(WASHINGTON, D.C.) – U.S. Senator Tom Coburn, M.D. (R-OK), a practicing physician who has treated patients with HIV/AIDS and a former co-chair of President Bush’s Advisory Council on HIV/AIDS, today unveiled legislation reauthorizing the Ryan White CARE Act.  President Bush called on Congress to reauthorize the Ryan White CARE Act in his State of the Union address. 

 

     Dr. Coburn authored the Ryan White CARE Act reauthorization in 2000 as a member of the House of Representatives.  Dr. Coburn’s updated proposals are designed to ensure that the CARE Act can better respond to changes in the epidemic by targeting federal resources to communities most in need, prioritizing early diagnosis, and expanding access to life-saving medical care and treatment.

 

     “As a practicing physician, I have personally cared for many of those who depend upon CARE Act funds and I know firsthand how critical the program is to meeting the needs of more than half a million Americans living with HIV/AIDS.  The CARE Act must be reauthorized and restructured to meet the changing needs of the AIDS epidemic,” Dr. Coburn said. 

 

     “Despite spending more than $20 billion annually on HIV/AIDS at the federal level, up to 59% of Americans with HIV are not receiving proper treatment and nearly 40,000 Americans become newly infected annually with HIV,” Dr. Coburn added.  “Increasingly, HIV/AIDS is a disease that affects minorities with African American women representing the fastest growing proportion of new cases.  The proposed Ryan White CARE Act Amendments of 2006 addresses disparities of care by prioritizing early diagnosis, expanding access to primary medical care and treatment, and better targeting federal resources to communities where the epidemic is growing to ensure that our focus remains on where the disease is today and where it is headed.”

 

     Dr. Coburn’s legislation was introduced with the support of the AIDS Healthcare Foundation, the largest provider of HIV/AIDS services in the U.S., the Children’s AIDS Fund and National AIDS Treatment Advocacy Project.

 

 

 

     The Ryan White CARE Act Amendments of 2006 reauthorizes the nation’s largest HIV/AIDS-specific care and treatment program for an additional five years.  The CARE Act was first authorized in 1990 and funding has grown from $257 million in 1991 to over $2 billion in 2006.  The program and its grantees serve 533,000 people each year.

 

     While funding for the CARE Act has increased dramatically, thousands of Americans with HIV are on waiting lists for access to life saving AIDS medications and many others face formulary restrictions.  In fact, about half of those infected with HIV in the U.S. are not receiving medical care.  One in four with HIV/AIDS, don’t even know they are infected. 

 

     This bill makes a number of important reforms to address these shortcomings:

 

 

(1)   Provides more equitable distribution of federal funding to ensure that all Americans living with HIV are recognized and valued equally for the purpose of federal funding and care services.

 

(2)   Targets more resources to areas with waiting lists for and restrictions on treatment.

 

(3)   Prioritizes primary medical care, including doctors visits, tests and medications.

 

(4)   Authorizes an increase of $70 million annually for the AIDS Drug Assistance Program (ADAP), which provides life saving medication to underinsured Americans living with HIV.

 

(5)   Guarantees at least $35 million annually for ADAP supplemental grants targeted to needy areas.

 

(6)   Redirects unspent CARE Act funding into ADAP supplemental grants.

 

(7)   Reduces administrative, planning and other non-essential costs.

 

(8)   Improves efforts to identify those with HIV and get them into treatment early when medication can be the most effective.

 

(9)   Provides greater flexibility, coordination and accountability of CARE Act funds.

 

(10)           Allows treatment coverage for HIV-positive individuals co-infected with Hepatitis B and/or Hepatitis C and seeks to increase health care providers’ knowledge of co-infection treatment.

 

 

 

 

 

     It has been 25 years since the first cases of what is now known as HIV/AIDS were recognized.  Since that time, at least 1.6 million people in the U.S. are estimated to have been infected with HIV, including more than 500,000 who have already died.  The Centers for Disease Control and Prevention (CDC) estimates that 40,000 American become newly infected with HIV each year and more than one million are now living with HIV/AIDS. 

 

     One in four of those infected do not know it and are, as a result, being denied life saving treatment and may be unknowingly infecting others.  Furthermore, approximately half of those infected are not receiving medical care.  Racial and ethnic minorities have been disproportionately affected by HIV/AIDS since the beginning of the epidemic, and now represent the majority of new AIDS cases and African American women represent the fastest growing proportion of new cases.

 

     It is an indictment of our failed policies that the federal government spends nearly $20 billion annually on HIV/AIDS-related programs and so many are going undiagnosed and untreated and the disease continues to spread unabated.

 

     This is a direct result of ineffective policies, misplaced priorities, and a lack of accountability.

 

     The Ryan White CARE Act Amendment of 2006 seeks to address these shortcomings.  It first prioritizes early identification and access to primary medical care and treatment.  It provides more equitable funding that better targets federal resources to underserved populations and emerging areas being impacted by this epidemic.  It also ensures greater accountability for how funds are spent.

 

 

 

     The Ryan White CARE Act Amendments of 2006 emphasizes early intervention by providing greater opportunities for diagnosis and guaranteeing access to medical care.

 

     To identify those with HIV who are unaware of their status, this bill would expand access to testing and remove barriers that prevent diagnosis.  At least 1.5 million rapid tests would be made available annually.  HIV testing would become a routine medical procedure, as recommended by CDC, in facilities receiving federal funding and for patients covered by federal health programs, specifically pregnant women and newborns.  Furthermore, states would be encouraged to remove barriers that prevent alerting those who may have been exposed to HIV that they should seek testing and, if infected, care.  All those identified with HIV would receive appropriate counseling and linked to care.

 

     To ensure optimal treatment for all those identified with HIV, this bill would provide additional resources for treatment and seek to update and improve care services.  At least 75 percent of all CARE Act funds would be required to be spent on primary medical care, including doctor visits and prescription drugs.  Each year, an increase of $70 million would be authorized for the AIDS Drug Assistance Program (ADAP) and an additional amount of at least $35 million would be guaranteed annually to provide assistance to patients living in states with ADAP shortfalls.  Appropriate care for patients living with HIV who are also co-infected with hepatitis B or C would now be provided by the CARE Act and states would have the option to use CARE Act funds to supplement AIDS-related treatment provided under Medicaid.  A standard formulary for AIDS drug treatment would be developed by the Department of Health and Human Services (HHS), which would report annually on the progress of providing such care.  In addition, best practices for disease management for patients with HIV/AIDS and an electronic patient information system would be developed to ensure patients are receiving appropriate and coordinated care.

 

 

 

     The Ryan White CARE Act Amendments of 2006 emphasizes targeting resources equitably and to those most in need. 

 

     To more equitably distribute federal resources, the bill ensures that all those living with HIV/AIDS are recognized in funding formulas beginning in fiscal year 2007.  Formulas would also be updated to ensure HIV/AIDS cases are not counted more than once and that deceased patients are no longer used to determine funding for both the CARE Act and HOPWA.  To ensure stability, these changes would be phased in and states with newer HIV reporting systems will be permitted to use estimates of HIV/AIDS prevalence.

 

     To better target funding, additional funding will be provided under the ADAP supplemental that provides funding for AIDS medication for patients in areas with severe need.

 

 

 

     The Ryan White CARE Act Amendments of 2006 emphasizes accountability at all levels to ensure that federal resources are spent wisely.

 

     The Health Resources and Service Administration (HRSA) must routinely analyze and report the costs for AIDS drugs to ensure that the CARE Act is receiving the best possible prices.  Annual “report cards” would be issued evaluating states’ efforts to provide patients with the most up to date AIDS treatment and identifying the barriers to doing so.  A majority of Title I planning council members must be free of any conflicts of interest and any such conflicts of council members must be publicly disclosed.  The local chief executive officer must approve of CARE Act funding decisions and states would have more authority to coordinate care.  Overhead, administrative costs and other non-essential expenditures would be reduced to ensure more funding for primary medical care and treatment under the CARE Act and housing assistance under HOPWA.