Earlier this afternoon, there were comments made in the Senate by the Senator from New York, Mrs. Clinton. Some of those comments distressed me a little bit. We have been trying to get the Ryan White…
Earlier this afternoon, there were comments made in the Senate by the Senator from New York, Mrs. Clinton. Some of those comments distressed me a little bit. We have been trying to get the Ryan White Care Act, which passed out of committee and passed on the House floor, to pass in the Senate. This is one of those rare bipartisan, bicameral bills. We worked it out in advance with the House so the bill the House passed is essentially the bill we passed out of committee. It is a modernization act that would ensure equitable distribution of funds for HIV/AIDS treatment in the United States.
I am compelled to discuss some of the points that the Senator from New York made today about the Ryan White Care Act and our bipartisan bicameral legislation. I will talk about each of her claims in turn.
Senator Clinton claimed that when you look at the funding for the whole bill, New York is not receiving the most funds per case. I don't doubt those figures. However, those are deceptive numbers. As an accountant, I have to point that out. They are deceptive for two reasons. First, her statement dealt only with funds per AIDS case. We have been talking about including HIV cases as well. Why would she neglect to include HIV? I assume it is because 25 States have 50 percent of their HIV/AIDS cases not being counted today because those individuals have HIV, which has not progressed to AIDS.
Please note that all of my numbers have included both HIV and AIDS. We must include HIV in the funding formulas. Before, including only AIDS made sense because we were just waiting for people to die. Now, we have lifesaving treatment for those with HIV; therefore, we must count each person who can receive lifesaving care.
Additionally, Senator Clinton is looking at more than just the formula funding. Her figures include funding for community health centers, health care providers, providers who reach out to women and children. Thus, her figures include a lot of extra funding that is not at the heart of the debate.
If Senator Clinton wants to rely on these numbers, numbers outside of the formulas, then she can do so under the current bill. She can trust that the other portions of the CARE Act will assist those who she is saying are being harmed by the bill.
As for her claim that her State has not spent Ryan White funds for things such as dog-walking, I will note that the Senator from Oklahoma provided information for the record regarding that.
Now, Senator Clinton further claims that New York only carried over $3 million. Well, I find that surprising, given that New York, on the average, has carried over $29 million.
Mr. President, I ask unanimous consent to have printed in the Record a document from the Health Resources and Services Administration documenting the funds carried over for New York.
Now, the Senator from New York mentions her 1-year extension bill. I will also discuss the Senator's 1-year extension, her resolution for Ryan White, her solution that would simply delay the reauthorization for another year. It simply says to those States that have not been getting adequate funds: We do not care about you, and you are not going to get adequate funds. We are going to re-debate all of this again next year. We are not even going to move toward making it fair.
The underlying bipartisan, bicameral bill has a provision providing 3 years of hold harmless funds for New York. For 3 years, New York will not have to follow the formula. They would like to have 5 years. The 3 years already in the bill is at the expense of the other States. The 5 years would be at the expense of the other States, although I will cover a question that was asked yesterday in a little while.
This is not a time to delay. This is a time to act. We absolutely cannot delay the much needed updates to current formulas that ensure that all Americans with HIV and AIDS are treated fairly and have access to life-sparing treatments no matter their race, their gender, or where they live.
We have a chart that shows the losses that would occur under current law versus the gains that would occur after this reauthorization. The red States here are going to lose significant funding under the current law, beginning on October 1. One hundred thousand Americans are going to be left out. The chart on the right, the blue chart, shows the gains under the Ryan White authorization. All States gain except five, who lose less funds under the reauthorization than they would under current law. Only two of the five are asking for a difference.
The time is now or never. As soon as the clock strikes midnight tomorrow, thousands of Americans will begin losing access to life- sparing treatment unless we pass this bill now. This amendment does not address this fact. This amendment would extend a formula that will cause dramatic reductions in funding to many States and thousands of Americans.
The House has passed this critical legislation, and now five Senators must decide if they will stand in the way of bipartisan legislation with broad support--a bill that will ensure equitable treatment for all Americans living with HIV and AIDS. I would say, I believe that is down to four Senators now.
Now, my second problem with the bill of the Senator from New York is that it shuts out Americans infected with HIV and does not provide them with equal access to treatment. Rather, it focuses on outdated funding formulas that only examine AIDS, not the full spectrum of the disease.
Just like her numbers on funding per person, the Senator from New York refuses to acknowledge those with HIV. This chart shows that today, in over 25 States, half of the cases in those States are not counted because those Americans only have HIV, not AIDS. These States receive funding for less than half their total HIV/AIDS cases because of the current, outdated, failed formula. Half the Nation does not receive enough funds to provide the most basic care to their residents. Now, my third problem with the bill of the Senator from New York or the Senator from New Jersey is that it ducks the key issue. Rather than more equitable distribution for funding and more equitable access to treatment for all Americans, my colleagues supporting this bill are simply throwing more money at the problem, assuming it will ensure more equitable access to lifesaving treatments. We know this is simply not the case because it does not solve the inherent flaws in the funding formulas.
Now, this chart shows that under the current law, more than 3 percent of Ryan White funding is returned to the Treasury each year. That is more than 3 percent--much of this coming from New York and New Jersey, the very States that objected to the passage of the bill that would more equitably distribute funding across the Nation.
Again, you will see here that under the current law, New York is receiving $509 per case more than the national average. Under the new bill, they would still get $304 more than the average case per person across the United States. And they have an average $29 million unspent. New Jersey, the other State, is receiving $310 above the national average. They would still get $88 above the national average. This bill does not get to equity. This bill moves toward equity. And it does not move there until 3 years from now. Other bills we have done start transitioning immediately.
Now, I am surprised that the Senator from New York or New Jersey would offer a bill to increase funding, ignoring the outdated formula issues, only to increase the inequity of the program and allow more funds that could save lives to be returned to the Treasury each year. Why would we offer more money to States that are already grossly overpaid and unable to spend their money and increase the disparities of outdated funding formulas, further harming those States with an emerging crisis?
This amendment would have us give a few States even more money than they are receiving now, while the majority of the States will receive significantly less funding over the next year. The Senators from New York and New Jersey want to extend this inequity rather than fixing the formula, fixing the formula now, fixing it before the tomorrow-night deadline, to allow fair and equitable treatment and access to care for Americans who have none now.
I can tell you that the HIV/AIDS community and families want this bill now. Now, perhaps my colleague can explain why she wants to give more money to States that cannot spend what they already have, while taking money away from States that are struggling, as we speak, to provide the basic life-sparing treatments to their residents. We are talking about life and death here. It seems they want to throw money at States where the epidemic started and ignore the areas where the epidemic has spread, underfunding areas in a growing crisis.
When you look at the money being spent, what we are talking about in this amendment is saving institutions, not saving people, not saving lives. This is not an economic development bill. This is not meant to assure that institutions that might be interested in providing these services still get the same amount of funds to do so even though they do not have as many people to provide the services to as they are being paid for.
I wish putting more money into the program could fix these inequities but, unfortunately, these inequities stem from outdated funding formulas and a lack of accountability. We must address the problem at its core and ensure that we are not denying the growing number of minorities and women living with HIV and AIDS equal protection under the Ryan White CARE Act.
Now, another comment by the Senator from New York was that she needs more money because it is more expensive to provide care in New York. The big cost driver is HIV/AIDS medication, costs that are similar in every State. Therefore, I do not understand that claim, unless it is protection of the institutions rather than the people.
I have another unanimous consent request that I intend to propound, and I, again, am hoping that someone will be here to object who is actually objecting to the bill instead of sending a surrogate who has had to go through this ritual several times already, even though he supports the bill, because the request earlier, of course, was to have a chance to vote on the bill of the Senator from New York and the Senator from New Jersey. And I am going to offer that. I am going to offer a short time for debate and a vote on that and then a vote on the bipartisan, bicameral bill that has already passed the House.
I am hoping that somebody actually involved in the substitute bill will come to the floor to either agree or object. That should be fair. They can have a vote. It seems reasonable to me. But it really ought to be the people offering the amendment who say they have the better idea, even though it leaves out the HIV folks, hundreds of thousands of Americans. This amendment doesn't even provide a quick fix for 1 more year, because it keeps the flawed formulas that will cause tremendous funding shortfalls in place. They will come back in another year then and ask for 5 more years of being held harmless.
I want to get a vote on the bill that includes HIV and follows the patient.
We need to do that. We need to do it today, not tomorrow, not next month. Tomorrow night, a bunch of States will be in crisis--and their residents with HIV/AIDS will begin losing access to care. I would imagine in their amendment they have slipped in a little thing to protect the States that will fall into a trap tomorrow. But let's not just throw money at the problem, let's do the right thing for the long- term, for the entire Nation. Let's solve the formula. Let's do what we have done on a number of other bills that have gone through my committee, which is to look at the formula and say: What is fair to all the States?
I have to say, there are some people on my committee and others in this body who have said: If I look at the charts and I see what is happening to my State, yes, I may lose some money, but we are trying to come up with a solution that solves a problem across this country. And that is what we are here for, to solve problems across the country. I can tell you that the HIV/AIDS families and community want it to be fair and want the bill we have been asking unanimous consent on for several days now.
So I will be asking for unanimous consent. I will throw in this opportunity to have a vote on the other bill, to see if people want to do more of the same or if they want to fix this over a period of time, again, holding all States harmless for 3 years before we move into a transition to full fairness.
Just last night the House passed this critical, bipartisan, bicameral legislation by an overwhelming bipartisan vote, 325 to 98, and sent it to us to act upon it immediately. The House understood the critical, time-sensitive nature of this legislation. Now the Senate must act quickly to reauthorize this critical program by September 30; otherwise, hundreds of thousands of individuals in States and the District of Columbia will lose access to lifesaving services. The only thing standing between us and the President's signature to enact this bill is a Senate vote on the House bill--or perhaps a Senate vote on the possible substitute amendment and then a vote on the House bill.
Now, I have asked the Senate to move this critical legislation two other times. Currently, four Senators from two States are blocking a vote and thus may prevent many individuals and families from receiving critical AIDS and HIV treatment under a more equitable program.
I appreciate the number of my colleagues who have been on the floor to talk about the people in their States who are dying because they are on a waiting list and cannot get the treatment, because they have had huge influxes of population, huge increases in the number of people who have been infected by HIV and AIDS. We cannot let that happen. We cannot continue that. We cannot continue to say: Well, if we have been shipping money to one part of the country, we are going to continue to ship money to that part of the country even though the problem has shifted. So four Senators are blocking us.
Mr. President, I would like to take this opportunity to recognize the hard work of the Senators from California on this legislation. I appreciate their willingness to continue to talk to us to address their concerns. They have indicated they are no longer objecting to this legislation. I thank them. However, this bill, due to other objections, is still not moving forward.
This legislation ensures that Federal moneys are distributed more fairly and the dollars will follow the person. This is something our outdated funding formula failed to do. Hundreds of thousands of people living with HIV and AIDS, who live in these States, will be needlessly harmed if a few Senators continue obstructing good policy.
What is more, these four Senators will not come to the floor to defend their objection to this critical legislation at a time when we are talking about it. So today I will ask again for the Senators from New York and New Jersey to come to the floor themselves, lodge their objections, listen to the unanimous consent request, where I am going to offer them the right to have a vote on their bill, in exchange for the right to vote on the bill that came out of committee--the bill that is bicameral and bipartisan.
Now, as part of the unanimous consent request, I am also allowing those Senators to offer that amendment, of course, the opportunity for them to put forward their best solution for dealing with the concerns they have. We have run hundreds of programs trying to come up with the most equitable way to do this. The one we are presenting is the one we found that had the most people to support it. I was told this is identical to the bill introduced by the New York and New Jersey delegations this week. That is the amendment we would be voting on. This bill and/or amendment is not a solution; rather, it is a harmful delay, putting off what we should and must do today.
These States simply raise objections about what funds are received this year compared to last year. These States were grossly overpaid last year and will continue to be overpaid next year. However, they will no longer be grossly overpaid under the bill I am proposing. These few Senators keep saying they will lose money under the reauthorization. No matter the dollar formula they say they may lose on a given day, it doesn't add up to the amount of dollars they would stand to carry over from the current flawed formula. The State of New York would carry over an average of $150 million over 5 years.
According to GAO data, even with the formula adjustment that will allow for more equitable treatment, save lives in more places, New York would still carry over about $115 million based on their past spending. In the past, New York and New Jersey have been able to under-spend hundreds of millions of leftover dollars. At the same time, 25 other States are struggling to provide even the most basic life-sparing medications to their residents living with HIV/AIDS. Because of the current flawed formula, this amendment doesn't even count Americans living with HIV. New York can afford to generously offer more than 495 different medications to their residents. That is 23 times the number of medications that Louisiana is able to offer their HIV/AIDS residents because of a lack of appropriate funding. While New York offers a range of elective drugs, many other States are unable to provide the basic life-sparing treatments that every American should have access to. This is indefensible. New York carries over an average of $30 million each year; yet, 25 other States are having significant difficulty providing the basic drugs to all of its eligible residents. Eleven States have waiting lists--that is right, residents in 11 States are unable to receive life-sparing treatments because their States do not receive appropriate funds.
New York, in 2005, spent an astonishing $25 million on administration costs for just two titles of this law. That is more than the entire amount of money received by 38 States in 2005 for those two titles to provide care to their residents with HIV/AIDS. This inequity must be addressed, and it is addressed in this reauthorization. Stalling now because a couple States stand to lose a fraction of the money they already cannot spend is indefensible. Lives are at risk and a solution is on the table today. A solution has been passed by the House and is before us now.
I hope those four Senators will defend their objection and allow a vote on their amendment. The continued expansion of the AIDS epidemic in this country is a certainty. While the epidemic continues in the urban areas in the country, the number of new cases not diagnosed in small urban, suburban, and rural areas are reaching alarming levels. As the epidemic expands in all these areas, local health care systems have often been unable to meet the growing demands for medical and support services.
The problems created in rural areas are often similar to those experienced in large cities. However, these problems are exacerbated by poor health care infrastructure and limited experience with HIV/AIDS care. The lack of trained primary care providers, the absence of long- term care facilities, the scarcity of resources, and a scattered population are additional obstacles that may be faced in a developing, coordinated outpatient service program.
If New York thinks it is more expensive to handle a new problem, they ought to deal with the distances these people have to travel in some of the rural areas to get care for some of the most basic ailments. Small areas are
also often not able to provide the specialized services required by some persons with HIV. When primary services are unavailable, individuals and families must travel long distances to receive the necessary care. Furthermore, rural health care systems must address not only the epidemic but also other conditions, including substance abuse, mental illness, and sexually transmitted diseases which they may be poorly equipped to deal with.
Thus, as we think of the problem today in its expansion into rural areas, we must provide the same effort to those areas we did for urban areas in the early 1990s. We must target resources to those in need and assure that those infected with HIV and living with AIDS will receive our support and our compassion, regardless of their race, gender or where they live.
Finally, I want to answer the question posed by the Senator from Minnesota last night. Senator Dayton asked what it would cost to give these States, over the next 5 years, the same amount of money as they receive presently. Alarmingly, to keep those States whole, it would cost $614 million a year. That is over half a billion for the next 5 years.
It is not possible just to provide increases to New York and New Jersey due to the funding distribution; therefore, to ensure that everybody receives as much money per person with HIV that New York is currently receiving, it would cost over $3 billion--if we went to equity, it would cost $3 billion, or a 30 percent increase in Ryan White funding to maintain States' funding level that are grossly overpaid and unable to spend the money they do receive.
Our obligation as Senators is to the people of the United States. We still have four Senators who continue to obstruct the Senate from passing a bill because of the September 30 deadline--a bill which passed the House 325-to-98, a bill that can save more than 100,000 lives, including the lives of the growing number of women and minorities who are afflicted by this devastating disease, and provides the money to where it is needed most.
As I said last night, this is not an economic development project. The bottom line is simply, where States have more people with HIV/AIDS, they should get more money. Where States have less people with HIV/ AIDS, they should get less money. As we all know, the Ryan White program provides critical health care services for people infected with HIV and AIDS. These individuals rely on this vital program for drugs and other services. We need to pass this legislation so we can provide them with the treatment they desperately need.
I urge the Senators who are holding up the bill to stop playing the numbers game so the Ryan White CARE Act funding can address the epidemic of today, not yesterday.
I ask the Chair how much time remains.
Mr. President, I will yield 5 minutes to the Senator from Alabama, Mr. Sessions.
Mr. President, I yield 10 minutes to the Senator from Utah, Senator Hatch, who has been actively involved in the HIV/AIDS discussion for years. In fact, he selected the Ryan White name for this bill many years ago when he chaired this committee.
Mr. President, it is my understanding that I have 9 minutes remaining?
I thank the Chair, and since there is a Senator now here from one of the two states objecting to us moving on with the Ryan White HIV/AIDS Treatment Modernization Act, I would like to propound the unanimous consent.
Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of H.R. 6143, which was received from the House. I ask unanimous consent that the only amendment in order be an amendment by Senator Lautenberg, which is the text of S. 3944, with 30 minutes of debate equally divided. I ask consent that following the disposition of that amendment, the bill, as amended, if amended, be read the third time and passed, a motion to reconsider be laid upon the table, and that any statements relating to the bill be printed in the Record.
Mr. President, I am sorry to hear the objection. We have been trying to find a way, any way, to be able to move on to a vote on this bill that is bipartisan, bicameral. It has already passed the House and I am sure it would pass here. So I am really disappointed.
Mr. President, I allocate 5 minutes of time to the Senator from North Carolina, Mr. Burr.
Mr. President, for the last few seconds I am going to just mention that the bill by the Senators from New York and New Jersey was introduced on Tuesday. Surely they have had time to think about having that amendment debated and voted on in that amount of time. I am really disappointed that they won't give some kind of an answer that will allow a vote on that amendment. If that is what they need for cover, that is OK with me. I just need to get this done.
New York and New Jersey are stealing the future from those with HIV, and that just cannot happen in the U.S. Senate. We have to worry about all the people from all of the United States, and that is what the reauthorization would do. That is why it is important to do it. I have asked those questions numerous times now trying to find a way to bring this bill up for a vote, and am being denied in every way--I am not being denied--those with HIV, those with AIDS, their families are being denied the right to have a vote on this bill in the U.S. Senate.