorization. The Hold Harmless provision initially continued the previous 95% rate for the first two fiscal years, but increased to 100% of fiscal year 2010 funding for each of the fiscal years 2011 and 2012. For fiscal year 2013, the amount will be 92.5% of the previous fiscal year’s grant. This hold harmless continues to apply to both Part A and Part B grants.[1]

On July 16th, Rep. Frank Pallone (D-NJ) introduced H.R.2699. The legislation would "extend the hold harmless provisions of the Ryan White HIV/AIDS Program pending reauthorization of the overall program." The legislation has no co-sponsors and it also reportedly doesn't have the support of the majority staff on the House Committee on Energy & Commerce, Subcommittee on Health. In other words, Rep. Pallone's legislation probably isn't going anywhere in the Congress.

According to Bill McColl of AIDS United and Co-Chair of the Ryan White Work Group, "We are aware that hold harmless will be a major issue for many people in the HIV community and will be trying to develop points of agreement as the Congress works on a continuing resolution or appropriations bill in FY 2014."

Meanwhile, ADAPs have already experienced a major systemic shock between the changes in the funding formula, and the pending cuts from Sequestration. Data from the Health Resources & Services Administration (HRSA) demonstrates the changes between this year's number with last year's totals.

The totals are calculated from the actual reduction from last year per locality after subtracting accounting adjustments and carryovers from prior years. The numbers paint a picture that should keep Ryan White stakeholders on the edge of their seats.

PART A FUNDING: (Avg. Cut 7.12%)

The Part A spreadsheet encompasses all Part A areas in the country. This section of funding had experienced a few changes, including:
1) There was a new TGA in the Part A funding stream (i.e., Columbus, Ohio) , As a result, the EMA/TGA pie had to be divided up with one more additional locality.
2) Sequester had played a varying effect per locality as reflected by the percentages.
3) Shifting trends in epidemiology and formulas towards the South; therefore the cuts were somewhat cushioned and less drastic.

PART B FUNDING: (Avg. Cut 5.61%)

The Part B Basic Earmark spreadsheet is the bulk (90-95%) of the Federal Grant to the States for ADAPs.
1) The Part B Grant for Medical Services has not been broken out yet as that will take some time to separate and compile that data as the Part B grants are multi-layered.
2) Again, Sequester had played a big factor in the reduction but the Southern States were saved the brunt of the Sequester because of a new formula change.

Hope you have a beary safe and great Wednesday!

Until we meet again; here's wishing you health, hope, happiness and just enough.

big bear hug,

Daddy Dab