by Anthony Glassman

Washington, D.C.--The House of Representatives gave its final approval to three more years of the Ryan White Comprehensive AIDS Resources Emergency Act on December 9, ending a battle pitting the large coastal cities first hit by the AIDS crisis against the Midwest and the South, where the epidemic is growing fastest.

The reauthorization bill was held up in the Senate by opposition from New York Sens. Hillary Rodham Clinton and Charles Schumer, Robert Menendez and Frank Lautenberg of New Jersey and Barbara Boxer of California over fears that their states could lose a large amount of federal AIDS funding. New York and New Jersey faced cuts of around $70 million.

Boxer dropped her opposition after being assured California would not suffer unduly.

The compromise bill was approved by the Senate on December 5, and keeps intact ?hold harmless? provisions that would prevent losses of more than 5 percent of funding for the larger states, while still increasing funding for rural areas and the South.

AIDS Taskforce of Cleveland executive director Earl Pike said the bill ?levels the playing field? without hurting the cities first and hardest hit by the epidemic.

Pike said the original plan, which would have redistributed the funds based on a new formula, would have ?crippled? the coastal cities like New York and San Francisco.

The deal, brokered by Sen. Edward Kennedy of Massachusetts, also calls for counting all HIV-positive people for funding regardless of where they reside, continuing to create a Health and Human Services framework for HIV and AIDS care, and keeping money for drugs and other therapies.

?The bill represents a compromise between a number of competing interests, and no one got 100 percent of what they wanted,? Pike noted. ?Nevertheless, it looks good for Ohio, which could stand to receive several million more in Title 2 funds.?

Ryan White Title 1 funds are given to metropolitan areas above a certain number of cases of HIV infection, while Title 2 funds are given to states for use across the board. Title 3 is for early intervention services, while Title 4 is for pediatric care.

Cleveland, Lorain and Elyria comprise the only eligible metropolitan area for Ryan White Title 1 in Ohio, and would be guaranteed 95 percent of its 2006 funding under the new rules. The state as a whole, through its Title 2 funding, may actually increase dramatically.

President Bush, in his December 9 radio address, indicated that the bill would soon bear his signature.

?This legislation focuses on life-saving and life-extending services and increased accountability, and will provide more flexibility to the Secretary of Health and Human Services to direct funding to areas of greatest need,? he said. ?The Ryan White CARE Act demonstrates the compassionate and generous spirit of America, and I look forward to signing this important legislation into law.?

The bill will expire three years after it is enacted.

?There will be additional legislative work to carry out in the very near future to prepare for 2010,? Pike said. After the law expires, ?all bets are off? and health services must ?figure out anew where resources are needed.?

He pointed out that, as its name implies, the Ryan White CARE Act was intended as an emergency measure, but it has been ?floated for 20 years.? Pike said that the government and AIDS service advocates need to find out how to integrate AIDS services with other programs like Medicare and Medicaid before 2010 rolls around.