August 4, 2006

This Week in Washington
1. AIDS Action Expresses Concern about Line Item Veto and Sunset Commissions
2. AIDS Vaccine Resolution Passed by House

CARE Act in Brief
1. CARE Act Program Guidance Released
2. Reauthorization Added to Senate Calendar

Announcements
1. US Surgeon General Resigns
2. New Members Named to PACHA

This Week in Washington
1. AIDS Action Expresses Concern about Line Item Veto and Sunset Commissions
Both the Senate and House recently took up budget process legislation which contains proposals which may result in future reductions in HIV and AIDS funding. AIDS Action is concerned about the effect the Line Item Veto Act of 2006 and Sunset Commission Proposals could have on HIV/AIDS programs. Learn more about this legislation below. AIDS Action urges our members to ask your Senators and Representatives to oppose these versions of the line item veto and sunset commissions during the August recess.

Line Item Veto Act of 2006
The Legislative Line Item Veto Act of 2006 was recently added as an amendment by the Senate Budget committee to a larger budget process bill, S. 3521, sponsored by Senator Judd Gregg (R-NH). S 3521 was then approved by the Budget Committee and sent to the Senate floor. While health care advocates hope that this bill does not come to the Senate floor, it is likely that it will be voted on before November elections. The Line Item Veto Act would enable the President to reject individual items within spending bills passed by Congress rather than accept or reject the bill as a whole. Rejected items would then be placed into a “cancellation package” which Congress would be required to approve or reject as a whole. The President could submit no more than four packages of cancellations a year, so each package will likely contain several unrelated line item vetoes from a number of different bills (making it more difficult to oppose). Once the President has constructed a cancellation package no amendments are permitted, and congress must vote on it within 13 days of receiving it.

Health care advocates note that this Line Item Veto proposal goes well beyond Line Item Veto Act of 1996 enacted during the Clinton Administration (and rejected by the Supreme Court as unconstitutional). In fact, the current proposal is very different from the 1996 proposal and contains provisions that shift extraordinary appropriations power to the President. This year alone the President proposed the elimination of 91 programs, all of which Congress has restored. In the Line Item Veto Act of 2006, the President has an entire year after a law is enacted to exert his veto power. The 1996 Act only gave the President 5 days. The 2006 Act would enable the President to combine line item vetoes of provisions from different bills into one veto package, whereas in the 1996 Act, vetoes were brought to Congress individually. This Act even allows the President to withhold funds after Congress has overridden his veto, simply by submitting the veto package to Congress within 45 days of the end of the fiscal year.

In particular, shifting so much power to the President and away from Congress gives the President great power to cut basic funding for not only discretionary programs but also mandatory programs such has Medicare and Medicaid. This bill could potentially put HIV/AIDS funding and programs in jeopardy. For these reasons, AIDS Action is joining with other healthcare organizations in opposition to the Line Item Veto Act of 2006.

Please urge your Senators to vote against the Line Item Veto Act of 2006.

Sunset Commissions Proposals
On July 20 The House Government Reform Committee approved two bills that would establish “sunset commissions”. The two bills are H.R. 5766 introduced by Representative Todd Tiahrt (R-KS) and H.R. 3282 introduced by Rep. Kevin Brady (R-TX). A “sunset commission” proposal is also included in the Senate’s far-reaching budget process legislation (S. 3521) discussed above. Both Houses of Congress are planning to vote on the controversial legislation that includes the creation of sunset commissions after the summer recess.

The purpose of the proposed sunset commissions would be to investigate federally funded programs and recommend elimination and reductions of programs to increase efficiency and reduce waste. However, The Office of Management and Budget (OMB), The Congressional Budget Office (CBO), and Government Accountability Office (GAO) already produce extensive research findings and information about the operations of federal programs.

In both the Tiahrt Bill (H.R 5766) (and a separate Bush Administration Sunset Commission proposal), the President would appoint all seven commission members. The President would be required to “consult” the Speaker of the House, House Minority Leader, Senate Majority Leader, and Senate Minority Leader on one nomination each. This leaves the potential for a 5-2 partisan majority on the commission. Under the Brady Bill (H.R. 3282) the Speaker of the House would appoint six members and the Majority Leader of the Senate would appoint the other six members. It is required that two of the six must be of the minority party. Thus, the likely result of commission appointment would be an 8-4 partisan majority

Only a simple majority of the commission would be needed for the commission to approve its recommendations and submit legislation. This means that the recommendations could be developed and adopted strictly on a partisan basis. Successful commissions of the past have traditionally operated on a non-partisan basis. Those in favor of the commissions often point out the success of sunset commissions in state governments. However, most state sunset commissions are comprised of elected district representatives, accountable to constituents, unlike the appointed committee members of the proposed federal sunset commissions.

If these two bills were to pass, existing programs and funding could be terminated or severely cut due to proposals put into effect on a purely partisan basis, without any support at any stage of the process from a single member of the minority party. These recommendations can be forced through Congress on a fast track with limited debate and no opportunity for amendment. For this reason, AIDS Action is also joining other healthcare organizations in opposing this legislation. We urge you to ask your Representative to vote “No” on sunset legislation over the August recess!

For more information on the Line Item Veto Act of 2006 and The Sunset Commissions visit www.cbpp.org and www.ombwatch.org

2. AIDS Vaccine Resolution Passed by House
On July 28, 2006 the House approved, 407-0, a resolution (H. Res. 844) congratulating the International AIDS Vaccine Initiative (IAVI) on ten years of significant achievement in the search for an HIV/AIDS vaccine.

In honor of IAVI's 10th anniversary, the House recognized their crucial role in raising awareness and increasing financial and political support for AIDS vaccines and acknowledged IAVI's collaboration with developing country researchers, governments and civil society in finding a vaccine.

House Resolution 844, sponsored by Rep. Eliot Engel (D-NY), states that HIV/AIDS has killed more than 25 million people worldwide and poses a serious threat to the economic and political stability of the countries hit hardest by this terrible epidemic. The resolution applauded IAVI for advancing six vaccine candidates from concept to clinical trials since its founding and expanding countries participating in HIV/AIDS vaccine trials to include countries in sub-Saharan Africa and Asia. According to the resolution, IAVI’s model of the International AIDS Vaccine Initiative, which closely links clinical trial site investigators to product developers, has resulted in the first HIV/AIDS vaccine trials being conducted in Kenya, Rwanda, and India, as well as trials in Uganda and South Africa.

In light of these findings, the resolution: “(1) congratulates the International AIDS Vaccine Initiative on ten years of significant achievement in the search for an HIV/AIDS vaccine, (2) recognizes the role of the International AIDS Vaccine Initiative in raising awareness and increasing financial and political support for this important cause, (3) admires the commitment of the International AIDS Vaccine Initiative to collaborating with developing country researchers, governments, and civil society in the common goal of finding a vaccine, and (4) expresses support for the continued success of the International AIDS Vaccine Initiative.”

IAVI is a global non- profit organization working to accelerate the search for an HIV vaccine. It was founded in 1996 to ensure the development of safe, effective, accessible, preventive HIV/AIDS vaccines. IAVA operates in 23 countries by directing and financing partnerships with more than 30 private companies and academic and government agencies worldwide.

CARE Act in Brief
1. CARE Act Program Guidance Released
On July 28th, the Health Resources Services Administration (HRSA) released “Program Guidance for Fiscal Year 2007” to allow Title I Eligible Metropolitan Areas (EMAs) to apply for Fiscal Year (FY) 2007 Title I funding. The program guidance requires EMAs to switch to HIV (HIV non-AIDS and AIDS cases) as the basis for Title I formula allocation. The guidance appears to allow only states whose data are certified by the Center for Disease Prevention and Control CDC to use their HIV case counts, in effect requiring applicants to use name-based HIV reporting. States which have not yet switched to name based reporting (and therefore have not yet been certified by the CDC) may use their AIDS case counts, but will not be allowed to count HIV cases which they have obtained through non-certified systems. In addition, HRSA currently intends to try to follow the current allocation process as closely as possible. The current formula allocation is based on the estimated number of living cases of AIDS over the previous ten year period. Thus HRSA intends to use HIV (non-AIDS) data from the previous ten years. They will then add estimated living AIDS data which will continue to be derived from the current formula (and which counts recent years more heavily than previous years).

AIDS Action has been told, but has not yet confirmed that similar language will apply to Title II formula allocation. Jurisdictions that have not yet been certified by the CDC and therefore may be ineligible to use HIV cases include: California, Connecticut, Delaware, the District of Columbia, Georgia, Hawaii, Illinois, Kentucky, Maine, Maryland, Massachusetts, Montana, New Hampshire, Oregon, Pennsylvania, Puerto Rico, Rhode Island, Vermont and Washington. EMAs within these states will also be ineligible to use HIV counts for Title I formula allocation.

According to staff at HRSA, the “protection period” provisions from the 2000 CARE Act Amendments will apply to those EMAs that are not eligible to use HIV data. In the first year of the protection period, an EMA may not lose more than 2% of its total funding. In the second through fourth year of a protection period, EMAs would lose 3% of their funding each year and in the fifth year an EMA may lose 4% of its funding. There is also a hold harmless amount of 1% per year for states that would lose funds.

2. Reauthorization Added to Senate Calendar
On August 3, 2006 the Health, Education, Labor, and Pensions (HELP) Committee submitted the “Ryan White HIV/AIDS Treatment Modernization Act” (S. 2823) to the Senate for consideration. The bill had previously passed the committee on a 19-1 vote on May 24th.

The Senate has now placed the reauthorization bill on the Senate’s Legislative Calendar under “General Orders.” General orders simply lists all Senate and House measures placed on the Senate's Legislative Calendar sequenced by order number and eligible for Senate floor consideration. Placing the bill on the Senate Calendar is the normal next step for legislation which has passed committee.

No definite date has been set for a vote by the full Senate. Senate staffers working on the reauthorization confirmed that they currently intend to wait for the Full House Energy and Commerce Committee to hold a markup on the reauthorization bill before they move any legislation forward on the Senate floor.

Announcements
1. US Surgeon General Resigns
U.S. Surgeon General Richard H. Carmona resigned on July 31, 2006 after his four year term expired this weekend, with no announcement from the Department of Health and Human Services (HHS). A letter that he wrote to fellow U.S. Public Health Service Officers declaring his resignation has begun to circulate around Capitol Hill. In this letter Carmona cited several accomplishments of his term, including educating Americans about the importance of preparing for natural and other disasters. He also noted his focus on trying to eliminate health disparities among parts of the population on such diseases as AIDS and diabetes.
There have been no comments at HHS or The White House about a possible successor to Dr. Carmona.

More details can be found here: http://www.washingtonpost.com/wp-dyn/content/article/2006/07/31/AR2006073100974.html.

2. New Members Named to PACHA
On July 27, 2006 the U.S. Department of Health and Human Services (HHS) Secretary Mike Leavitt announced Marilyn Maxwell, M.D. and Alan Holmer J.D. as new co-chairs of the Presidential Advisory Council on HIV/AIDS (PACHA). In addition to naming the council co-chairs, Secretary Leavitt named six new members. New members will join the 14 currently on the council.

Alan Holmer, J.D. has been a member of the Advisory Council since March 16, 2006, serving on PACHA’s International Committee. He is president and CEO, of Holmer Associates LLC. He recently retired as President and Chief Executive Officer of the Pharmaceutical Research and Manufacturers of American (PhRMA) where he spent nearly 10 years leading this organization that represents the interest of leading pharmaceutical and biotechnology companies. Marilyn Maxwell, M.D., is a board-certified pediatrician and internal medicine physician. She is Associate Director of a Combined Internal Medicine/Pediatric Residency Training Program at St. Louis University School of Medicine and is an Associate Professor. She recently served on the Centers for Disease Control and Prevention (CDC) HIV/AIDS Advisory Workgroup. She also provides primary care for patients with HIV/AIDS. Other New PACHA members announced on July 27 include Dr. Freda McKissick Bush, Shenequa Flucas, Robert J. Kabel, Dr. David Malebranche, Dr. John C. Martin, and Barbara Wise.
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The Presidential Council on HIV/AIDS provides recommendations to the President and Secretary of HHS regarding programs and policies intended to anticipate and respond to the world's HIV/AIDS epidemic. Council members serve terms of up to four years and are selected for their expertise in HIV/AIDS and their diverse personal and professional backgrounds.

More details can be found here: http://www.medicalnewstoday.com/medicalnews.php?newsid=48203&nfid=rssfeeds.

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