Sen. Edward Kennedy (D-Mass.), ranking Democrat on the Health, Education, Labor and Pensions Committee, on Tuesday announced that lawmakers have compromised on a bill to reauthorize the Ryan White CARE Act, which provides funding for HIV/AIDS programs in the U.S., CQ HealthBeat reports (Wayne, CQ HealthBeat, 12/5). HELP Chair Michael Enzi (R-Wyo.) and Kennedy on Friday at a meeting with HIV/AIDS advocates said it was unlikely that legislators would reach a compromise to renew the CARE Act before Congress adjourns for the year. Five senators, including those from New Jersey and New York state, earlier this year blocked Senate consideration of a House-approved bill (HR 6143) sponsored by Rep. Mary Bono (R-Calif.) that would change CARE Act funding formulas so that rural areas experiencing increasing numbers of HIV/AIDS cases receive higher funding amounts and urban areas' funding would decrease. Some legislators from states with large urban areas -- including California, New Jersey and New York -- have opposed measures that would change CARE Act funding formulas, saying they could harm HIV/AIDS programs in areas with higher HIV prevalence. Enzi in November attempted to compromise with the senators by offering a three-year reauthorization of the measure, rather than the five-year reauthorization that they previously had blocked, Senate aides said. Enzi said he thought the deal might be acceptable because New York and New Jersey would have experienced their steepest financial loses in HIV/AIDS funding in the last two years under the original CARE Act reauthorization proposal (Kaiser Daily HIV/AIDS Report, 12/5). Sen. Hillary Rodham Clinton (D-N.Y.) and other New York and New Jersey lawmakers on Tuesday agreed to a proposal by Kennedy, the AP/San Jose Mercury News reports (Barrett, AP/San Jose Mercury News, 12/5).

Bill Details
Kennedy's proposal includes provisions to:

• Strengthen "hold harmless" provisions and maintain funding levels so that states would not receive less than 95% of their 2006 funding levels;

• Count all HIV-positive people for funding regardless of where they live or how the data is reported;

• Maintain the funding pool for prescription drugs and therapeutics;

• Expect HHS to continue developing a framework addressing HIV/AIDS in the U.S. and to report their progress in 2008;

• Maintain a four-year transition period for states with code-based reporting systems to switch to names-based reporting systems without being penalized (Kennedy release, 12/5).

The compromise also would repeal the Ryan White program after three years, forcing Congress to write a new law and reconsider the program's structural challenges before then, Senate aides said. "It puts the pressure on us to get a reauthorization done in a timely fashion and not just extend something," a Senate Democratic aide said (CQ HealthBeat, 12/5).

Reaction, Next Steps
Kennedy in a statement said, "After years and years of negotiations, this final proposal clears the way for reauthorization of the Ryan White CARE Act this year so that all people living with HIV/AIDS will get the care and services they need to live long and productive lives." The compromise deal came after "months at the negotiating table trying to find an agreement that will ensure that Americans have access to life-saving HIV/AIDS treatments regardless of their race, gender, or where they live" Enzi said. "I'm very proud of the way that we just basically dug our heels in and stood our ground against a bipartisan coalition," Rodham Clinton said, adding, "[T]hey gave ground and we came up with a compromise that we can live with. We're very happy" (Barrett, AP/Long Island Newsday, 12/5). The bill this week is expected to pass in both chambers of Congress (AP/San Jose Mercury News, 12/5).

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