A Moment of Truth on Capitol Hill

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Hundreds of AIDS activists from around the country converged on Washington, D.C., this weekend to demand policymakers invest resources in stopping the virus’ spread and treating those who are already positive. The march coincides with what is shaping up to be a crucial week on Capitol Hill, in which lawmakers will decide whether to embrace deep budget cuts to several safety net programs crucial to poor people living with HIV/AIDS.

Republican leaders in the House of Representatives are pushing an omnibus spending bill that would cut $50 billion from the federal budget for social service programs over the next five years. The vote comes as representatives also prepare to vote on the fifth tax cut in five years, totaling $70 billion.

Medicaid would bear a large chunk of the proposed cuts to service programs. The House bill trims the program by $12 billion over five years and $48 billion over the next ten years. The bill achieves these savings in large part by opening the program to copays and premiums for the first time, charging patients from $3 to $5 per doctors’ visit or prescription. A Congressional Budget Office analysis predicted those steps would achieve the desired savings not by bringing in actual revenue but by acting as a disincentive for poor people to actually use the program.

Medicaid is the largest payer for AIDS treatment in the nation, with almost half of those receiving care doing so through the program. Sixty-four percent of HIV-positive African Americans getting treatment pay for it with public health insurance.

The House bill would also cut $844 million out of the food stamps program over the next five years, largely by changing the rules to disqualify tens of thousands of legal immigrants from the program. New rules would require immigrants live in the United States for seven years before becoming eligible for food aid; currently they must reside in the U.S. for five years. AIDS service providers often complain that clients are unable to take the steps needed to both stay healthy with HIV and to prevent its further spread because they are overwhelmed by basic daily needs, in particular the costs of food and transportation to and from jobs or clinics.

The House bill would further cut nearly $400 million from the foster care program by denying foster care payments to relatives who take in children who have been removed from their parents’ homes by court-order.

These and other provisions in the House bill up for consideration this week are far more drastic than those passed by the Senate last week. The Senate’s budget-cutting measure stripped $35 billion from federal expenses over the next five years.

The Senate bill passed Thursday night, Nov. 3, largely along party lines, with only two Democrats voting for it and five Republicans against it. But even the bill’s critics have noted that the senators found relatively painless ways to slash spending in social services. It would save $36 billion over the next decade by getting rid of a piece of the new Medicare drug-benefit program that would give managed care companies financial incentives to participate in the now partially privatized program. And it focuses much of its Medicaid and Medicare cost-cutting energy on reducing fraud by hospitals and nursing homes.

The Senate bill also included a provision that would set aside $450 million to aid states that try opening Medicaid to people who have tested HIV positive but are not yet diagnosed with AIDS. Currently, Medicaid eligibility is limited to those with an AIDS diagnosis, because only people with full-blown AIDS are considered disabled. For years, AIDS advocates have urged a widening of the program, noting that early access to treatment is often what separates those who live with and die from HIV.

Once the House votes on its budget bill, the two versions must be reconciled before being sent to President Bush. But the White House has threatened to veto the final budget bill if it includes the Senate’s plan for reducing Medicare costs.

Meanwhile, 10 caravans from 100 cities across the country arrived in D.C. on Saturday, part of a year-long initiative to re-energize AIDS activism and demand action from national and local policymakers. Dubbed the Campaign to End AIDS, the participants were scheduled to march on the White House on Monday, Nov. 7, and assemble a mock cemetery to symbolize those who have died from AIDS. The following day, activists will hold a press conference with the Congressional Black Caucus and visit each congressional office to discuss federal AIDS policies.

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