Cliff Notes


With the election behind us, all eyes are on Washington as lawmakers face the looming “fiscal cliff.” It’s making big headlines, but what does it mean for people living with HIV and what can we do about it? We pose those questions to Ernest Hopkins, director of legislative affairs at San Francisco AIDS Foundation.

What is the “fiscal cliff?”
The fiscal cliff is a term used to describe the confluence of serious budgetary decisions that must be addressed by government in order to avoid dramatic consequences. If Congress does nothing, cuts mandated by the failure of the Joint Congressional Budget Committee to reach an agreement will go into effect at the beginning of January 2013. Sequestration, as the cuts are called, was never really designed to be enacted. It was viewed as a “poison pill” incentive to avoid a mutually unacceptable outcome for both parties. If it is enacted, sequestration would result in dramatic cuts to both defense and non-defense discretionarily funded programs.

Why should we be concerned about it?
Federal HIV/AIDS programs are entirely funded through discretionary funding that is determined annually by Congress. The cuts proposed to discretionary budgets would automatically impact all program line items threatening to oust thousands of people living with HIV/AIDS from many of our most important and effective programs like the AIDS Drug Assistance Program (ADAP), housing assistance, and medical care through Ryan White. HIV prevention programs at the U.S. Centers for Disease Control & Prevention and thousands of research projects at the National Institutes of Health also face cuts or elimination.

These cuts really would impact some of our most vulnerable citizens?
It would hit them hardest.  Uninsured and underinsured people who rely on federal programs to address their health care and support-service needs would risk losing access to services that they consider essential to their health, well-being, and quality of life.

Is there anything we, as average citizens, can do about it?
The President and Democratic caucuses of the House and Senate have said that any budget agreement must be balanced. This means raising revenues, or taxes, to mitigate the size of cuts needed in discretionary programs. If you believe that federal government programs like ADAP and Housing Opportunities for Persons with AIDS (HOPWA), that provide a critical safety net to people living with HIV, are important, please contact your congressional leadership in the House and Senate to let them know that you care about these programs and do not want them cut. A personal visit to the district office is best, written letters are next best, phone calls to the district office are good, and emails tied to a constituent address are also very helpful.

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Additionally, policy experts at San Francisco AIDS Foundation are busy meeting with members of Congress to make the case for people living with HIV/AIDS. The foundation is a member of the national AIDS Budget and Appropriations Coalition (ABAC) and the AIDS community is working with the larger health care community to make the case for essential, safety net programs.

What is the most important message for members of Congress to hear?
Over the last 20 years, Congress has funded the Ryan White CARE Act. It is the largest single disease discretionary program and is a model for comprehensive, community-based medical care and supportive services. As we integrate people living with HIV into the broader framework established under the Affordable Care Act, we will need resources to transition and coordinate seamless access to care for people living with HIV, and Ryan White can provide those resources.

For people at risk for HIV, new research reinforces the critical importance of routine testing and early access to treatment. Early HIV treatment improves the health of the individual and also dramatically reduces the viral burden in communities. That, in turn, reduces the likelihood of new infections. Early investments in preventive health services ultimately reduce overall health care costs on federal, state, and local systems.

The Medicare and Medicaid programs are essential to people living with HIV/AIDS, the elderly, the low-income, and individuals with disabilities and chronic diseases. They are truly the lifeline for millions of Americans and must not be undermined, but strengthened, at a time when the aging population in the U.S. is increasing. Now more than ever, the partnerships between community-based health care organizations and government-centered systems must be enhanced and maximized.

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