2016 Budget Funding Bill, Effects on HIV and LGBT Issues

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Carl Schmid

The federal funding bill of December 2015 changes littles for those health services important to the LGBT community. Carl Schmid, of the AIDS Institute, said that the Institute and other lobbyists had defeated attempted budget cuts. As the National Institutes of Health (NIH) received a $2,000 million increase, HIV research funding could increase. Chronically underfunded LGBT health priorities, such as transgender health, will remain underfunded.

Congress approved a $4.5 million increase in funding for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention. This brings total funding for these programs to $1,122.3 M, a 0.4 percent increase. The administration had requested a $63.9 million increase.

According to Schmid, three programs fund most HIV treatment: Medicare, Medicaid, and Ryan White Care. Prior statutes have set the funding formulas for Medicare and Medicaid. Congress cannot easily change those formulas. While Congress has not yet reauthorized Ryan White Care (RWC), it can continue to operate as long as Congress funds it. This bill funds Ryan White Care through the end of the 2016 budget year.

For most RWC programs, Congress funded the same amounts for 2016 as it had for 2015. One RWC program, the Early Intervention Program received a $4 million increase in 2016. Congress rejected the Administration’s request to move Children, Youth, Women, and Families programs into the Early Intervention Programs. Looking at these figures in isolation hides the effects of the Affordable Care Act (ACA) on RWC. Many RWC clients are enrolling in Marketplace Health Plans or Medicaid plans in those states (not Florida) which Expanded Medicaid. Instead of RWC paying for their entire health care, RWC is now paying only for their premiums. This creates more funds available for other RWC programs.

Language in the House Sub-Committee report prioritizes research about bio-medical interventions rather than behavioral interventions. Carl Schmid emphasized that these interventions are inter-related. Behavioral interventions are necessary to improve adherence and to increase HIV testing behaviors. Pre-exposure prophylaxis (PrEP), a bio-medical intervention, relies on a schedule of daily dosing (adherence), a behavior, for its effectiveness.

According to Schmid, attempts to cut HIV funding come from many sources. The GOP, now the majority party, generally favors cutting non-defense spending. Some Christian rightists tend to oppose funding programs that benefit the LGBT population. As HIV has become more manageable, other disease constituencies have also begun to question its amount of research funding. They charge that diseases that affect more people should receive greater research funds. People making this argument have tended to favor using “disease burden” as the criteria for allocating research funding.

Historically about 10 percent of the NIH budget has gone to HIV research. Some members of Congress have wanted to reduce that amount. According to Carl Schmid, the exact allocation of funds within NIH remains an administrative choice, not a Congressional one. Ominously, Congress has peppered this budget report with instructions to report on the “disease burden” of specific diseases.

Medical research about one disease may yield knowledge about another. For example, research to increase adherence to a daily dosing schedule for PrEP can benefit other disease treatments that require daily dosing such as tuberculosis or cardio-vascular disease.

Schmid said that allocation for research funding decisions should be made on multiple criteria, rather than just the “disease burden.” For example, infectious diseases may require more public health resources than non–infectious diseases. Some diseases, such as HIV, have a global impact. Most HIV infected people live in Africa, which lacks resources for research. Schmid stated, “The AIDS Institute can understand why other disease constituencies might question the amount that HIV receives. Disease burden, however, should not be the sole criteria for making these decisions.”


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