Policy & Politics

Bush FY 2006 Budget Proposal Would Increase Funding for Global HIV/AIDS, Including PEPFAR, Millennium Challenge Corp.

February 8, 2005

President Bush's proposed fiscal year 2006 budget, which was released on Monday, would increase funding for global HIV/AIDS, tuberculosis and malaria initiatives, including the third year of the President's Emergency Plan for AIDS Relief and the Millennium Challenge Corporation, Reuters reports (Reuters, 2/7). HIV/AIDS and development programs "come out big winners" in Bush's proposed budget, which includes $3.2 billion earmarked for PEPFAR, $300 million of which would go to the Global Fund to Fight AIDS, Tuberculosis and Malaria, according to CQ Healthbeat (CQ Healthbeat, 2/7). PEPFAR is a five-year, $15 billion program that directs funding for HIV/AIDS, TB and malaria to 15 focus countries, including Botswana, Ethiopia, Cote d'Ivoire, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Zambia, Haiti, Guyana and Vietnam. In November 2004, Congress approved a FY 2005 omnibus spending package that included $2.9 billion to fight HIV/AIDS, TB and malaria -- $99 million more than Bush had requested and much of which will go to PEPFAR (Kaiser Daily HIV/AIDS Report, 1/24).

Millennium Challenge Corporation
Bush's budget proposal also includes $3 billion for the MCC, which was created to administer funds for the Millennium Challenge Account, a program meant to encourage economic and political reforms in developing countries. Although the proposed $3 billion is an increase of $1.5 billion over MCC's FY 2005 funding, the amount is less than the $5 billion Bush had planned for FY 2006 when he created MCA in 2002, the State Department's Washington File reports. Because eligible countries have "taken longer than expected" to develop funding proposals, the administration now expects to earmark $5 billion annually beginning in FY 2007, according to the Washington File (Washington File, 2/7). Currently, 17 countries -- Armenia, Benin, Bolivia, Cape Verde, Georgia, Ghana, Honduras, Lesotho, Madagascar, Mali, Mongolia, Morocco, Mozambique, Nicaragua, Senegal, Sri Lanka and Vanuatu -- are eligible to apply for MCC funding (Reuters, 2/7).

Bush's funding request for MCC likely will "meet the same resistance" in Congress as his previous two funding proposals, which lawmakers said "cannot effectively allocate so much money in a single year," according to CQ Healthbeat. Achieving Bush's original funding goal for MCA also seems "unlikely," even if Congress meets his funding request for FY 2006, CQ Healthbeat reports (CQ Healthbeat, 2/7). Bush's budget proposal also "came under fire" from some HIV/AIDS advocacy groups that said any increases "masked" a funding decrease for "working projects in the poorest countries," the Financial Times reports. Jamie Drummond, executive director of the debt, trade and AIDS advocacy group DATA, said that Bush has "broken all the promises" he made when he created MCC because not only is its budget less then the $5 billion annually "originally promised," but no funding has been disbursed and it seems that the agency has "taken funds from other aid programs," the Times reports. "They need to light a fire under the MCC," Drummond said (Dinmore, Financial Times, 2/8).

Domestic Programs
In his State of the Union address last week, Bush outlined an agenda aimed at U.S. inner cities, including a pledge to fight the growing HIV/AIDS epidemic in the African-American community. Bush also asked Congress to reauthorize the Ryan White CARE Act "to encourage prevention and provide care and treatment" to people living with the disease. "And as we update this important law, we must focus our efforts on fellow citizens with the highest rates of new cases: African-American men and women," Bush said (Kaiser Daily HIV/AIDS Report, 2/3). However, Bush's budget proposal includes cuts for some domestic HIV/AIDS programs, including a $14 million decrease for the Housing Opportunities for Persons With AIDS Program and a $4 million reduction for CDC's Division of HIV/AIDS Prevention, according to the San Francisco Chronicle (San Francisco Chronicle, 2/8). Bush's budget proposal also includes reductions in Medicaid of about $45 billion over the next decade. According to the AIDS Alliance for Children, Youth and Families, Medicaid provides more than $5.6 billion in health care services to people living with HIV/AIDS annually (AIDS Alliance release, 2/7). The proposed FY 2006 budget requests nearly $2.1 billion for Ryan White funding, which represents flat funding except for a $10 million increase for AIDS Drugs Assistance Programs nationwide, according to the AIDS Project Los Angeles (APLA release, 2/7). ADAPs are federal- and state-funded programs that provide HIV/AIDS-related medications to low-income, uninsured and underinsured HIV-positive individuals (Kaiser Daily HIV/AIDS Report, 2/4).

Bush's "rhetoric and numbers do not add up," Ernest Hopkins, director of federal affairs at the San Francisco AIDS Foundation, said, adding, "How can the president call for an improved response to the epidemic but then cut or underfund the programs that are absolutely critical to achieving this goal? To focus efforts on African Americans living with and at risk for HIV/AIDS requires focused leadership and targeted dollars. Rhetoric without action is disingenuous" (SFAF release, 2/7). APLA Executive Director Craig Thompson said, "Los Angeles is undergoing a crisis in affordable housing for everybody, including low-income people with HIV/AIDS. The president's budget takes HOPWA funding back to pre-2001 levels, despite growing demand. These kinds of cuts undermine our ability to provide people with HIV/AIDS safe and stable housing, which is essential to managing [the] disease" (APLA release, 2/7). "HIV/AIDS is on the rise among women and minorities in the United States, so now is not the time to shortchange critical domestic programs, including Ryan White," Mark Isaac, vice president of the Elizabeth Glaser Pediatric AIDS Foundation, said, adding, "Compounded by Medicaid cuts of approximately $45 billion, programs funded by the already overburdened Ryan White CARE Act can expect more patients and longer waiting lines to access treatment. As we know, waiting just a few months for treatment or access to a clinical trial can literally mean the difference between life and death" (EGPAF release, 2/8). AIDS Alliance President Ivy Turnbull said, "We call on Congress to prioritize care and treatment for people living with HIV/AIDS by restoring cuts to Medicaid and fully funding the Ryan White CARE Act. Anything less cuts short our commitment to taking care of the most vulnerable people in our society" (AIDS Alliance release, 2/7).

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