June 2006

Victory for Public Health Funding in House Battle Over Budget Resolution
Moderate Republicans, upset over cuts in the President’s budget to health and education spending, threatened to vote against the Republican sponsored Budget Resolution unless money was diverted to those accounts.  A Budget Resolution is passed in the beginning of the year setting broad limits that appropriators must abide by when creating the 12 appropriations bills that make up the federal discretionary budget.  The threats by moderates to vote against the Budget Resolution would have doomed passage of that resolution and thus forced the Republican leadership to negotiate. 

Ultimately, the moderates were able to win concessions.  $4.1 billion was shifted from defense and foreign aid spending to health and education accounts by Appropriations Chairman Jerry Lewis and the Republican leadership promised moderate Republicans that an additional $3.1 billion would be found during the appropriations process for health and education funding.  In exchange, the Republican’s passed their $2.7 trillion budget by a vote of 218-210.    

Ryan White Reauthorization
The Senate and House have adopted a bicameral, bipartisan approach to drafting Ryan White Reauthorization legislation this year.  As of press time, the Senate Health Education Labor and Pension (HELP) Committee had passed its version of the Ryan White CARE Act.  The CARE Act, which gives billions of dollars to states and localities to combat HIV/AIDS, has not been reauthorized since 2000.  It expired in September 2005.  NACCHO is looking at two particular issues of concern to local health departments: the use of grants for “core medical services,” and the creation of a “severity of needs index” by the Secretary of Health and Human Services (HHS) to be used when distributing Ryan White funds.

According to the core principles set out by the President and adopted by the two houses of Congress, 75 percent of all funds in Titles I-IV of the Act must be used for “core medical services.”  While on the surface this appears to strip localities of crucial local control and limit their ability to administer vital support services such as transportation to doctors’ appointments, “medical case management, including treatment adherence services” is included, which would cover many of these crucial support services.  

In addition, the President suggested creating an index based on severity of need to determine future funding formulas among states and eligible metropolitan areas.  Among the criteria to be considered when determining need was whether resources are already available to individuals with HIV/AIDS from local or state government sources.  If the federal government was to give less Ryan White money to states and localities that were already using their own funds to care for individuals living with HIV/AIDS, the federal government would be essentially punishing those localities that chose to use their own resources to help fight the disease.  This language did not make it into the Senate bill; however, NACCHO has gone one step further, urging the Senate to add report language telling the HHS Secretary not to use funds from local or state governments as a factor when considering the severity of need.   

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