BILL ANALYSIS
AJR 9
Page 1
ASSEMBLY THIRD READING
AJR 9 (John A. Perez)
As Amended April 14, 2009
Majority vote
HEALTH 19-0
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|Ayes:|Jones, Fletcher, Adams, Ammiano, |
| |Block, Carter, Conway, De La |
| |Torre, De Leon, Emmerson, |
| |Gaines, Hall, Hayashi, |
| |Hernandez, Bonnie Lowenthal, |
| |Nava, V. Manuel Perez, Salas, |
| |Audra Strickland |
| | |
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SUMMARY : Urges the United States (U.S.) Congress and President
to enact legislation to extend, from September 30, 2009 to
September 30, 2012, the sunset of the Ryan White HIV/AIDS
Treatment Modernization Act of 2006 (Ryan White Act), including
the existing formula-based funding for states with maturing
names-based HIV reporting systems.
EXISTING FEDERAL LAW establishes the Ryan White Act,
administered by the U.S. Department of Health and Human
Services, Health Resources and Services Administration (HRSA) to
provide HIV/AIDS care for those who do not have sufficient
health care coverage or financial resources for coping with HIV
disease. The Ryan White Act provides funding through states,
localities, and providers for primary health care, drugs, and
support services.
EXISTING STATE LAW requires health care providers and clinical
laboratories to report cases of HIV infection to local health
officers (LHOs) using patient names, and requires LHOs to report
unduplicated HIV cases by name to the Department of Public
Health (DPH).
FISCAL EFFECT : None
COMMENTS : According to the author, this bill is needed to
protect funding for California; preserve existing systems of
treatment, care and other vital services for people living with
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HIV/AIDS; and, ensure that California and other states have
sufficient time to mature their names-based HIV reporting
systems. The author states the Ryan White Act currently
requires the use of names-based HIV data to determine the
allocation formula for funding to states and certain local
jurisdictions, but also includes exceptions to the names-based
HIV data requirement for states with immature HIV data systems.
California did not institute a names-based system of HIV data
collection until 2006, and currently does not have a fully
mature names-based data system. The author states that without
the protections that exist in the Ryan White Act for states that
do not have fully matured names-based HIV data systems,
California could suffer a substantial reduction in formula
funding which could devastate established treatment, care, and
support systems throughout the state.
The Ryan White Act was first enacted by Congress in 1990 and has
been reauthorized three times to improve the quality and
availability of care for low-income, uninsured, and underinsured
individuals and families affected by HIV. The federal
government provides over $2.1 billion annually for Ryan White
Act programs, which provide primary medical care, pharmaceutical
treatments, and support services for over 500,000 Americans
living with HIV disease who would otherwise not have access to
these services.
The Ryan White Act requires states to have name-based HIV data
which the secretary of HHS has certified are accurate and
reliable for determining the number of people living with HIV.
Ryan White Act funding for states and metropolitan areas is
formula-based and depends on how many people in an area have
HIV. In the most recent reauthorization of the Ryan White Act,
states with names-based reporting systems that are not yet
mature, such as California, are allowed to submit HIV data to
HRSA, but incur a 5% penalty on funds for states and
metropolitan areas. California's federal fiscal year 2007-08
allocation of state funds was approximately $122 million. DPH
estimates allocations to local governments and community-based
organizations at $111 million, for a combined total exceeding
$230 million for California through the Ryan White Act in fiscal
year 2007-08.
Numerous private HIV/AIDS advocacy organizations and the City of
Los Angeles AIDS Coordinator's Office write in support that the
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Ryan White Work Group and other groups are advocating an
extension of the existing law rather than going through the
cumbersome process of new legislation. These supporters write
that extending the Ryan White Act would free up time and energy
in Washington for developing a comprehensive national AIDS
strategy and health care reform, and most importantly, that an
extension will give California more time to mature its
names-based HIV case reporting system. The County of Los
Angeles (County) writes that it supports this bill because an
extension of the Ryan White Act will preserve and possibly
increase funding for the County, as well as allow the County to
continue to develop HIV data over the next three years, which
would maximize the County's competitiveness for Ryan White Act
funding.
The AIDS Healthcare Foundation (AHF), which is based in Los
Angeles and states it is the nation's largest provider of
HIV/AIDS medical care, writes that it wholeheartedly agrees with
the objective of extending the Ryan White Act while California's
names-based reporting system matures so that California can
receive its fair share of funding under a new formula. However,
AHF objects to extending the Ryan White Act without changes that
would improve control of the HIV/AIDS epidemic. AHF is
concerned with funding equity within and among states and that
the Ryan White Act does not go far enough to provide a practical
means for California and other states to normalize HIV care,
routinize HIV screening, and improve linkages to care. AHF
states it would support this bill if its message to Congress
were solely pertinent to delaying a names-based funding
allocation formula, and suggests that the author amend this bill
to simply urge the U.S. Congress to include a deferral of the
new funding formula in any reauthorization of the Ryan White
Act.
Previous legislation: SB 1184 (Kuehl) Chapter 347, Statutes of
2008, requires clinical laboratories to report all CD4 test
results to the LHO, and if the CD4 test is related to an HIV
infection, requires the LHO to report the infection to DPH. SB
1184 was intended to make HIV/AIDS reporting and data more
complete. SB 699 (Soto), Chapter 20, Statutes of 2005, requires
HIV cases to be reported to the LHO by name rather than by code
and requires LHOs to report HIV cases by name to DPH.
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Analysis Prepared by : Allegra Kim / HEALTH / (916) 319-2097
FN: 0000308