Congress, Late Sept. 1996: Funding, ADAP, Immigration

* AIDS funding success. Funding for AIDS services has done better than expected in Congress, which has just approved $100 million more than President Clinton's request for the fiscal 1997 (which begins October 1, 1996).

Much of the credit for this success goes to the AIDS lobbying and political organizations, and to those who have supported them with their contributions, their calls and letters to Congress and the media, and their votes. What made a funding increase possible was the continuing concern of the public; a WASHINGTON POST poll released last month showed that AIDS ranked #2 in public concern, tied with crime and slightly behind education, despite the relative silence of politicians about AIDS. Also, on many issues the Republican Congress decided to give Clinton what he requested this year, instead of shutting down the government again, for which the Republicans received much of the blame last year.

AIDS funding got more than Clinton requested because of a bipartisan effort by Congresswoman Nancy Pelosi (Democrat, San Francisco) and Congressman John Porter (Republican, Wilmette, Illinois) to add $100 million for ADAP (the AIDS Drug Assistance Program, part of Title II of the Ryan White CARE Act) -- later changed to $50 million to ADAP and $50 million to other AIDS programs (see below). ADAP is facing a major emergency due to the advent of protease inhibitors, more use of combination therapy, and more people seeking treatment due to greater hope. A conservative estimate is that $195 million more in Federal contributions is needed to prevent widespread denial of treatment. A $65 million increase was requested by Clinton and previously accepted by Congress, and the $100 million would have added most of the difference.

* ADAP Funding Controversy. A few days before Congress adjourned, one group of AIDS organizations mounted a major lobbying drive without telling its coalition partners, and got half of the hundred million dollars for new ADAP funding for AIDS drugs redirected to other AIDS services of the Ryan White CARE Act. The long-running dispute between advocates for different titles within Ryan White became bitter.

We do not have our own opinion about where the money would do the most good. We share the widespread concern about lack of cooperation among AIDS organizations -- and about the risk that the money could have been lost entirely because of the last-minute maneuver, and that future credibility and negotiating strength of AIDS advocates could be damaged.

ADAP advocates built their case for funding by careful analysis and documentation of the merits. Admittedly it is harder to sell services than drugs in Congress, regardless of need, because ADAP funding is strongly supported by the pharmaceutical industry and the AIDS community working together on this particular issue. In politics, money and moral authority are synergistic (more powerful together than would be expected by adding their separate strengths). Some activists want to do what is possible, given the system we have; others fear accepting the view that Congress cannot allocate resources rationally among AIDS programs, when some programs have big-money backers and others do not.

The bottom line is that we need better coordination to build unity among different AIDS organizations -- and to maintain public confidence that actions reflect the interests of constituents over those of professionals and insiders.

* Immigration and the politics of hate. Last week the U.S. came very close to having a new Federal law singling out HIV by prohibiting Federally funded medical programs from providing HIV/AIDS treatment to immigrants, including legal immigrants.

Congress never had a chance to consider this provision in any normal way. What happened is that both the Senate and the House passed different versions of an anti-immigrant bill, neither of which involved HIV. These bills went to a Conference Committee to compromise the differences. The provision against HIV treatment was added in that Committee by a person or persons unknown, and Committee members were not allowed to introduce any amendment to delete the change. The bill with the anti-treatment provision then passed the House on September 25 by a vote of 305-123 (no amendments are allowed at that stage) and was set to pass the Senate, again with no opportunity for negotiation -- and with President Clinton leaning toward signing the legislation despite objecting to many provisions, especially those targeting legal immigrants. But because of the many problems in the bill, the Senate did not vote, but instead attached much of the legislation to an unrelated budget bill. This allowed negotiation of the immigration provisions, and on September 28 the ban on HIV treatment was killed.

What this incident shows is that the U.S. can make a significant legal change in days -- this immigration provision would have created a Federal precedent for second-class status for persons with HIV -- with no opportunity whatever for consideration, debate, or negotiation. This is done by back-room manipulation to attach "technical" changes to bills with great momentum, which are likely to pass and be signed into law no matter what. Those who object must then create a national campaign for new legislation to get the provision repealed -- or find an opportunity for another legislative trick. We saw this before with the Internet censorship legislation, now tied up in litigation, which technically bans abortion information from the Internet, a provision Congress discovered only one day before its final vote (see AIDS TREATMENT NEWS #249, #240, and previous issues).

The growing propensity of Congress to move hate legislation and other giveaways to special interests through the back door -- a scheme can advance within days from first being hatched to becoming the law of the land, with no discussion of its merits -- means that the public must be more vigilant than ever to protect itself. That is why it is important now to use email and the Internet as a communication backbone for rapid mobilizing; see "Grassroots Organizing by Internet: An Example" in this issue. The AIDS community was completely united on the immigration provision and mobilized immediately, helping to defeat the treatment ban.