The U.S. House has put its imprimatur on $1.3 trillion in funding to keep the U.S. government running in the next fiscal year, but among the programs that didn’t receive full funding was the Trump administration’s request for increased money to beat HIV/AIDS by 2030.
Although the Trump administration requested $450 million in new funds to ramp up the “Ending the HIV Epidemic” initiative, the Democratic-controlled House — faced with budget caps limiting its appropriations for discretionary programs — approved on Friday a total of $65 million in new money for the plan as part of FY-21 minibus legislation.
The Trump administration, as part of its FY-21 budget request in February, had sought $716 million for the HIV initiative, a PrEP-centric program aimed at containing new HIV infections where they are most prevalent in the United States. The funds were requested for major health agencies — the Centers for Disease Control, the Ryan White Program, the National Institutes for Health, HRSA Health Center Programs and Indian Health Services — to deliver PrEP and HIV treatment.
The request was $450 million more than what Congress agreed to appropriate last year. As the numbers in new funds break down for each U.S. agency, the House agreed to a fraction of that increase: An additional $10 million for CDC, $25 million for Ryan White, $15 million for HRSA Health Center Programs, $10 million for NIH and $5 million for Indian Health Services — a total of $65 million.
Those numbers don’t reflect the baseline $266 million funding that was already approved by Congress for the initiative last year as part of the fiscal year 2020 budget and renewed in the House minibus for FY-21. Adding the new funds with that baseline, the House approved a total of $326 million for the Ending the HIV Epidemic Initiative.
Carl Schmid, co-chair of the Presidential Advisory Council on HIV/AIDS and executive director of the HIV+Hepatitis Policy Institute, said, “we didn’t do very well” in securing additional funds for the HIV initiative and the shortfall proposed by the House is “very disappointing.”
“We were on this trajectory to end HIV, and this is not a good sign,” Schmid said.
With just the baseline and no increases, Schmid said he fears without the increases health officials won’t be able to ramp up efforts to end HIV by the 2030 target.
“The first year funding was to carry out the planning process to end HIV in each jurisdiction and begin implementation,” Schmid said. “Increased second year funding is needed to ramp up activities, including testing and linkage to care and PrEP activities. Without those increases, cities and states will not be able to.”
Schmid added only 200 community health centers received a limited amount of funding in the first year to do PrEP outreach and provide the HIV prevention drug. The second year funding, he said, is necessary to increase funding to each center and expand the number of centers to 500.
One issue the House faced as it made appropriations for the upcoming fiscal year is statutory budget caps imposed by the Bipartisan Budget Act of 2019, which restricts defense and non-defense spending.
Evan Hollander, a spokesperson for the House Appropriations Committee, cited those budget restraints — as well as the need for Congress to restore funds for other programs slashed in the Trump budget — in response to an inquiry on HIV funds, insisting, in fact, the program saw real growth despite those constraints.
“The Trump administration’s budget request for the Ending the HIV Epidemic Initiative was cruelly predicated on eliminating social services that low-income people depend on,” Hollander said. “Despite tight budget caps that make funding hard to come by, the Appropriations Committee rejected this unnecessary either-or approach by protecting social services while providing $326 million for the Ending the HIV Epidemic Initiative. This significant 23 percent increase will make a real difference in beating HIV/AIDS.”
Examples of cuts in the Trump budget, Hollander said, that allowed the administration to propose its “wildly unrealistic number” for the HIV initiative was complete elimination of the Low Income Home Energy Assistance Program, a cut of $3.7 billion, the Community Services Block Grant, a cut of $740 million, and the Teen Pregnancy Prevention program, a cut of $101 million. House appropriators, Hollander said, funded those programs at either the same level or slightly higher than last year.
But Congress has a way of getting around the budget caps. For example, the House approved as part of the FY-21 minibus legislation $210 billion in emergency spending to help federal agencies fight the coronavirus pandemic. That off-the-book spending would go toward “state and local public health departments, public health prevention efforts, medical research, infrastructure, public housing and more,” according to a report in Politico.
Schmid said the House had the option to allocate funds for the HIV initiative in a similar way as the $210 billion in emergency funding was allocated for coronavirus relief.
“The House could have done that for the HIV funding,” Schmid said. “Because some people in the community say, ‘Oh it’s the budget caps.’ Yes, it is. But they could have done it outside the budget caps and that’s one thing actually we were advocating in this public health crisis, and we feel that HIV is very similar.”
Schmid said that idea would be consistent with recent congressional testimony from Tom Freidan, former director of the Centers for the Disease Control during the Obama administration, who has suggested creating a separate fund — one unaffected by budget caps — to address epidemics.
Hollander said appropriations based on emergency spending are intended for non-recurring situations, like the coronavirus epidemic, not for regular expenditures.
“Emergency spending is utilized for non-recurring expenses responding to declared natural disasters or national emergencies like COVID-19,” he said. “It is not typically used for recurring program expenses.”
If the House appropriated money for HIV with emergency funds, it might not go very well. The Trump administration has issued a veto threat on appropriations bills that sidestep the Bipartisan Budget Act of 2019 to include emergency spending, including the House minibus in a Statement of Administration Policy.
Asked whether he thought the House decision not to fund the HIV increases fully was political, Schmid conceded “there’s not a good relationship” between House Speaker Nancy Pelosi (D-Calif.) and House Appropriations Committee Chair Rosa DeLauro (D-Conn.) and the Trump administration, but said he was uncertain.
A senior administration official, who spoke on condition of anonymity, criticized House Democrats for not being able to come up with additional funds for Trump’s plan to beat the domestic HIV epidemic.
“It’s disappointing to see that Democrats did not meet the president’s funding request for this vital program, which combats AIDS/HIV across America,” the official said.
The White House issued a Statement of Administration Policy last week indicating Trump would veto the House minibus if it were sent to his desk, but makes no mention of the HIV funds.
Announced by Trump at the 2019 State of the Union address, the “Ending the HIV Epidemic” initiative aims to reduce new HIV diagnoses by 75 percent within five years, and by 90 percent within 10 years. The plan targets 48 counties in the United States, D.C., and San Juan, Puerto Rico, as well as seven states where the epidemic is mostly in rural areas.
Daniel Bruner, senior director of policy at the D.C.-based Whitman-Walker Health, said it’s important for Congress to address the coronavirus pandemic, but Congress should also come up with additional funds for the Trump administration’s plan.
“We appreciate the urgent need for Congress to respond to the increasing COVID-19 pandemic with substantially greater funding for testing, contact tracing and financial relief for the millions of people in financial crisis,” Bruner said. “However, we also need to remain committed to Ending the HIV Epidemic, and we urge the House and the Senate to find additional funding for this critical public health initiative.”
Schmid said the fight to secure additional funds for the HIV initiative continues in the Senate, but it remains to be seen whether the Republican-controlled chamber will be helpful.
“We still have the Senate, and the final bill and the administration could weigh in, too, [in] negotiations on a final bill, but we don’t know when the final bill is going to happen,” Schmid said.
According to Politico, the House legislation has “no shot” in the Senate and is under a veto threat from Trump. The appropriations process is “totally stalled” in the Senate, with Democrats and Republicans bickering over whether to include emergency coronavirus cash in their annual spending bills, Politico reports.
“There’ll be a continuing resolution,” Schmid added. “We don’t know how long. Will they try to finalize it this year? Will they wait until next year, when there’s a new Congress? Those questions won’t be answered until after the election.”