Statement of Administration Policy: H.R. 4785 - AIDS Prevention Act of 1990

(House)
(Waxman (D) CA)

The Administration strongly supports efforts to help needy Americans afflicted with AIDS and other diseases gain access to health care. The Administration also strongly supports efforts to provide assistance to areas disproportionately affected by AIDS and other diseases.

The Administration, however, opposes passage of H.R. 4785 for the following reasons: ?????????????????????????????????????????????

—  The bill's narrow disease-specific approach sets a dangerous precedent, inviting treatment of other diseases through similar ad hoc arrangements. This approach also runs counter to the government's existing health care financing system, which will provide more than $870 million in Federal Medicaid payments for HIV disease in 1991. Additionally, this approach could encourage existing health care payors (e.g., States, insurance companies, and localities) to limit or reduce coverage for the disease being given special treatment. Enactment of this bill could thus bring results that are counter to the goal we all seek to achieve.

—  The bill's authorization levels are excessive. According to CBO, the authorizations would total $978 million in FY 1991 and at least $5 billion over FYs 1991-95. These large authorizations could drain appropriations from the Federal government's highest priorities in battling HIV/AIDS. Those priorities are finding therapies and vaccines through biomedical research, and reducing the spread of infection through prevention and education. The President requested $1. 7 billion for these activities in his FY 1991 Budget.

—  The bill does not target funds to assist financially needy individuals first, a primary principle of Federal health care treatment financing. Because the bill does not target assistance according to financial need, it runs the risk of providing assistance to persons with independent resources at the expense of those in financial need.

—  The bill lacks an adequate maintenance-of-effort provision to ensure that grantees continue current investments in fighting HIV. Federal resources could simply substitute for current State, local, and private spending. Further, the bill does not leverage Federal resources efficiently through dollar-for-dollar matching provisions.

—  The bill's $500 million State formula grants exceed by over $200 million the funding for all other Federal formula grants for prevention.

H.R. 4785 is also technically flawed. For example:

—  Individual health care providers (such as sexually transmitted disease clinics) would be eligible for both direct funding from the Federal government and formula funding from States. Bypassing State health departments through this unorthodox financing mechanism could lead to confusion regarding which activities are being supported with categorical funds versus formula funds and State funds versus local funds. This would reduce the Public Health Service's ability to properly monitor program expenses.

H.R. 4785 would be improved by Rep. Madigan's amendments. Those amendments would: (1) impose State matching requirements for titles I and IV of the bill; (2) add an income related sliding fee schedule for individuals receiving preventive services; (3) require grantees to agree to maintain their current effort in combatting AIDS; and (4) reduce the authorization levels in the bill (from $885 million to $760 million in FY 1991, and by $600 million over FYs 1991-95 from $4. 4 billion to $3.8 billion).

The bill would also be improved by Rep. Dannemeyer's amendment to require confidential reporting to State health authorities of information that identifies individuals who test positive for HIV.

Although these amendments would improve H.R. 4785, they do not go far enough to remedy the basic flaws in the bill.