RYAN WHITE CARE ACT: Coburn Criticizes Fund Distribution
In announcing his plans to revamp the Ryan White CARE Act, Rep. Tom Coburn (R-Okla.) yesterday released a General Accounting Office report and said that rural areas, women and minorities are shortchanged in the amount of CARE Act funding they receive (Myers, Tulsa World, 3/23). According to the report, three-quarters of those who benefit from the CARE Act are men, while women and minorities, who account for an increasing number of AIDS cases, "generally receive less appropriate health care for their disease when assessed in terms of physical visits, emergency room visits, hospitalizations and antiretroviral and prophylactic drug therapies." Additionally, when compared to whites, African Americans and Hispanics received "less appropriate care." Urban areas also received higher funding per AIDS case than did rural areas, which therefore "may offer more limited medical and social services" (Coburn summary, 3/23). Phoenix, for example, received $3,133 for each of 1,670 AIDS patients in 1997, while areas around the city received $1,000 less per patient for 760 AIDS patients. Detroit received $3,296 for each of 2,765 AIDS patients, compared to $2,170 each for 1,285 patients in the rest of Michigan. Although the government provides more funding for AIDS cases in urban areas, the number of rural AIDS cases is on the rise; rural AIDS cases accounted for 7.2% of all AIDS cases, a 5.4% increase since 1993 (Gullo, Associated Press, 3/23). Coburn said, "Because of the built-in funding disparities, those living with HIV/AIDS in rural America have limited medical and social services and often times may have to travel to urban areas to receive proper care. ... Geography should not determine a patient's fate" (Coburn release, 3/23).
The Ryan White CARE Act should be refocused to concentrate on prevention rather than treatment, Coburn also said yesterday, as he announced his intention to make "sweeping changes" in this year's CARE Act reauthorization, CongressDaily/A.M. reports. Coburn lamented that the federal government spends an estimated $10 billion annually to treat HIV/AIDS, but allocates only about 10% of that amount for prevention efforts. He said, "In any epidemic, the most important thing is to prevent the next person from getting it" (Rovner, 3/24). Coburn added, "If the best care is prevention, our current federal prevention program is guilty of malpractice" (Tulsa World, 3/23). Coburn also criticized the CARE Act's funding method, which doles out monies based upon the number of AIDS cases, not HIV cases, which "tends to disadvantage women and minorities." He said, "If you base it just on AIDS, you're looking at the epidemic seven to 10 years ago." Because of that distribution method, Coburn asserted that in Oklahoma, "someone has to die before they can access lifesaving medications, while in New York City, federal funds are used for special services such as dog walking and art classes in addition to care" (CongressDaily/A.M., 3/24). Coburn added that because of the AIDS-only focus results, "states and cities with relatively new epidemics [do not receive] the federal support they need" (Health News Daily, 3/24). In the next several weeks, Coburn plans to make his proposals public, focusing on education and other prevention- related programs, as well as increased funding to provide AIDS drugs to those with HIV and for treating IV drug users (CongressDaily/A.M., 3/24). Coburn's legislation also would require all states to implement HIV surveillance and conduct partner notification by 2003 (Health News Daily, 3/24).
Coburn also had requested that the GAO investigate allegations of abuse and misuse of CARE Act funds, and the inquiry turned up three cases. In San Juan, Puerto Rico, 12 individuals were indicted for conspiring to commit fraud by transferring more than $2.2 million from the city to a private corporation. The Western North Carolina AIDS Project was found to have misappropriated a CARE Act-funded educational position and overstated reports of individuals receiving educational assistance. In Florida, a Central Florida AIDS Unified Resources Inc. bookkeeper was arrested for allegedly embezzling more than $200,000 in funds (GAO briefing paper).