The resolution of the debt ceiling negotiations between the White House and congressional leaders has HIV/AIDS advocates concerned that federal funds for prevention and drug initiatives could be on the chopping block as a result of the agreement.
The agreement — which enables President Obama to raise the debt ceiling by $2.1 trillion and eliminates the need for another increase until 2013 — also requires a total of nearly $2.5 trillion in spending cuts to reduce the federal deficit, which could affect federally funded HIV/AIDS programs.
Carl Schmid, deputy executive director of the AIDS Institute, said any cuts to federal spending as a result of the deal will likely “impact HIV programs in a negative way.”
“There will be less money to go around and it will be more competition over that smaller amount of funding,” Schmid said. “And there can be direct cuts to our programs particularly if they are taken across the board. Not going in the right direction if we are going to end AIDS let alone prevent new infections and provide care and treatment to people with HIV/AIDS.”
All federal funding of discretionary HIV/AIDS programs could see an impact as a result of the decision, Schmid said, including the Centers for Disease Control & Prevention, the Ryan White HIV/AIDS Program and AIDS research programs. Additionally, Schmid said AIDS Drug Assistance Programs could be cut and already lengthy wait lists to receive medication through this program could be extended.
“It’s going to be harder and harder to make the case for our programs, but, hopefully, Congress will be receptive to our voices and concerns about the importance of preventing HIV in our country and to provide care and treatment for people who are HIV positive,” Schmid said.
The concerns come as the CDC on Wednesday unveiled new numbers showing that HIV incidence in the United States continues to be a problem affecting young gay and bisexual men, although as a whole infection rates have been relatively stable in recent years.
New infections among among young men who have sex with men increased 34 percent between 2006 and 2009, while infections among young, black men who have sex with men increased 48 percent from 4,400 in 2006 to 6,500 in 2009.
Fred Sainz, vice president of the Human Rights Campaign, said any concerns HRC would have over the debt deal depends on what cuts to federal programs are eventually made. However, he noted for time being, those cuts have yet to be identified and maintained it’s too early to cry foul.
“We are consulting with our coalition partners to better assess the situation,” Sainz said. “We would be concerned, for instance, if programs that fund critical HIV/AIDS were cut. There is no knowledge yet so we’re not in a position to know.”
Obama signed the deal into law on Tuesday after both chambers of Congress approved the measure. The Democratic-controlled Senate approved the measure on Tuesday by a vote of 74-26 while the Republican-controlled House passed the measure by a vote of 269-161.
Prior to the signing, Obama delivered a statement in the White House Rose Garden in which he said the federal government will have to make tough choices to reduce spending, and no programs will be excluded from cuts.
“This compromise requires that both parties work together on a larger plan to cut the deficit, which is important for the long-term health of our economy,” Obama said. “And since you can’t close the deficit with just spending cuts, we’ll need a balanced approach where everything is on the table.”
The agreement calls for a first tranche of spending cuts that total nearly $1 trillion over 10 years. Those cuts include $350 billion from the defense budget, but the remaining cuts could impact discretionary HIV/AIDS initiatives. However, Medicare and Medicaid — as well as the services they provide to people with living with HIV/AIDS — are protected under this first round of cuts.
To institute more cuts, the deal creates a bipartisan panel that has become known as a “Super Congress” made up of congressional leaders and will be required to identify an additional $1.5 trillion in deficit reduction that could include cuts to entitlement programs and tax reform. Both Medicare and Medicaid as well as discretionary HIV/AIDS initiatives could be on the chopping block for this round of cuts. The committee must report out legislation by Nov. 23 and Congress is required to vote on committee recommendations by Dec. 23.
Should Congress fail to act on the committee’s recommendations, a trigger mechanism will be enacted for mandatory spending cuts. Those cuts — which would begin in January 2013 — will be split 50/50 between domestic and defense spending, although Social Security, Medicare beneficiaries and “low-income programs” would be exempt from those cuts. Additionally, Obama has pledged to veto any extension of the Bush-era high-income tax cuts as a means to increase government revenue should Congress fail to come up with a balanced deal.
In a joint statement, Kathleen Squires, chair of the HIV Medicine Association, and Jim Raper, c0-chair of the Ryan White Medical Providers Coalition, urged Congress not to target HIV/AIDS programs in its search for funding cuts in federal programs.
“Congress has outlined a framework for enacting major cuts to the federal budget over the next decade that could have far reaching consequences for people living with, and at risk for, HIV infection here and abroad,” Squires and Raper said. “We urge members of Congress to seriously consider the human impact of the funding and policy decisions that they will be making in the coming months.”
Squires and Raper maintained that continued federal funding for HIV/AIDS initiatives is important because they extend the lives of those living with the disease and stop new infections. Access to HIV care, Squires and Raper said, reduces transmission by 96 percent, but only 50 percent of people with HIV in the United States have reliable access to treatment. Further, Squires and Raper said as many as 15 million people in developing countries await access to lifesaving therapy.
“A retreat in the battle against HIV disease will be costly whether measured in lives lost or federal dollars,” Squires and Raper conclude. “As the deficit reduction process moves forward, we urge members of Congress to consider the impact of their decisions on people with HIV disease and other medically vulnerable populations.”
Shin Inouye, a White House spokesperson, said the debt agreement is “a down payment on deficit reduction so that we begin to live within our means,” but maintained the details of which programs will be cut have yet to be decided.
“The nearly $1 trillion in discretionary spending cuts are achieved through spending caps both on security and non-security spending,” Inouye said. “Specifics about how these levels will be met will be determined through discussions between the administration and appropriators in Congress over the coming months.”