February 09, 2006

15 MINUTES WITH:
Rep. Eliot Engel (D-NY)

ENGEL: "We've given away all our money on tax cuts and war."

Back in early November, we gave props (scroll waaay down once you click) to nine-term U.S. congressman and lifelong Bronx resident Eliot Engel (D-NY) for slipping into the House budget bill a pilot program for the Early Treatment for HIV Act (ETHA). The bill would allow states to extend Medicaid coverage to low-income people with HIV before they became disabled by AIDS—something that current Medicaid eligibility requires. Introduced in the Senate by Hillary Rodham Clinton (D-NY) and Gordon Smith (R-OR) and in the House by Nancy Pelosi (D-CA) and Jim Leach (D-IA), ETHA is a smart bill because the cost of keeping people well on HIV meds is far lower than that of treating and hospitalizing them when they get sick from AIDS. Rep. Engel recognized that, calling ETHA "both compassionate and cost-effective."

Alas, ETHA didn't make it out of the House, while on the Senate side the bill passed but didn't make it out of conference. That's no surprise given the priorities of who's got the ball in Washington right now, says Engel, who since 1988 has been representing his heavily Democratic district, which slices through the Upper Bronx and Westchester and Rockland counties. He is also a powerful Democratic presence on the House Energy and Commerce (E+C) Committee (which oversees the Ryan White CARE Act) and International Relations Committee.

Last week, the day before the House narrowly passed the Medicaid-bashing budget bill, the congressman took a few minutes to talk with AIDS Issues Update about how AIDS has touched him personally, the future of healthcare in America—and why the only team he's rooting for right now is the Democratic party come November.

AIDS Issues Update (AIU): The House is gearing up for the big budget bill vote tomorrow, which contains harsh hits on Medicaid copays for low-income people. Do you think a few moderate Republicans could defeat the bill?

Engel: I don't think there's much of a chance for that. They [the Republican leadership] can yank [moderate swing votes] back the other way, and they're going to do whatever is necessary to pass the bill. They've been saying, "We can't let the Democrats have a victory on this one."

AIU: I guess we'll soon know. Meanwhile, let's talk about ETHA for a minute. What drew you to introducing the bill in the House?

Engel: Well, I come from New York, which has always unfortunately been one of the epicenters of AIDS in the U.S., so that's made me very much aware of the tragedy of this disease and why we must do everything possible to eradicate it—and to come up with the treatment that can prolong life while we're trying to find a cure.

It was called to my attention that the current Medicaid rules [require that] people have to be disabled by AIDS [before they are eligible for Medicaid]. That's ludicrous. If they could have received access to care and treatment through Medicaid, it would have prevented them from [getting] AIDS in the first place. [ETHA would put Medicaid eligibility] in line with the federal HIV treatment recommendations [to start HIV meds well before Cd4 cells drop to an AIDS-defining level] that are the standard of care in the U.S. We don't put in enough common-sense measure like ETHA.

AIU: So what happened once you introduced it?

Engel: It got the same response as most things that the Democrats introduced—it was defeated on a party-line vote. Heather Wilson (R-NM) was the only Republican who supported it. The mantra around here [the House] right now is tax cuts for the rich. There's no money for anything [else] because we've given all our money away on tax cuts and war. As for ETHA, I'll wait and see the most appropriate time [to put it up for a vote again]. [It's good that] we got the demo project for ETHA passed in the original Senate bill. We're hoping that will help move it forward.

AIU: You're on the House E+C Committee that oversees the Ryan White CARE Act (RWCA), which gets care and services to a half million Americans with HIV/AIDS—and which awaits reauthorization, amidst lots of complicated questions about how to shore up funding for non-metropolitan areas, especially in the southern states.

The Bush administration has recommended shifting a lot of RWCA money from metropolitan areas like New York, which often put a lot of their own money into AIDS services, to southern states, which tend to contribute very little of their own money. Do you have an approach to RWCA that wouldn't hurt New York, which has the country's highest AIDS rates and needs all the money it can get, but still addresses these disparities around the country?

Engel: New York is the epicenter of the AIDS epidemic in this country. We shouldn't be penalized [in RWCA funding] because we have put forward our own money. If you carry [that line of thinking] to its logical extreme, it creates a powerful disincentive for other states to prioritize future funding for AIDS [if the less they put in themselves, the more RWCA money they'll get].

AIU: So how will the E+C Committee work with the Appropriations Committee to ensure that all areas of the country are adequately funded—especially considering that RWCA has been flat-funded the past five years?

Engel: Well, we could [resolve that conflict] if we could appropriate adequate amounts of money, but as long as you're robbing Peter to pay Paul...

AIU: A lot of groups have been calling for an added $80 million for Title II of RWCA to shore up funding for non-metropolitan areas. Do you think that idea stands a chance?

Engel: As long as you have the current political make-up of this Congress, there's not much of a chance, no. In November, if we make some change and get a new majority in here, there would be a great chance to do some things [like that], but as long as this bunch is in control, it's more of the same.

AIU: So let's say the Democrats take back the House in November. In your seat on the E+C Committee, you'll be in a powerful position. Do you have a plan to ensure that all people with HIV would have medical coverage, and to make healthcare a priority?

Engel: If we took the majority back, we'd have totally different priorities, and they would extend to health care. AIDS is one aspect of healthcare. But other aspects are also being shortchanged terribly. Leading up the November elections, the Democrats are going to make healthcare one of the pillars of our platform.

AIU: Can you be more specific?

Engel: People don't understand that of the 45 to 46 million Americans [without healthcare], 86 percent is working people. So I think we should try very hard to make more people eligible. Personally, I favor a single-payer [system] where everyone would be covered under the federal government. [Short of that, I think we have to accept the idea of] spending more money regardless of how you do it.

There are certain bills that have been introduced that would help things. We have a Small Business Health Insurance Promotion Act, which would provide a 50 percent health-insurance tax credit for small businesses and the self-employed. We have the Family Care Act, in which the parents of children who are eligible [for subsidized healthcare] would also be eligible. And then there's the Medicare Early Access Act, which would allow people 55 to 64 to purchase Medicare coverage, because we find that when people in that age bracket are fired from their job, they're too young to be covered by Medicare but they still can't get private coverage.

AIU: Intriguing bills. Going back to AIDS for a minute, has it ever affected anyone close to you?

Engel: There was one friend in particular, a political activist in the Bronx. We were young Turks in our twenties, the Bronx Reform Democrats, about two dozen of us, looking to battle the entrenched political machine. I met my wife because she was part of this group. This friend was affected with AIDS in the first wave and subsequently died, and it was a big tragedy to all of us. His name was Timothy Sullivan. We got a street named after him in my district.

AIU: So it's almost a foregone conclusion that you'll win your tenth term in the House this November, huh?

Engel: I don't think I'm going to have a tough time but I'll [run] as if I were. You can't be too arrogant or certain about it. [But if I do win], I'll have served as many terms as my predecessor!

AIU: Now for the obligatory sports question. Who are you rooting for these days?

Engel: Since there are no New York teams involved [in championships] right now, I'm going to sit back and relax. Actually, I'm rooting for the Democrats in November.