Disputed AIDS
funding bill passes House

The U.S. House agreed Thursday night to send more AIDS care money to rural areas and the South, overcoming angry opposition from big-state lawmakers who stand to lose millions. ''It's shameful and disgraceful,'' shouted New York representative Eliot Engel, before lawmakers voted 325-98 to amend the $2.1 billion Ryan White Act. ''The HIV/AIDS epidemic is moving,'' countered Texas representative Joe Barton. ''This is a very fair compromise. It begins to treat all states on an equal footing.'' The bill faces uncertain prospects in the Senate before Congress recesses at the end of the week to campaign for reelection. Several senators are blocking it, and an attempt by supporters to force a Senate vote Thursday night failed. Supporters said the election-year updates were needed because of how AIDS has changed since the 1990 passage of the Ryan White law, the largest federal program specifically for people with HIV/AIDS. Once a big-city epidemic infecting mostly gay white men, the disease is now prevalent in the South and among minorities. By some measures federal funding has not kept up, and states like California, New York, and New Jersey get more money per patient than Alabama, Kentucky, or North Carolina. The Ryan White amendments, the first since 2000, make a number of changes aiming to spread money more equally around the country. While current law counts only patients with full-blown AIDS, the revision also would count patients with HIV who have not developed AIDS. That change would favor parts of the country where the disease is a newer phenomenon, which tend to be Southern and rural areas. As a result, New York State stands to lose $100 million over the five years of the bill. New Jersey would lose $70 million. Alabama, by contrast, would get an increase from $11 million a year to about $18 million a year. Resistance from senators from New York, New Jersey, and California threatens to stall the bill in the Senate, where opposition from a single senator can block legislation. Republican senator Mike Enzi of Wyoming took to the Senate floor Thursday night to call for an immediate vote, his second attempt this week. Democratic senator Mark Dayton of Minnesota objected on behalf of the holdouts, blocking the gambit. Enzi, frustrated and shaking his head, said that if the bill doesn't pass before Congress recesses, he will ask majority leader Bill Frist to call a procedural vote to overcome the stalling tactics. That would take 60 votes. ''I'm desperate. I usually don't have to do that sort of thing, but I'm willing to do it on this bill,'' said Enzi, chairman of the Senate Health, Education, Labor, and Pensions Committee. ''I'm really disappointed that we reached a sticking point like this, and people are going to die.'' Several lawmakers complained that the differences could be resolved if more money were added to the bill. Under the revisions Ryan White funding would grow by only $70 million. ''That means if we're going to give to some people who are very deserving, we're going to take from others who are very deserving,'' said California representative Henry Waxman. California and some other states are worried about a change in the bill that mandates counting HIV patients by name instead of codes. Some states used code-based systems out of concern for patient privacy. California could lose some $50 million in the last year of the bill, when the names-based system would take effect, if it can't make the transition. Congressional aides were working on a compromise on that issue that could win support from California senator Barbara Boxer, one of the holdouts. (Erica Werner, AP)