Obama’s Final Budget Request Continues Investments in Domestic HIV
President Obama issued his Fiscal Year (FY) 2017 federal funding request, which runs from October 1, 2016 through September 30, 2017. Because of election year politics, the President’s proposed budget will carry even less weight in the annual spending and appropriations debate than in previous years, but it remains an important indicator of the types of policies the administration may pursue. Overall, the FY17 budget casts a wide net around deficit reduction, health care mandatory savings and new revenue. As you may recall, last year’s Bipartisan Budget Act (BBA), which established spending caps for federal funding—alleviated the effects of the sequester for FY 2016 and 2017, that impact most programs, including health programs.
Like many programs, several HIV health programs were subject to flat-funding in this year’s budget. For instance, most parts of the Ryan White Program (RWP) and the HOPWA program were level-funded. It is noted that in reconfiguring the SPNS (Special Projects of National Significance) component, the President proposes adding $9 million to the RWP for an initiative to expand Hepatitis C treatment for people living with HIV.
The budget invests $2.3 billion in the Ryan White HIV/AIDS Program to provide treatment and care to people living with HIV, and includes $900 million for the AIDS Drug Assistance Program (ADAP) to ensure that people living with HIV have access to lifesaving antiretroviral (ARV) treatments. The budget also includes funding for a new initiative to increase screening and expands access to Hepatitis C care and treatment among people living with HIV. As with any budget, there are winners and losers, and some items that simply miss the mark and for the HIV advocate community this budget is no different. In such austere times we are largely thankful for flat funding and modest increases.
However, corners have been cut. For instance, for the 3rd budget in a row this administration calls for the erasure of Ryan White Part D, and instead folds it into the Part C program in an effort to create efficiencies and “reduce the administrative burden.” The problem with this approach is that the administration has failed for a 3rd budget in a row, to consult the very community of advocates and providers that implement the program. They have neither articulated proposed eligibility criteria, nor shared how this new format would adequately address the unique needs of the women and families Part D is charged with supporting.
The Centers for Disease Control and Prevention (CDC) stands to receive $788,712,000 for Domestic HIV Prevention and Research, which is equal to the FY 2016 enacted level. Funds will include $20 million in additional grant resources for a new demonstration project to increase availability and improve utilization of pre-exposure prophalaxis (PrEP) in high-burden communities in FY 2017. This demonstration project will allow health departments to use up to 30% of these available funds to pay for PrEP as the payor of last resort. This is consistent with the updated National HIV/AIDS Strategy, which calls for providing more people with highly effective prevention services such as PrEP to reduce new HIV infections. PrEP has been shown to reduce the risk of HIV infection by greater than 90 percent when taken as prescribed.
The budget provides level funding for the Housing Opportunities for Persons with AIDS (HOPWA) program at $335 million to address housing needs among people living with HIV and their families. The President’s budget request again proposes a legislative reform that would update the formula HOPWA uses to distribute funds. The updated formula would be based on current CDC data on people living with HIV, rather than cumulative AIDS cases, and a fair market factor and a poverty factor.
An alternative change in the HOPWA funding formula was introduced as an amendment to a housing bill in the House by Representatives David Price (D-NC) and Robert Aderholt (R-AL). In line with the HIV communities concerns, the amendment lessens the impact of the formula change on HOPWA jurisdictions and phases in the full formula change over a longer period than that proposed by the president. The amendment, and the overall bill, was passed in the House last week.
In recognition of the media and congressional attention to rising opioid overdose death rates which have quadrupled between 2002 and 2014, taking the lives of 78 people each day. The Budget invests $1 billion over two-years in mandatory spending to expand access to treatment for prescription drug abuse and heroin use. In addition to these funds, the budget allows the use of federal funds for ancillary services related to syringe exchange programs. The majority leadership in the House and Senate were uniform in their rejection of the President’s budget. Whether each chamber moves forward with its usual schedule of hearings and markups of the 12 appropriations bills remains to be seen. We will continue to advocate for the highest investments for the domestic HIV portfolio and keep you updated throughout the process.