Petrelis Files

CQ: Pelosi Central to LA v SF
HIV Federal Money Battle

The fight over Ryan White CARE Act federal funding to benefit people living with HIV/AIDS (PWAs) is heating up again, reports an article in Congressional Quarterly Weekly. If you subscribe to the publication, you can read the full article here.

What's the latest skirmish with San Francisco versus the rest of America in dealing with the needs of PWAs and the higher amounts of federal dollars we receive out here?

A three-year-old disagreement over AIDS funding is forcing Congress to devote a little of its health care debate to the future of the Ryan White CARE Act [...]

In 2006, Congress couldn’t agree on how to deal with a growing inequity in funding between big cities, where the disease hit first and where the law directs most of its resources, and the smaller cities and rural areas that now make up a growing share of the cases. Unable to resolve the dispute, Congress just tweaked the funding formulas.

At issue is the missing reauthorization of the Act by Congress and the big divide between cities and rural areas.

[...] And a detente on the issue seems unlikely, given that the city benefiting the most from the law’s original funding formula is San Francisco, home of House Speaker Nancy Pelosi .

Oh, yeah, expect the Speaker to fight tooth and nail to keep up SF's AIDS funding, even when it harms PWAs in other areas.

The debate centers on a “hold harmless” provision guaranteeing that 24 urban areas, including San Francisco, that initially suffered the most from AIDS and its originating virus, HIV, would not lose the federal help they were getting as their case numbers leveled off. [...]

After Congress in 2006 changed the way AIDS funding is calculated — allocating more money through formulas and less through grants in a way that reduced San Francisco aid — Pelosi began adding riders to appropriations bills to help the city out. This year, the Speaker arranged for $5 million for San Francisco (and an extra $200,000 for New York) to be added to the House version of the fiscal 2010 spending bill that covers the Department of Health and Human Services.

This is the first I'm reading about those riders, which no doubt greatly please the SF DPH and AIDS Inc in the Speaker's district.

The “hold harmless” provision that helps San Francisco bothers other places. “I very much respect our colleagues in San Francisco and the work they’ve done, and the trauma they had early on,” says Whitney Engeran-Cordova, director of the AIDS Healthcare Foundation’s Public Health Division in Los Angeles. “But the data simply doesn’t support their funding levels.”

The SF data, which has long shown dramatic decreases in both full-blown AIDS diagnoses and new HIV infections, should make it more difficult for Pelosi to engineer her riders, but that's not yet the case. Good for AIDS leaders in Los Angeles to point this out. If federal AIDS funding were fair and based on caseloads and hard data, not Pelosi's pork-delivering power, federal money would be equitably distributed, helping out more American PWAs who don't live in Pelosi's district.

According to the GAO, San Francisco is receiving the most money of any jurisdiction in this fiscal year to treat individual cases of AIDS or HIV — $852 for each patient. Baltimore, Los Angeles and Washington, by contrast, receive just $646 per patient.

The GAO contends that San Francisco is receiving such largess in large part because it is the only place in the country receiving funding based on its HIV and AIDS cases plus the number of people who have died there of the disease. Other places may count only people living with AIDS or HIV.

This GAO contention is also known as "San Francisco exceptionalism" and it harms the well-being of PWAs who live elsewhere.

Wyoming’s Michael B. Enzi, ranking Republican on the Senate Health, Education, Labor and Pensions Committee, says he will fight to block additional San Francisco funding this year. [...]

But Pelosi spokesman Drew Hammill says Enzi’s charges are disingenuous, since it’s been Pelosi, not Enzi, who’s fought to expand Ryan White funding year after year. The increased funding Pelosi has won, he says, has “benefited all jurisdictions.”

Let's wait and see what she does as this matter moves forward in Congress, and hope that Pelosi actually looks out for the best interests of every PWA, and not just the needs of AIDS Inc in San Francisco.