Washington, DC – In remarks today on the Senate floor, Senator Hillary Rodham Clinton underscored the devastating consequences the proposed bill to reauthorize the Ryan White CARE Act would have on New York. Senator Clinton emphasized her commitment to making sure that all of those living with HIV and AIDS have the care they need and emphasized her commitment to reworking this proposal in order to ensure that states across country have the funding they need. However, taking funding away from New York and other states with the highest rates of HIV and AIDS would only make matters worse.

“As a Senator from New York, which has experienced the heaviest burden of the AIDS epidemic, I don't think anyone cares more about this legislation. I understand completely the profound importance of the Ryan White CARE Act. I'm committed to the reauthorization of a good bill that strengthens and improves the ability of all Americans to access HIV and AIDS care, support, and treatment. But a bill that destabilizes existing systems of care and devastates, even destroying the ability of high-prevalence communities to address needs, is unacceptable. I stand ready to work with my colleagues on a fair, open-minded, nonpartisan, practical solution,” Senator Clinton emphasized on the Senate floor.

The full text of Senator Clinton’s remarks on the Senate floor follows:

In 1990, Congress enacted a law that has been a vital part of our national strategy to fight AIDS and HIV: The Ryan White CARE Act, which directs support and resources to the people and places most in need throughout our nation. It was an incredible act of compassion, smart decision making and bipartisanship. Members in this chamber put aside politics, recognized the seriousness of the crisis and took action; how far we have come. Unfortunately, though, the recent debate around the Ryan White CARE Act has been marred by misconceptions and mired in politics. And it's time to set the record straight.

First, some of my colleagues have alleged that New York receives more funding per case than the national average, suggesting that New York is somehow getting more than its fair share. But the numbers I’ve heard being used on the floor yesterday only represented part of the funding under the Ryan White Care Act, skewing the data to make a political point. When you look at the whole picture and see the funding under the whole bill, the story is very different.

According to an analysis prepared by the Communities Advocating For Emergency Aids Relief Coalition, the CAEAR Coalition, as seen here, the national per-case allocation for people with AIDS is $4,745. Here's the state-by-state breakdown. New York is by no means at the top and this analysis does not even account for the higher cost of living and treatment in my state. You know, some of my colleagues have cried foul, saying they get far less per person with AIDS than New York. I heard my friends and colleagues from Wyoming and Alabama making that point, but here are the facts, and they say otherwise. When you look at all of the titles under the Ryan White Care Act, Wyoming and Alabama actually receive more per person with AIDS than New York and more than the national average. The difference between Oklahoma and New York is about $100 per person living with AIDS, and again, these numbers do not account for differences in costs.

Second, there are those making misleading statements about my state- that we misuse funding or do not use the funding we receive- claims that are simply not true. Some have even asserted that New York has allowed dog walking to count under the CARE Act. Well let me set the record straight. New York is not using federal dollars for such services. And to point fingers and make such outlandish assertions impugns my state and is profoundly unfair to the thousands of New Yorkers who rely each and every day on the Care Act for treatment and needed services.

New York has been audited by the HHS, the Health and Human Services Inspector General. They said New York complies with all requirements and is not misspending or mismanaging its funds. Another specious claim is that New York is somehow not even using the funds which we received, that we retain surpluses every year. Well, being fiscally responsible is good management. In New York, a tiny percentage of unspent funds are carried from one year to the next. This year, New York carried about $3 million over, representing about three days worth of expenses. That's exactly what I want states to do, manage resources wisely and avoid interruptions in care or create waiting lists. Sound fiscal management I don't believe is something to denigrate.

Third, we are having a debate now over a shrinking pot of funding at a time when I absolutely agree, more and more states have greater and greater needs. But to argue about the formula instead of arguing about the program and what it needs to be funded appropriately seems like a diversion to me. We're having a formula fight when we should be focused on fixing our strategy and strengthening our funding to meet the growing challenge and crisis of HIV/AIDS in America. That is the real debate we should be having on the floor of the Senate.

Here is a chart that shows the increase of people living with HIV/AIDS in the United States. That's this line right here. And it shows the declines in funding for Title 1 of the Care Act, so you can see the disparity. I have a great deal of sympathy for my friends from states that are just realizing the full extent of the AIDS crisis in their communities, who are deeply concerned by the fast-growing number of such cases among poor women, among our African-American and Hispanic populations. But here's part of the reason why we're in this dilemma. Here's the number of AIDS cases, and here's the amount of funding available to deal with them. Instead of honoring our moral obligation, instead of strengthening our efforts, as the epidemic continues to grow, state and local agencies and community groups have been forced to do more with less. And this is especially true in New York, a state that has been hardest hit by the AIDS epidemic.

You know, back in the 1980s and 1990s people were moving from other states to be able to come to New York where, at least they thought, somebody would care enough to try to take care of them. And New York still leads the nation in both the number of overall HIV/AIDS cases as well as the number of new HIV infections each year.

Now, what's this fight about? Well, I'll tell you. New York stands to lose more than $78 million in funding over the next five years. We would see New York City lose $17 million next year alone. But we know who would really lose -- the patients whose health and lives are on the line. With the exception of the AIDS Drug Assistance Program, which still does not go nearly far enough given the long waiting lists for the poorest and the sickest of those who cannot afford the drugs they need to stay healthy and alive, the CARE Act has been cut over the past three years even as costs and the number of people with the virus have risen, adding to the pressure on New Jersey, New York, and other states with higher costs of living and the largest numbers of people living with HIV and AIDS. In addition, the Ryan White CARE Act is the payer of last resort. It is the safety net for the safety net. And this Congress and the administration have spent years trying to cut big holes in both.

In fact, the CARE Act is only part of the strategy against this terrible disease. The Medicaid program serves nearly half of those living with HIV and AIDS in America and this Republican congress and the Republican administration have tried time and time again to cut Medicaid and have succeeded in passing drastic reductions.

I've introduced bipartisan legislation with my colleague, Senator Gordon Smith, The Early Treatment For HIV Act. This legislation would provide federal funding to extend Medicaid eligibility to low-income Americans living with HIV before they develop symptoms allowing them to access life-extending medical services. And there are those suggesting that somehow the epidemic has changed, trying to pit one part of the country against another, trying once again to divide us.

My Republican colleagues have told me there's not enough money to prevent cutbacks for New York and other states that lose under this proposed formula. Nine states, plus Puerto Rico lose. Every other state makes gains. So, in effect you want to take money away from my 100,000 people living with HIV/AIDS and give it to worthy people in other parts of the country because this administration and this congress won't put more money into funding treatment programs for HIV and AIDS.

My colleagues on the other side have still refused to provide us with a guarantee, at a time when the epidemic continues to grow, that New York and the other states facing losses will not lose out --- a guarantee meant to make sure that people dying with AIDS have the treatment they need. In fact, the White House and Republican leadership in the Congress are cynically pressuring many of my colleagues that if they don't reauthorize the bill this year, they will face cuts in funding next year. But approving a fundamentally flawed bill under pressure, that will end up hurting people living with HIV and AIDS, is the wrong thing to do. We should be working to strengthen the Care Act for everyone.

You know, the epidemic is expanding. There's no doubt. Forty thousand new HIV infections occur every year in the United States and they have a disproportionate impact on people of color. In my state, African-Americans account for 45 percent of the total population living with HIV and AIDS, while Hispanics account for an additional 29 percent of the cases. But this bill cuts funding for both. Groups such as the National Minority AIDS Council, the Hispanic Federation, the Latino Commission on AIDS, have expressed concern over these cuts that would limit access to care for far too many people of color and people of modest, limited means.

We're also seeing the infection rate rise among women. In New York alone, over 30,000 women living with HIV and AIDS. Women would also be shortchanged on the latest version of the CARE Act. Indeed, the version of the bill my colleagues want to bring up would flat-fund what's called Title 4, the very programs designed to address the needs of women, infants, and children -- the populations that so many have come to this floor and spoken about eloquently. Well, let's put the money where our mouths are. Let's put more money into this program so we're not picking between a poor African-American woman in New York City and a poor African-American woman in Alabama.

And the epidemic is spreading. People talk about the south. They’re talking not only about Alabama and North Carolina, but Washington, D.C., Texas, Florida and Maryland, places that have been the hardest hit by this epidemic. Texas and Florida alone account for about 20 percent of people living with AIDS. Yet Florida, too, would lose money under this proposal. As we decide to beat the growing AIDS epidemic in our nation, I hope that we can look at the facts about how the program works now and try to come to a bipartisan solution that covers the entire country's needs and leads to a real solution, not a political one.

We know there are solutions. Those of us representing the states that are going to be giving up money, so money can be shifted to take care of other people who are worthy and deserve help, have proposed solutions. And this is not about politics. This is about how we help people. You know, my colleagues from New York, from New Jersey, Illinois and Florida, we've proposed a one-year extension for the Ryan White CARE Act. So let's then extend it for a year and then let's figure out how we can fix it. I think we could raise the authorization levels across the titles by 3.7 percent, set up a grant program to address unmet needs in states that do not receive Title 1 funding in order to address the challenge in rural areas where HIV incidence has also increased. Our proposal would delay penalties for those who cannot meet the HIV reporting requirements and give them time to come into compliance with the CDC.

As a Senator from New York, which has experienced the heaviest burden of the AIDS epidemic, I don't think anyone cares more about this legislation. I understand completely the profound importance of the Ryan White CARE Act. I'm committed to the reauthorization of a good bill that strengthens and improves the ability of all Americans to access HIV and AIDS care, support, and treatment. But a bill that destabilizes existing systems of care and devastates, even destroying the ability of high-prevalence communities to address needs, is unacceptable. I stand ready to work with my colleagues on a fair, open-minded, nonpartisan, practical solution. In the spirit of the original bill that brought people together to develop a strategy to combat this horrible epidemic that has caused so much death and destruction, destroyed so many lives, created such a challenge to our health care system and our basic values Mr. President, we can do this if we really want to. All it takes is to narrow the gap between these two lines, HIV/AIDS cases and the amount of funding available.

You know, some of the priorities that we're asked to vote on in this chamber certainly don't reflect the pressing needs that I've heard described on this floor. So, Mr. President, I would hope we could come up with a real solution for the Ryan White CARE Act.

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