AIDS Funding for Federal Government Programs: FY1981-FY1999

AIDS Funding for Federal Government Programs: FY1981-FY1999

96-293 SPR
Updated March 31, 1998
CRS Report for Congress
Received through the CRS Web
AIDS Funding for Federal Government Programs:
FY1981-FY1999
Judith A. Johnson
Specialist in Life Sciences
Science Policy Research Division
Summary
This report provides a synopsis of the budget activity related to AIDS from the
discovery of the disease in 1981 through FY1999. Funding for AIDS research,
prevention and treatment programs within the Department of Health and Human Services
(HHS) discretionary budget has increased from $200,000 in FY1981 to an estimated
$3.85 billion in FY1999.
Background
Acquired immune deficiency syndrome (AIDS) impairs the immune system and leaves
affected individuals susceptible to Figure 1: HHS Funding for AIDS, FY1999
certain opportunistic infections and
CDC
cancer. Since 1981, over 600,000
9%
AIDS cases have been reported to the
NIH
HRSA
23%
Centers for Disease Control and
18%
Prevention (CDC). The vast majority
of federal AIDS research, prevention
Other HHS
2%
and treatment programs are
administered by four HHS agencies:
HCFA-Medicare
CDC; the National Institutes of
20%
HCFA-Medicaid
Health (NIH); the Health Resources
28%
and Services Administration (HRSA);
Other HHS: FDA, SAMHSA, AHCPR, OS, and IHS; see Table 3.
and the Health Care Financing
Administration (HCFA), which manages Medicaid and Medicare. AIDS programs within
HHS account for over 75% of the total amount spent on AIDS by the federal government
(see figure 2). Government-wide AIDS spending is estimated at $9.67 billion in FY1999.
NIH is the principal agency of the federal government charged with the conduct and
support of biomedical and behavioral research. NIH conducts research at its own 20
Congressional Research Service ˜ The Library of Congress

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institutes and centers and
Figure 2: HIV/AIDS, FY1999
supports over 50,000 scientists
Total Federal Government Spending
at 1,700 U.S. institutions. For
FY1998, NIH is allocating a
HHS Entitlement 37%
(Medicaid & Medicare)
total of $1.61 billion for AIDS
research, or 12% of the $13.6
billion total NIH budget.
Funding for research on AIDS
Other Federal 2%
in FY1998 is second only to the
HUD 2%
National Cancer Institute ($2.3
HHS Discretionary 40%
OPM-FEHB 3%
(NIH, HRSA, CDC, FDA,
Veterans 4%
billion non-AIDS funds) and SAMHSA, AHCPR, OS, IHS)
more than that for the next
Social Security 12%
highest funded institute, the
National Heart, Lung, and
OPM-FEHB: Office of Personnel Management-Federal Employees Health
Blood Institute ($1.5 billion
Benefits; HUD: Department of Housing and Urban Development . See Tables 4
non-AIDS funds).
and 5.
The President's FY1999 request of $1.73 billion for AIDS research at NIH is an
increase of $124 million or 7.7% over the FY1998 level. The FY1999 includes all NIH
AIDS funds in a single account for the Office of AIDS Research (OAR). This is consistent
with provisions in the NIH Revitalization Act of 1993 (P.L. 103-43) which gave OAR the
overall responsibility to plan, coordinate, evaluate and fund the AIDS research program
at NIH. Although for FY1995 NIH AIDS research funds were appropriated to OAR, in
subsequent fiscal years the funding mechanism for NIH AIDS research has been
contentious. FY1996 AIDS funds bypassed OAR and went directly to each NIH institute
as specified in a continuing resolution (P.L. 104-91). The House rejected a separate OAR
account in order "to enhance NIH's flexibility to allocate funding based on scientific
opportunity." For FY1997, the House again did not provide a separate appropriation for
OAR; funding for NIH was provided in an omnibus bill (P.L. 104-208). The conference
report (H.Rept. 104-863) stated that AIDS funding was "included within the appropriation
for each institute ... as proposed by the House." However, a compromise was reached in
that the conference report "directs that the funding for AIDS research as determined by
the Directors of NIH and OAR be allocated directly to OAR for distribution to the
institutes consistent with the AIDS research plan."
The heated debate over allocating NIH funds among various diseases received
increased scrutiny during the 105th Congress. House and Senate hearings were held in the
spring and summer of 1997 on how NIH determines its research priorities. NIH contends
that decisions are made based on scientific opportunity. Critics charge that NIH spending
often follows current politics and political correctness, responding to media attention
focused on diseases such as AIDS and breast cancer (see CRS Report 97-917, Disease
Funding and NIH Priority Setting).
HRSA administers the Ryan White CARE Act (P.L. 101-381; P.L. 104-146), a four-
part federal grant program designed to provide emergency relief and essential health care
services to AIDS patients and persons infected with the human immunodeficiency virus
(HIV). Funding in FY1998 is $1.16 billion. The Administration's request for FY1999 is
$1.32 billion, an increase of $165 million or 14% over FY1998. A total of $385.5 million
is requested for the AIDS Drug Assistance Program (ADAP) in Title II of Ryan White,
a $100 million or 35% increase over FY1998. The increase will ensure that patients have

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access to combination drug therapy. For the remaining non-ADAP Ryan White activities,
a total of $930 million was requested for FY1999, a $65 million increase over FY1998.
Table 1: HRSA HIV/AIDS Funding ($ in thousands)
FY1997
FY1998
FY1999
Ryan White
-Title I
$449,772
$464,800
$489,800
-Title II
416,954
543,000
670,000
-Title III
69,739
76,300
86,300
-Title IV
36,000
41,000
44,000
-Other Ryan White
23,787
25,100
25,100
Subtotal, Ryan White
996,252
1,150,200
1,315,200
Other HRSA
4,996
4,996
4,996
Total, HRSA
$1,001,248
$1,155,196
$1,320,196
Source: HHS Budget Office, March 1998.
CDC works with community, state, national, and international public health agencies
to prevent HIV infection and reduce AIDS-associated morbidity and mortality through its
information and education programs. CDC also supports research, surveillance, and
epidemiology studies on HIV/AIDS. Funding in FY1998 for CDC's AIDS activities is
$634 million. The Administration's request level for FY1999 is $642 million. The FY1999
total consists of $631.8 million for CDC's HIV prevention program (a decrease of $2.5
million below the FY1998 appropriation, reflecting savings from the Office of the Director
operations) and a $10 million increase to expand HIV/STD (sexually transmitted disease)
efforts.
Table 2: HHS Discretionary Funding for HIV/AIDS
($ in thousands)
Funding
$ Increase Over
% Increase Over
Prior Year
Prior Year
FY1981
$200
---
---
FY1982
5,555
$5,355
2,678%
FY1983
28,736
23,181
417%
FY1984
61,460
32,724
114%
FY1985
108,618
47,158
77%
FY1986
233,793
125,175
115%
FY1987
502,455
268,662
115%
FY1988
962,018
459,563
94%
FY1989
1,304,012
341,994
36%
FY1990
1,592,756
288,744
22%
FY1991
1,891,232
298,476
19%
FY1992
1,963,414
72,182
4%
FY1993
2,079,591
116,639
6%
FY1994
2,568,682
489,091
24%
FY1995
2,700,498
131,816
5%
FY1996
2,897,923
197,425
7%
FY1997
3,267,220
369,297
13%
FY1998 est.
3,547,838
280,618
9%
FY1999 est.
3,852,354
304,516
9%
Source: HHS budget office, March 1998.

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Table 3: HHS Discretionary Funding for HIV/AIDS, by Agency ($ in thousands)
Agency
FY1991
FY1992
FY1993
FY1994
FY1995
FY1996
FY1997
FY1998*
FY1999*
NIH
$807,465
$1,047,456
$1,071,457
$1,296,471
$1,333,875
$1,410,926
$1,501,073
$1,607,053
$1,730,796
CDC
496,960
479,620
498,253
543,253
589,831
584,080
616,790
634,266
641,779
ADAMHA
236,504
---
---
---
---
---
---
---
---
SAMHSA
---
26,025
25,655
27,320
24,095
54,201
63,857
70,125
77,826
FDA
63,395
72,302
72,628
72,399
72,745
72,745
72,745
72,745
72,745
HRSA
265,915
316,912
390,341
607,796
661,185
762,398
1,001,248
1,155,196
1,320,196
AHCPR
10,252
10,135
9,624
10,624
9,084
6,343
4,192
1,100
1,500
OASH
5,938
4,794
5,330
5,263
4,071
---
---
---
---
OS
3,000
3,000
3,000
2,000
1,975
3,754
3,811
3,813
3,972
IHS
1,803
3,170
3,303
3,556
3,637
3,476
3,503
3,540
3,540
TOTAL
$1,891,232
$1,963,414
$2,079,591
$2,568,682
$2,700,498
$2,897,923
$3,267,220
$3,547,838
$3,852,354
Source: HHS budget office,March 1998.
*FY1998 and FY199 are estimates.
NIH: National Institutes of Health
CDC: Centers for Disease Control and Prevention
ADAMHA: Alcohol, Drug Abuse, and Mental Health Administration (abolished in FY1992; activities divided between NIH and SAMHSA.)
SAMHSA: Substance Abuse and Mental Health Services Administration (established in FY1992, activities formerly part of ADAMHA.)
FDA: Food and Drug Administration
HRSA: Health Resources and Services Administration
AHCPR: Agency for Health Care Policy and Research (established in 1990, formerly in OASH)
OASH: Office of the Assistant Secretary for Health (abolished in FY1996; activities now under OS)
OS: Office of the Secretary (AIDS programs in Office for Civil Rights, Office of Minority Health, and National AIDS Program Office)
IHS: Indian Health Service

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Table 4: Total Federal Government Spending on HIV/AIDS by Function ($ in millions)
FY1997
FY1998
FY1999
Income
Income
Income
Agency/Department
Research
Prevent
Treatmt
Support
Total
Research
Prevent
Treatmt
Support
Total
Research
Prevent
Treatmt
Support
Total
HHS Discretionary
$1,702
$522
$1,044
$0
$3,267
$1,806
$541
$1,200
$0
$3,548
$1,929
$544
$1,374
$0
$3,847
-HCFA/Medicaid
--
--
1,800
--
1,800
--
--
1,900
--
1,900
--
--
2,100
--
2,100
-HCFA/Medicare
--
--
1,300
--
1,300
--
--
1,400
--
1,400
--
--
1,500
--
1,500
Subtotal, HHS
$1,702
$522
$4,144
$0
$6,367
$1,806
$541
$4,500
$0
$6,848
$1,929
$544
$4,974
$0
$7,447
Other:
Social Security - DI
--
--
--
$691
$691
--
--
--
$726
$726
--
--
--
$776
$776
Social Security - SSI
--
--
--
310
310
--
--
--
335
335
--
--
--
360
360
Veterans Affairs
6
31
295
--
332
6
31
306
--
343
6
31
321
--
358
Defense Dept.
22
12
66
--
100
24
13
68
--
105
25
13
69
--
107
Agency for Int. Dev.
--
117
--
--
117
--
121
--
--
121
--
121
--
--
121
Justice Dept.
-Bureau of Prisons
--
1
6
--
7
--
1
7
--
8
--
1
8
--
9
State Department
--
--
--
--
--
--
--
--
--
0
--
--
--
--
--
Labor Department
--
2
--
--
2
--
1
--
--
1
--
1
--
--
1
Education Dept.
--
--
--
--
--
--
--
--
--
0
--
--
--
--
--
Housing & Urban Dev.
--
--
--
196
196
--
--
--
204
204
--
--
--
225
225
OPM-FEHB
-
--
241
--
241
--
--
253
--
253
--
--
266
--
266
Subtotal, Other
$28
$163
$608
$1,197
$1,996
$30
$167
$634
$1,265
$2,096
$31
$167
$664
$1,361
$2,223
TOTAL
$1,730
$685
$4,752
$1,197
$8,363
$1,836
$708
$5,134
$1,265
$8,944
$1,960
$711
$5,638
$1,361
$9,670
Chg from Previous Yr
$77
$50
$665
$86
$876
$106
$24
$382
$68
$581
$124
$3
$504
$96
$727
% Chg from Prev Yr
5%
8%
16%
8%
12%
6%
3%
8%
6%
7%
7%
0%
10%
8%
8%
Source: HHS budget office, Mar. 30, 1998. FY1998 and FY1999 are estimates. HHS: Department of Health and Human Services; HCFA: Health Care Financing Administration; DI: Disability Insurance; SSI: Supplemental Security
Income; OPM-FEHB: Office of Personnel Management-Federal Employees Health Benefits.

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Table 5: Government-wide Spending on HIV/AIDS ($ in millions)
Dept./Agency
FY83
FY84
FY85
FY86
FY87
FY88
FY89
FY90
FY91
FY92
FY93
FY94
FY95
FY96
FY97
FY98
FY99
HHS
-Discretionary
$29
$60
$109
$234
$502
$962
$1,304
$1,593
$1,891
$1,963
$2,080
$2,569
$2,701
$2,898
$3,267
$3548
$3,847
-HCFA
--Medicaid
10
30
70
130
200
330
490
670
870
1,080
1,290
1,490
1,640
1,600
1,800
1,900
2,100
--Medicare
0
0
5
5
15
30
55
110
180
280
385
500
600
1,100
1,300
1,400
1,500
SS
-DI
0
5
10
30
55
95
150
215
305
415
515
585
640
696
691
726
776
-SSI
0
1
3
5
15
20
35
55
95
150
200
240
300
280
310
335
360
VA
5
7
8
20
51
78
136
220
258
279
299
312
317
331
332
343
358
Defense
0
0
0
79
74
53
86
125
127
129
159
129
112
98
100
105
107
AID
0
0
0
0
0
30
40
71
78
94
117
115
120
115
117
121
121
DoJ-Prisons
0
0
0
0
1
1
2
5
5
5
5
6
6
6
7
8
9
State
0
0
0
0
0
0
1
1
1
1
1
1
1
0
0
0
0
Labor
0
0
0
0
1
1
1
1
1
1
1
1
1
1
2
1
1
HUD
0
0
0
0
0
1
0
0
0
48
100
156
171
171
196
204
225
OPM-FEHB
0
0
0
5
8
13
22
37
61
103
175
193
212
226
241
253
266
Education
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
TOTAL
$44
$103
$205
$508
$922
$1,615
$2,322
$3,103
$3,872
$4,548
$5,327
$6,297
$6,821
$7,522
$8363
$8944
$9670
Source: HHS budget office, Mar. 1998. FY98 and FY99 are estimates. May not add due to rounding. In FY82, AIDS spending was $8 million: $6 million HHS discretionary and $2 million VA.
HHS:
Department of Health and Human Services; Discretionary AIDS budget
HCFA
Health Care Financing Administration
SS:
Social Security
DI:
Disability Insurance
SSI:
Supplemental Security Income
VA:
Veterans Affairs
AID:
Agency for International Development
DoJ-Prisons:
Department of Justice, Bureau of Prisons
HUD:
Department of Housing and Urban Development
OPM-FEHB:
Office of Personnel Management-Federal Employees Health Benefits