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Senate & House Appropriators Provide Different Visions of What Funding the End of the HIV Epidemic Means

3 months after the House passed their appropriations bill to provide next year’s funding for the Departments of Labor, Health and Human Services, Education, and other related agencies (L-HHS), the Senate Appropriations Committee revealed their own this week. While the Senate Appropriations Committee has matched President Trump's funding requests around his Ending the HIV Epidemic plan, they have also mirrored many of his cuts to other programs that are vital to the health of people living with and affected by HIV. The content of the bill confirms advocates’ concerns that we’re in for a long fiscal year 2020 appropriations ride still.

Members of the Senate Appropriations Committee seem well in line with the Administration’s Ending the HIV Epidemic: A Plan for America initiative, announced by President Trump at his February State of the Union Address this year. The Senate bill includes increases of $140 million for HIV prevention at the Centers for Disease Control and Prevention,  $70 million for the Ryan White Program, $50 million for community health centers, and $6 million for the Centers for AIDS Research at the National Institutes of Health – all mirroring the President’s original budget request for the plan. The Senate Labor-HHS appropriations numbers fall well short of those allocated by the House earlier this year, with the House bill providing $46.4 million more for the Ryan White Program and roughly $54 million more for the CDC’s viral hepatitis, STD prevention, tuberculosis elimination, and opioid related infectious diseases programs.

Unfortunately, some Senators on the committee still stand by provisions, in this bill and others, that are antithetical to the goal of ending the domestic HIV epidemic. In their L-HHS bill, Senators propose maintaining a ban on the use of federal money to purchase syringes without proof of ongoing or impending HIV or viral hepatitis outbreak, a measure that Representatives omitted from their bill. The committee’s Transportation, Housing, and Urban Development funding proposal also slashed the Housing for Persons living with HIV/AIDS (HOPWA) Program by $63 million from its current funding level – a cut also proposed originally by President Trump. As has been well documented, housing is essential for folks living with or vulnerable to HIV to maintain good health and/or viral suppression.

Just like FY19 appropriations discussions, the success or failure of any appropriations discussions are going to come down to how Democrats and Republicans address funding for the border wall. As Politico notes:

The most difficult piece of the upcoming funding talks center on a small slice of the $1.4 trillion budget: the Department of Homeland Security. That bill alone, and the related fight over the wall, was the trigger of the longest-ever government shutdown that stretched from last December to January.

So far this year, neither party has formally released its opening bid on the DHS funding bill. House Democratic leaders have said they plan to offer zero dollars for Trump’s wall, while pursuing more restrictions for Immigration and Customs Enforcement, including fewer detention beds.

Senate Democrats, meanwhile, have skewered Republicans for proposing that $5 billion from domestic programs be spent on the wall, with plans to divert another $7 billion in military construction funds to border projects.

Lawmakers are certainly working towards a funding solution, but a shutdown has happened over this exact disagreement before, so no one is ruling out the possibility again – although the potential negative politics of a shutdown during a presidential election cycle may dampen Mr. Trump’s willingness to hold out as he did into January of this year.

Earlier this week, the House passed a continuing resolution (CR), extending FY19 funding levels into FY20 – until November 21, specifically – to avert a shutdown. The CR now heads to the Senate and is expected to be signed well ahead of the new fiscal year’s October 1 deadline so lawmakers can continue these thorny discussions.

Anomalies, or carve-out increases for certain programs during the period of a CR, in the House stopgap include continuing support for Community Health Centers, whose funding would have expired at the end of this fiscal year, and a temporary increase in Federal Medical Assistance Percentage for territories, including Puerto Rico, under the Medicaid program for the period of this CR. Should this temporary increase be included in a final CR, the federal government will match up to 100% of the territories’ Medicaid spending, an enormous increase from the mandated 55% match.

However, such anomalies for any new funding streams or programs were not included for this CR period, which means any new funding for Ending the Epidemic programs would be on hold until at least November 21. AIDS United will continue to work with allies in Congress to ensure the full and timely dispersion of funds for communities and organizations working to end the domestic HIV epidemic.


Posted By: AIDS United, Policy Department - Friday, September 20, 2019

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