Federal Funding for AIDS Research and Education

Order Code I887028 FEDERAL FUNDING FOR AIDS RESEARCH A N D EDUCATION U p d a t e d A p r i l 1, 1 9 8 8 by P a m e l a W. S m i t h and J i l l T. S v e r d l o f f Science Policy Research Division Congressional Research Service CONTENTS SUMMARY ISSUE DEFINITION BACKGROUND AND ANALYSI S FY81 FY82 FY83 FY84 FY85 FY86 FY87 Budget Budget Budget Budget Budget Budget Budget FY88 B u d g e t FY89 B u d g e t LEGISLATION FOR ADD1 T I ONAL READ1 NC APPENDIX Table Table Table Table 1. 2. 3. 4. F e d e r a l F u n d i n g f o r AIDS R e s e a r c h a n d E d u c a t i o n N I H E x p e n d i t u r e s f o r AIDS R e s e a r c h F u n c t i o n a l Breakdown o f PHs S p e n d i n g on AIDS G o v e r n m e n t - w i d e S p e n d i n g on AIDS FEDERAL FUNDING FOR AIDS RESEARCH AND EDUCATION F e d e r a l f u n d i n g f o r AIDS r e s e a r c h and e d u c a t i o n h a s i n c r e a s e d from Congress f i r s t a p p r o p r i a t e d $200,000 i n FY81 t o $951,039,000 i n FY88. money f o r AIDS r e s e a r c h i n FY83. I n each f i s c a l y e a r s i n c e t h e n , C o n g r e s s h a s i n c r e a s e d t h e b u d g e t f o r AIDS r e s e a r c h and e d u c a t i o n by 76% t o 115% o v e r t h e p r e v i o u s y e a r . The FY88 c o n t i n u i n g r e s o l u t i o n a p p r o p r i a t e d $951,039,000 f o r AIDS, an 89% i n c r e a s e o v e r t h e FY87 f i g u r e of $502,455,000. The P r e s i d e n t ' s FY89 budget r e q u e s t p r o p o s e s a c o n s o l i d a t e d a c c o u n t f o r AIDS w i t h i n t h e O f f i c e of t h e A s s i s t a n t S e c r e t a r y f o r H e a l t h , w i t h f u n d i n g o f $ 1 , 3 0 0 , 0 0 0 , 0 0 0 , a 37% i n c r e a s e o v e r FY88. ISSUE DEFINITION AIDS i s a newly o b s e r v e d m e d i c a l syndrome which i m p a i r s t h e immune s y s t e m and l e a v e s a f f e c t e d i n d i v i d u a l s s u s c e p t i b l e t o c e r t a i n t y p e s of c a n c e r and a number of o p p o r t u n i s t i c i n f e c t i o n s . A s o f l a t e March 1988, o v e r 57,000 AIDS c a s e s had been r e p o r t e d t o t h e C e n t e r s f o r D i s e a s e C o n t r o l (CDC). A g e n c i e s o f t h e U.S. P u b l i c H e a l t h S e r v i c e s u p p o r t a wide v a r i e t y of a c t i v i t i e s i n AIDS r e s e a r c h , e d u c a t i o n , and h e a l t h c a r e . This i s s u e b r i e f p r o v i d e s a s y n o p s i s of t h e budget a c t i v i t y r e l a t i n g t o AIDS s i n c e t h e d i s c o v e r y o f t h e d i s e a s e i n 1981. [ F o r f u r t h e r i n f o r m a t i o n on AIDS, s e e CRS I s s u e B r i e f 87150.1 BACKGROUND AND ANALY S I S FY81 Budget D u r i n g FY81, t h e C e n t e r s f o r D i s e a s e C o n t r o l (CDC) s p e n t $208,000 on A 1 DS . FY82 Budget D u r i n g FY82, CDC s p e n t $2,050,000; t h e Food and Drug A d m i n i s t r a t i o n (FDA), $150,000; and t h e N a t i o n a l I n s t i t u t e s of H e a l t h (NIH), $ 3 , 3 5 5 , 0 0 0 -- f o r a P u b l i c H e a l t h S e r v i c e (PHs) t o t a l o f $5,555,000. FY83 Budget D u r i n g f l o o r d e b a t e on t h e FY83 a p p r o p r i a t i o n s b i l l f o r t h e D e p a r t m e n t s o f L a b o r , H e a l t h and Human S e r v i c e s (HHS), E d u c a t i o n , a n d R e l a t e d A g e n c i e s (H.R. 72051, t h e House added $2.6 m i l l i o n s p e c i f i c a l l y t o Although H.R. 7205 was n o t f i n a l l y e n a c t e d s u p p o r t AIDS r e s e a r c h a t CDC. by C o n g r e s s , $2 m i l l i o n was s p e c i f i e d f o r AIDS r e s e a r c h a t CDC i n t h e c o n t i n u i n g r e s o l u t i o n f o r FY83 a p p r o p r i a t i o n s (H.J.Res. 6311, which was e n a c t e d on Dec. 2 1 , 1982 (P.L. 97-377). On J u l y 30, 1983, a n FY83 s u p p l e m e n t a l a p p r o p r i a t i o n s b i l l , H.R. 3069, was s i g n e d i n t o l a w , P.L. The law p r o v i d e d a n e x t r a $12.6 m i l l i o n f o r AIDS 98-63, by t h e P r e s i d e n t . research. Of t h e $12.6 m i l l i o n , t h e CDC r e c e i v e d $2.23 m i l l i o n ; N I H r e c e i v e d a p p r o x i m a t e l y $9 m i l l i o n ; and t h e A l c o h o l , Drug Abuse, and Mental H e a l t h A d m i n i s t r a t i o n (ADAMHA) r e c e i v e d $400,000. The CDC s p e n t $ 6 , 2 0 2 , 0 0 0 f o r AIDS r e s e a r c h i n FY83; NIH, $21,668,000; FDA, $350,000; and ADAMHA, $516,000 -- f o r a PHS t o t a l of $28,736,000. FY84 Budget I n August 1983, DHHS S e c r e t a r y H e c k l e r announced a r e v i s e d FY84 budget o f $39.8 m i l l i o n f o r f u n d i n g r e s e a r c h on AIDS. The Reagan A d m i n i s t r a t i o n ' s o r i g i n a l FY84 budget s o u g h t $17.6 m i l l i o n f o r AIDS r e s e a r c h , o f which NIH would have r e c e i v e d a b o u t $12.5 m i l l i o n ; FDA, The a d d i t i o n a l $22.2 $ 4 0 0 , 0 0 0 ; ADAMHA, $500,000; and C D C , $4.3 m i l l i o n . IB87028 CRS- 3 04-0 1-88 m i l l i o n o v e r t h e o r i g i n a l $17.6 m i l l i o n r e q u e s t would be t r a n s f e r r e d from t h e a c c o u n t s of t h e N a t i o n a l H e a l t h S e r v i c e s Corps f i e l d program ($12.5 m i l 1i o n ) a n d t h e R u r a l Development Loan program ($9.7 m i l l i o n ) , [Washington ~ e ~ o on r t H e a l t h L e g i s l a t i o n , Aug. 3 1 , 1983.1 Of t h e $22.2 m i l l i o n , CDC would r e c e i v e $7.3 m i l l i o n and N I H $14.9 m i l l i o n . On S e p t . 22, 1 9 8 3 , t h e H o u s e p a s s e d H.R. 3913, t h e FY84 a p p r o p r i a t i o n s b i l l f o r t h e Departments o f L a b o r , HHS, E d u c a t i o n , and r e l a t e d a g e n c i e s . The b i l l c o n t a i n e d $41 m i l l i o n f o r AIDS r e s e a r c h : $29.2 m i l l i o n f o r N I H , $11.36 m i l l i o n f o r CDC, and $500,000 f o r ADAMHA. On O c t , The S e n a t e v e r s i o n p r o v i d e d $41.6 4 , 1 9 8 3 , t h e S e n a t e p a s s e d H.R. 3913. m i l l i o n f o r AIDS r e s e a r c h i n FY84 and t h e f u l l a u t h o r i z a t i o n o f $30 m i l l i o n f o r t h e P u b l i c H e a l t h Emergency Fund (H.R. 2713, P.L. 98-49). Both House and S e n a t e a g r e e d t o t h e c o n f e r e n c e r e p o r t (H.Rept. 98-422) on Oct. 2 0 , 1983, which p r o v i d e d f u n d s f o r AIDS r e s e a r c h b u t n o t f o r t h e P u b l i c H e a l t h Emergency Fund. H.R. 3913 was s i g n e d i n t o law on O c t . 3 1 , 1983 (P.L. 98-139). 1, 1984, t h e House p a s s e d H.R. 6040, a s u p p l e m e n t a l On Aug. a p p r o p r i a t i o n s b i l l f o r FY84. According t o t h e House r e p o r t (H.Rept. 98-916), t h e b i l l c o n t a i n e d $8,300,000 f o r AIDS r e s e a r c h : $1,750,000 f o r CDC; and $6,550,000 f o r N I H . On Aug. 8 , 1984, t h e S e n a t e p a s s e d H.R. 6040. ~ c c o r d i n g t o t h e S e n a t e r e p o r t (H.Rept. 98-5701, t h e Senate v e r s i o n o f t h e b i l l c o n t a i n e d $10,925,000 f o r AIDS r e s e a r c h : $3,200,000 f o r CDC; $ 6 , 5 5 0 , 0 0 0 f o r N I H ; and $1,175,000 f o r ADAMHA. Both t h e House and t h e S e n a t e a g r e e d t o t h e c o n f e r e n c e r e p o r t (H.Rept. 98-977) on Aug. 1 0 , 1 9 8 4 , which p r o v i d e d f u n d s f o r AIDS r e s e a r c h a s f o l l o w s : $1,750,000 [Congressional f o r CDC; $6,550,000 f o r N I H ; and $1,175,000 f o r ADAMHA. H.R. 6040 was s i g n e d i n t o law on Aug. Record Aug. 1 0 , 1984, p. H8951.1 22, 1984 (P.L. 98-396). According t o PHs, CDC s p e n t $13,750,000; N I H , $ 4 4 , 1 2 1 , 0 0 0 ; FDA, $798,000; and ADAMHA, $2,791,000 f o r a PHs t o t a l of $61,460,000 i n FY84. -- FY85 Budget The Reagan ~ d m i n i s t r a t i o n ' s proposed FY85 budget f o r r e s e a r c h on AIDS was a s f o l l o w s : CDC, $12,020,000; NIH, $40,316,000; FDA, $475,000; and f o r a PHs t o t a l o f $54,092,000. Because of c h e ADAMHA, $1,281,000 d i s c o v e r i e s by N C I and o t h e r s on a p o s s i b l e AIDS v i r u s (HTLV-1111, t h e A d m i n i s t r a t i o n p l a n n e d t o r e v i s e t h e FY84 and FY85 f i g u r e s t o r e f l e c t e f f o r t s aimed a t d e v e l o p i n g a blood s c r e e n i n g method ( f o r e a r l y d e t e c t i o n of AIDS and f o r b l o o d d o n a t i o n p u r p o s e s ) and a v a c c i n e . -- The House p a s s e d H.R. 6028 (H.Rept. 98-911), t h e FY85 a p p r o p r i a t i o n b i l l f o r t h e D e p a r t m e n t s o f L a b o r , HHS, E d u c a t i o n and r e l a t e d a g e n c i e s on Aug. 1, 1984. Both t h e House and t h e S e n a t e a g r e e d t o t h e c o n f e r e n c e r e p o r t (H.Rept. 98-1132) f o r H.R. 6028 on O c t . 1 0 , 1984. The c o n f e r e n c e r e p o r t i n d i c a t e s t h a t "$84 m i l l i o n f o r r e s e a r c h on AIDS" i n FY85 was 6028. [ C o n g r e s s i o n a l Record, O c t . 1 0 , 1984, p. a p p r o p r i a t e d by H.R. H11800.1 A c c o r d i n g t o PHs, t h e FY85 f u n d s would be a l l o c a t e d a s f o l l o w s : CDC, $ 1 8 , 7 0 0 , 0 0 0 ; N I H , $62,589,000; and ADAMHA, $ 2 , 8 1 2 , 0 0 0 for a total of $ 8 4 , 1 0 1 , 0 0 0 . H.R. 6028 was s i g n e d i n t o law on Nov. 8 , 1984 (P.L. 98-6 19 ) -- . I n a d d i t i o n , FDA would have a c c e s s t o $8.350 m i l l i o n f o r AIDS r e s e a r c h i n FY85, a s p r o v i d e d by H.J.Res. 648 (H.Rept. 98-1159, p . 4 1 1 ) . H.J.Res. 648 was s i g n e d i n t o law on O c t . 1 2 , 1984 (P.L. 98-473). As o f J u l y 1 8 , 1 9 8 5 , PHs i n d i c a t e d t h a t t h e f o l l o w i n g amounts w e r e b e i n g s p e n t CDC, $23,200,000; NIH, on AIDS r e s e a r c h i n FY85: FDA, $8,825,000; $ 6 1 , 2 6 1 , 0 0 0 ; ADAMHA, $ 2 , 8 1 2 , 0 0 0 f o r a PHS t o t a l o f $96,098,000. -- On J u l y 1 9 , 1985, HHS S e c r e t a r y M a r g a r e t M. H e c k l e r s e n t a memorandum t o House A p p r o p r i a t i o n s Committee Chairman W h i t t e n i n d i c a t i n g t h a t HHS i n t e n d e d t o r e d i r e c t FY85 HHS f u n d s i n o r d e r t o spend t h e f o l l o w i n g amounts on AIDS: FDA, $9,005,000; CDC, $33,231,000; N I H , $63,482,000; ADAMHA, $ 3 , 2 4 2 , 0 0 0 f o r a PHs t o t a l of $108,960,000. Actual funding f o r AIDS r e s e a r c h was a s f o l l o w s : FDA, $9,005,000; CDC, $ 3 3 , 2 9 8 , 0 0 0 ; N I H , $63,737,000; and ADAMHA, $2,578,000 f o r a PHs t o t a l o f $108,618,000 i n FY85. -- -- (The S e n a t e a l s o had a n FY85 a p p r o p r i a t i o n s b i l l , S. 2836, f o r t h e D e p a r t m e n t s o f L a b o r , HHS, E d u c a t i o n and r e l a t e d a g e n c i e s , which was r e p o r t e d (S.Rept. 98-544) on J u n e 2 9 , 1984.) FY86 Budget T h e Reagan ~ d r n i n i s t r a t i o n ' s o r i g i n a l proposed FY86 budget f o r r e s e a r c h on AIDS was a s f o l l o w s : FDA, $ 3 , 7 2 5 , 0 0 0 ; CDC, $ 1 8 , 7 2 0 , 0 0 0 ; NIB, $60,316,000; and ADAMHA, $ 2 , 8 2 3 , 0 0 0 , f o r a PHs t o t a l o f $85,584,000. The A d m i n i s t r a t i o n i n d i c a t e d t h a t d e c r e a s e s i n CDC and FDA b u d g e t s f o r AIDS r e s e a r c h w e r e due t o one-time s o s t s of f a c i l i t i e s r e n o v a t i o n and b l o o d On J u l y 1 9 , 1985, HHS S e c r e t a r y M a r g a r e t M . H e c k l e r sent supply studies. a memorandum t o House A p p r o p r i a t i o n s Committee Chairman W h i t t e n which a s k e d f o r a n amendment o f a n a d d i t i o n a l $37,800,000 and a r e d i r e c t i o n of FY86 HHS f u n d s i n o r d e r t o spend t h e f o l l o w i n g amounts on AIDS: FDA, $ 6 , 6 3 0 , 0 0 0 ; CDC $45,645,000; N I H , $70,723,000; and ADAMHA, $3,459,000 f o r a PHs t o t a l of $126,457,000. -- 3424, t h e FY86 a p p r o p r i a t i o n s b i l l f o r t h e The House p a s s e d H . R . D e p a r t m e n t s o f L a b o r , HHS, and Educasion and r e l a t e d a g e n c i e s on O c t . 2 , 1985. The House r e p o r t (H.Rept. 99-289) i n d i c a t e s t h a t t h e House i n t e n d e d t o spend a t o t a l o f $189,666,000 on AIDS f o r r e s e a r c h , p r e v e n t i o n and treatment. A c c o r d i n g t o t h e r e p o r t , N I H would r e c e i v e $140,700,000; CDC, $45,645,000; and ADAMHA, a p p r o x i m a t e l y $3,321,000. The a d d i t i o n a l $70 m i l l i o n p r o v i d e d t o N I H o v e r t h e A d m i n i s t r a t i o n ' s r e q u e s t of $70.7 m i l l i o n was t a r g e t e d f o r " t h e O f f i c e of t h e D i r e c t o r o f N I H t o d i s b u r s e among t h e I n s t i t u t e s f o r new AIDS i n i t i a t i v e s and expanded programs" (H.Rept. 3037, t h e House p r o v i d e d FDA w i t h 99-289). I n a s e p a r a t e b i l l , H.R. $6,630,000 f o r AIDS r e s e a r c h . T h e r e f o r e , t h e t o t a l amount of AIDS f u n d s p r o v i d e d by t h e House f o r FY86 was a p p r o x i m a t e l y $196,000,000. On O s t . 2 2 , 1985, t h e S e n a t e p a s s e d i t s v e r s i o n o f H.R. 3424, w h i s h , a c c o r d i n g t o t h e S e n a t e r e p o r t (S.Rept. 99-151), p r o v i d e d a t o r a l of $221,686,000 f o r AIDS. N I H would r e c e i v e $128,057,000; CDC, $64,925,000; An a d d i t i o n a l $16,000,000 was a p p r o p r i a t e d t o and ADAMHA, $12,704,000. t h e S e c r e t a r y o f HHS f o r " f o u r d e m o n s t r a t i o n p r o j e c t s on t h e d e l i v e r y of h e a l t h c a r e services i n cornunity s e t t i n g s a s an a l t e r n a t i v e t o inpatient c a r e i n a r e a s o f h i g h c o n c e n t r a t i o n o f AIDS v i c t i m s " (S.Rept. 99-151, p. 3037, t h e S e n a t e p r o v i d e d FDA w i t h $10,015,000 f o r AIDS 156). I n H.R. research. T h e r e f o r e , t h e t o t a l amount of AIDS f u n d s p r o v i d e d by t h e S e n a t e f o r AIDS r e s e a r c h and t r e a t m e n t i n FY86 was $231,701,000. 3424 On Nov. 11, 1985, t h e House f i l e d a c o n f e r e n c e r e p o r t on H.R. (H.Rept. 99-4021, t o which t h e House and S e n a t e a g r e e d on Dec. 5 and 6 , respectively. On Dec. 1 2 , 1985, H.R. 3424 was s i g n e d i n t o law (P.L. 99-178) by t h e P r e s i d e n t . FY86 f u n d i n g f o r FDA was c o n t a i n e d i n H.J.Res. 465, which was s i g n e d by t h e P r e s i d e n t o n Dec. 1 9 , 1985 (P.L. 99-190). A c c o r d i n g t o PHs, FDA would h a v e r e c e i v e d $9,955,000; CDC, $64,925,000; N I H , $ 1 4 0 , 7 2 3 , 0 0 0 ; ADAMHA, $12,704,000; and t h e O f f i c e o f t h e S e c r e t a r y of f o r a t o t a l of $244,307,000. HHS, $16,000,000 -- P.L. 99-177, t h e Gram-Rudman-Hollings Balanced Budget and Emergency C o n t r o l A c t of 1 9 8 5 (GRH), r e q u i r e d a 4.3% " a c r o s s t h e board" s e q u e s t r a t i o n o f t h e FY86 AIDS r e s e a r c h b u d g e t . GRH r e d u c t i o n s f o r e a c h a g e n c y f u n d i n g AIDS r e s e a r c h were a s f o l l o w s : FDA, $428,000; CDC, $ 2 , 7 9 2 , 0 0 0 ; NIH, $6,051,000; ADAMHA, $546,000; and t h e O f f i c e o f t h e S e c r e t a r y , $688,000. Taking i n t o a c c o u n t t h e GRH b u d g e t s c u t s , t h e FY86 b u d g e t f o r AIDS r e s e a r c h was t h e f o l l o w i n g : CDC, $ 6 2 , 1 3 3 , 0 0 0 ; FDA, $ 9 , 5 2 7 , 0 0 0 ; N I H , $134,672,000; ADAMHA, $12,158,000; and t h e O f f i c e o f t h e f o r a PHs t o t a l of $233,802,000. The S e c r e t a r y of HHS, $15,312,000 A d m i n i s t r a t i o n proposed r e s c i n d i n g p o r t i o n s o f t h e FY86 AIDS r e s e a r c h b u d g e t i n o r d e r t o p r e p a r e f o r t h e n e c e s s a r y b u d g e t c u t s r e q u i r e d by GRH i n FY87. However, t h e House and S e n a t e A p p r o p r i a t i o n s Subcommittees on HHS r e j e c t e d t h e ~ d m i n i s t r a t i o n ' s r e s c i s s i o n p r o p o s a l s , and t h e r e f o r e t h e FY86 b u d g e t f o r AIDS r e s e a r c h c o n t i n u e d a t t h e post-GRH l e v e l . Actual f u n d i n g f o r AIDS r e s e a r c h i n FY86 was a s f o l l o w s : N I H , $134,667,000; CDC, $62,133,000; ADAMHA, $12,155,000; FDA, $ 9 , 5 2 7 , 0 0 0 ; and t h e H e a l t h for a total R e s o u r c e s and S e r v i c e s A d m i n i s t r a t i o n (HRSA), $15,311,000 of $ 2 3 3 , 7 9 3 , 0 0 0 . -- -- FY87 Budget -- I n a s p e c i a l budget document e n t i t l e d " ~ a j o r P o l i c y I n i t i a t i v e s FY87," t h e A d m i n i s t r a t i o n i d e n t i f i e d AIDS r e s e a r c h a s o n e o f i t s h i g h p r i o r i t y programs. The A d m i n i s t r a t i o n r e q u e s t e d $213,247,000 f o r AIDS r e s e a r c h i n FY87, and proposed e s t a b l i s h i n g a s i n g l e o f f i c e i n t h e O f f i c e of t h e A s s i s t a n t S e c r e t a r y f o r H e a l t h (OASH) t o p l a n t h e AIDS c o n t r o l effort. The A d m i n i s t r a t i o n r e q u e s t e d t h a t C o n g r e s s " e s t a b l i s h a s i n g l e AIDS f u n d i n g a u t h o r i t y and g i v e HHS t h e a u t h o r i t y t o r e d i r e c t , where a p p r o p r i a t e , up t o 1%of f u n d i n g from l o w e r p r i o r i t y HHS programs t o AIDS r e s e a r c h and c o n t r o l . " The A d m i n i s t r a t i o n a l s o proposed t h a t t h e OASH c o o r d i n a t o r would be a u t h o r i z e d " t o a l l o c a t e AIDS f u n d s among HHS a g e n c i e s a c c o r d i n g t o a c o m p r e h e n s i v e p l a n , " and t h a t t h e p l a n b e u p d a t e d " a s s c i e n t i f i c b r e a k t h r o u g h s o c c u r and new o p p o r t u n i t i e s a r e i d e n t i f i e d . " A c c o r d i n g t o t h e budget document, "an AIDS c o o r d i n a t o r w i l l improve r e s e a r c h f l e x i b i l i t y and t h e c o o r d i n a t i o n o f t h e m u l t i f a c e t e d AIDS program. HHS' AIDS s p e n d i n g p l a n s c o u l d be a d j u s t e d more e a s i l y i n r e s p o n s e t o e m e r g i n g r e s e a r c h and c o n t r o l o p p o r t u n i t i e s . " Establishment of a n AIDS c o o r d i n a t i o n o f f i c e i s c o n s i s t e n t w i t h c o n g r e s s i o n a l a p p e a l s f o r a n AIDS c z a r . " According t o PHs, t h e A d m i n i s t r a t i o n r e q u e s t e d $203,482,000 f o r OASH and $9,765,000 f o r FDA. The OASH money was d i v i d e d a s f o l l o w s : N I H , $142,990,000; CDC, $45,409,000; ADAMHA, $13,733,000; and OASH AIDS C o o r d i n a t o r , $1,350,000. Of t h e $1,350,000 i n t h e OASH AIDS C o o r d i n a t o r b u d g e t , $1,000,000 was p r o p o s e d f o r an AIDS p u b l i c i n f o r m a t i o n campaign and $350,000 f o r f i v e s t a f f p o s i t i o n s . On J u l y 24, 1986, t h e House C o m n i t t e e on A p p r o p r i a t i o n s r e p o r t e d H.R. 5233, t h e FY87 a p p r o p r i a t i o n s b i l l f o r t h e Departments of L a b o r , HHS, and E d u c a t i o n and r e l a t e d a g e n c i e s (H.Rept. 99-711). The r e p o r t i n d i c a t e d t h a t t h e Committee on A p p r o p r i a t i o n s had s e t a s i d e $336,753,000 f o r AIDS N I H would r e c e i v e $198,943,000; CDC, $87,007,000; r e s e a r c h i n FY87. ADAMHA, $ 4 7 , 5 5 3 , 0 0 0 ; OASH $1,350,000; and HRSA, $1,900,000. In a H.R. 5177, t h e House p r o v i d e d FDA w i t h $9,765,000 for separate b i l l , t o t a l AIDS b u d g e t o f $ 3 4 6 , 5 1 8 , 0 0 0 . The Cornmi t t e e r e j e c t e d t h e A d m i n i s t r a t i o n ' s p r o p o s a l t o c o n s o l i d a t e a l l AIDS r e s o u r c e s i n t h e O f f i c e of t h e A s s i s t a n t S e c r e t a r y f o r H e a l t h (OASH). AIDS r e s e a r c h f u n d s f o r N I H were p r o v i d e d i n t h e a p p r o p r i a t i o n f o r t h e O f f i c e of t h e D i r e c t o r o f N I H . The money a p p r o p r i a t e d t o HRSA would f u n d a new program p r o v i d i n g AIDS e d u c a t i o n and t r a i n i n g c e n t e r s f o r h e a l t h c a r e p e r s o n n e l . Within CDC'S appropriation, t h e C o m m i t t e e i n c l u d e d up t o $ 3 , 0 0 0 , 0 0 0 f o r t h e e s t a b l i s h m e n t o f a n a t i o n a l c l e a r i n g h o u s e t o p r o v i d e i n f o r m a t i o n on AIDS. -- The S e n a t e Committee on A p p r o p r i a t i o n s recommended a t o t a l of $355,403,000 f o r r e s e a r c h and o t h e r a c t i v i t i e s r e l a t e d t o AIDS i n H.R. 5233 (S.Rept. 99-408). According t o t h e S e n a t e r e p o r t , N I H would r e c e i v e $ 2 0 0 , 9 4 3 , 0 0 0 ; CDC, $89,007,000; ADAMHA, $47,553,000; HRSA, $ 1 , 9 0 0 , 0 0 0 ; and D e p a r t m e n t a l Management u n d e r t h e O f f i c e o f t h e S e c r e t a r y of HHS would r e c e i v e $ 1 6 , 0 0 0 , 0 0 0 t o c o n t i n u e t h e AIDS t r e a t m e n t d e m o n s t r a t i o n p r o j e c t s begun i n FY86. The S e n a t e d i d n o t a g r e e w i t h t h e ~ d m i n i s t r a t i o n ' sr e q u e s t t o c o n s o l i d a t e a l l AIDS f u n d i n g i n one a p p r o p r i a t i o n t o OASH, and d i d noc a p p r o v e t h e ~ d r n i n i s t r a t i o n ' s budget r e q u e s t o f $1,350,000 f o r an AIDS c o o r d i n a t o r . On S e p t . 1 0 , 1986, H.R. 5233 p a s s e d t h e S e n a t e , amended, w i t h an a d d i t i o n a l $47 m i l l i o n i n t h e N a t i o n a l I n s t i t u t e f o r A l l e r g y and I n f e c t i o u s D i s e a s e s (NIAID) budget f o r AIDS t r e a t m e n t e v a l u a t i o n c e n t e r s and e x p e r i m e n t a l d r u g t h e r a p y programs. I n H.R. 5177, t h e S e n a t e p r o v i d e d $ 1 4 , 3 9 0 , 0 0 0 f o r FDA. On Aug. 1 5 , 1986, t h e A d m i n i s t r a t i o n p r o p o s e d amendments t o i t s FY87 a p p r o p r i a t i o n s r e q u e s t f o r HHS (H.Doc. 99-259). The r e v i s e d r e q u e s t p r o v i d e d a n a d d i t i o n a l $137,896,000 f o r AIDS r e s e a r c h , $133,271,000 f o r OASH, and $4,625,000 f o r FDA, b r i n g i n g t h e t o t a l r e q u e s t f o r AIDS i n FY87 t o $351,143,000. O v e r a l l , t h e p r o p o s a l would have r e d u c e d t h e FY87 Counterbalancing t h e proposed r e q u e s t f o r HHS by a t o t a l o f $181,022,000. i n c r e a s e f o r AIDS w e r e p r o p o s e d r e d u c t i o n s i n o t h e r HHS a c t i v i t i e s : CDC, $ 3 , 8 6 8 , 0 0 0 ; N I H $83,082,000; ADAMHA, $5,068,000; and t h e Low Income Home Energy A s s i s t a n c e Program (LIHEAP) i n t h e S o c i a l S e c u r i t y A d m i n i s t r a t i o n , f o r a t o t a l of $319,918,000 i n p r o p o s e d budget r e d u c t i o n s . $227,918,000 -- On Oct. 2 , 1986, t h e House f i l e d (H.Rept. 99-960). According t o $247,943,000; CDC, $89,007,000; ADAMHA, D e p a r t m e n t a l Management under O f f i c e o f $10,000,000 t o c o n t i n u e t h e f o u r AIDS a c o n f e r e n c e r e p o r t on H.R. 5233 t h e r e p o r t , N I H would r e c e i v e $47,553,000; HRSA, $ 1 , 9 0 0 , 0 0 0 ; and t h e S e c r e t a r y of HHS would r e c e i v e treatment demonstration projects. IB87028 CRS- 7 04-0 1-88 F u n d i n g f o r FDA, $14,390,000 was p r o v i d e d i n H.R. 5177 (H.Rept. 99-686). The PHs t o t a l was t h e r e f o r e $410,793,000. Appropriations f o r a l l t h e a g e n c i e s i n v o l v e d i n AIDS r e s e a r c h were p a s s e d a s p a r t of t h e FY87 c o n t i n u i n g r e s o l u t i o n (H.J.Res. 738, P.L. 99-591). A d d i t i o n a l f u n d i n g f o r AIDS was p r o v i d e d i n t h e FY87 S u p p l e m e n t a l The House Committee on A p p r o p r i a t i o n s r e p o r t e d A p p r o p r i a t i o n , H.R. 1827. H.R. 1827 on Mar. 2 5 , 1987 ( H . R ~ P 100-28). ~. The b i l l i n c l u d e d $ 1 , 5 0 0 , 0 0 0 f o r FDA t o e x p e d i t e t h e r e v i e w o f new d r u g s , v a c c i n e s , and b l o o d t e s t s f o r AIDS. On May 1 , t h e S e n a t e Committee on A p p r o p r i a t i o n s recommended t h e same $ 1 , 5 0 0 , 0 0 0 f o r FDA, a n a d d i t i o n a l $20,000,000 f o r CDC f o r a mass m a i l i n g o f AIDS i n f o r m a t i o n t o e v e r y h o u s e h o l d , and $30,000,000 f o r t h e p u b l i c h e a l t h emergency fund t o c o v e r t h e c o s t of AZT o r o t h e r AIDS d r u g s f o r n e e d y p a t i e n t s (S.Rept. 100-48). During S e n a t e c o n s i d e r a t i o n o f t h e b i l l , $ 2 7 , 0 0 0 , 0 0 0 was added f o r CDC t e s t i n g , c o u n s e l i n g , and m i n o r i t y e d u c a t i o n a c t i v i t i e s , f o r a t o t a l of $78,500,000 i n a d d i t i o n a l AIDS money. The f i g u r e was a c c e p t e d i n t h e c o n f e r e n c e r e p o r t (H.Rept. 100-195) and a g r e e d t o by b o t h t h e House ( J u n e 3 0 ) and t h e S e n a t e ( J u l y 1 ) . The b i l l was s i g n e d i n t o law J u l y 1 1 , 1987 (P.L. 100-71). A c c o r d i n g t o PHS, a c t u a l f u n d i n g f o r AIDS r e s e a r c h and e d u c a t i o n f o r N I H , $260,907,000; CDC, $136,007,000; ADAMHA, FY87 w a s a s f o l l o w s : $ 4 7 , 5 0 4 , 0 0 0 ; FDA, $15,774,000; HRSA, $11,900,000; OASH, $30,363,000 for a PHS t o t a l of $502,455,000. -- FY88 Budget The Reagan ~ d m i n i s t r a t i o n ' s o r i g i n a l proposed budget f o r FY88 was a s N I H , $343,868,000; CDC, $112,511,000; ADAMHA, $ 5 4 , 4 1 7 , 0 0 0 ; FDA, follows: $ 1 5 , 6 9 0 , 0 0 0 ; HRSA, $ 6 , 6 0 0 , 0 0 0 , and OASH, $800,000, f o r a PHs t o t a l of $533,868,000. On J u n e 3 0 , 1987, t h e A d m i n i s t r a t i o n s u b m i t t e d a r e v i s e d r e q u e s t f o r an a d d i t i o n a l $257,075,000 f o r AIDS, t o be d i v i d e d a s f o l l o w s : N I H , $ 7 8 , 5 6 0 , 0 0 0 ; CDC, $121,500,000; ADAMHA, $ 4 6 , 8 3 5 , 0 0 0 ; FDA, $ 8 , 8 8 0 , 0 0 0 ; a n d OAStl, $1,300,000. The agency t o t a l s u n d e r t h e r e v i s e d r e q u e s t w e r e N I H , $422,428,000; CDC, $234,011,000; ADAMHA, therefore a s follows: $ 1 0 1 , 2 5 2 , 0 0 0 ; FDA, $ 2 4 , 5 7 0 , 0 0 0 ; HRSA, $6,600,000; and OASH, $ 2 , 1 0 0 , 0 0 0 f o r a PHS t o t a l of $790,961,000. -- On J u l y 3 0 , 1987, t h e House Committee on ~ p p r o p r i a t i o n s r e p o r t e d H.R. 3058, t h e FY88 a p p r o p r i a t i o n s b i l l f o r t h e D e p a r t m e n t s of L a b o r , HHS and E d u c a t i o n and r e l a t e d a g e n c i e s (H.Rept. 100-2561. The r e p o r t i n d i c a t e d t h a t t h e C o m n i t t e e e l e c t e d t o p l a c e t h e a p p r o p r i a t e d AIDS f u n d s i n o n e c o n s o l i d a t e d a c c o u n t i n t h e O f f i c e o f t h e S e c r e t a r y ; however, t h e bill s p e c i f i e d t h e amount t o be d i s t r i b u t e d t o e a c h a g e n c y and institution. NIH would r e c e i v e $ 4 7 2 , 4 2 8 , 0 0 0 ; CDC, $306,750,000; ADAMHA, $ 1 0 1 , 2 5 2 , 0 0 0 ; HRSA, $38,500,000; O f f i c e o f t h e S e c r e t a r y , $ 5 , 0 0 0 , 0 0 0 ; O f f i c e of Minority Health, $1,500,000; and C o n t i n g e n c y Funds, H.R. 3520, t h e House r e p o r t e d $20,000,000. In a separate b i l l , $ 2 4 , 7 8 0 , 0 0 0 f o r FDA -- f o r a t o t a l PHs AIDS budget o f $970,210,000. The S e n a t e Committee on A p p r o p r i a t i o n s r e p o r t e d H.R. 3058 o n O c t . 1, 1987 ( S . R e p t . 100-189). The Committee r e j e c t e d t h e House p r o p o s a l t o c o n s o l i d a t e a l l AIDS r e s o u r c e s i n t h e O f f i c e of t h e S e c r e t a r y and i n s t e a d i n c l u d e d AIDS f u n d i n g w i t h i n e a c h agency a p p r o p r i a t i o n . The r e p o r t i n d i c a t e d t h a t NIH would r e c e i v e $ 4 6 7 , 9 2 8 , 0 0 0 ; CDC, $310,011,000; ADAMHA, $ 1 1 7 , 2 5 2 , 0 0 0 ; HRSA, $ 4 3 , 6 0 0 , 0 0 0 ; OS/OASH, $ 2 , 6 0 0 , 0 0 0 ; and P u b l i c H e a l t h Emergency Fund, $5,000,000. An a d d i t i o n a l $20,000,000, n o t l i s t e d by t h e Committee w i t h o t h e r f u n d s f o r AIDS, was a p p r o p r i a t e d t o t h e N I H B u i l d i n g s and F a c i l i t i e s a c c o u n t f o r f a c i l i t y r e n o v a t i o n r e l a t e d t o AIDS o n t h e N I H campus. T h i s t h e n b r i n g s t h e t o t a l AIDS f u n d i n g f i g u r e f o r N I H t o $487,928,000. S i m i l a r l y , a r e a p p r o p r i a t i o n o f $ 9 , 5 0 0 , 0 0 0 t o CDC f o r t h e e v e r y - h o u s e h o l d m a i l i n g p r o j e c t ( o r i g i n a l l y a p p r o p r i a t e d i n t h e FY87 CDC b u d g e t ) was n o t i n c l u d e d i n t h e Committee's AIDS t a b l e . With t h i s In a separate a d d i t i o n , t h e t o t a l CDC AIDS f u n d i n g becomes $319,511,000. f o r a t o t a l PHs b i l l , S. 1800, t h e S e n a t e p r o v i d e d FDA w i t h $24,570,000 AIDS f u n d i n g f i g u r e of $ 1 , 0 0 0 , 4 6 1 , 0 0 0 . -- On Dec. 2 1 , 1987, t h e House f i l e d a c o n f e r e n c e r e p o r t (H.Rept. 1004 9 8 ) on t h e FY88 C o n t i n u i n g R e s o l u t i o n (H.J.Res. 3951, which i n c l u d e d a p p r o p r i a t i o n s f o r a l l P u b l i c H e a l t h S e r v i c e a g e n c i e s and i n c o r p o r a t e d r e d u c t i o n s n e c e s s a r y t o meet t h e budget summit a g r e e m e n t s . The r e p o r t i n d i c a t e d t h a t AIDS t o t a l s would i n c l u d e : NIH, $467,806,000; CDC, $ 3 0 4 , 9 4 2 , 0 0 0 ; ADAMHA, $112,257,000; HRSA, $ 3 6 , 9 5 6 , 0 0 0 ; OASH, $ 2 , 8 7 2 , 0 0 0 ; f o r a PHs AIDS M i n o r i t y H e a l t h , $1,436,000; and FDA, $ 2 4 , 7 7 0 , 0 0 0 f u n d i n g t o t a l o f $951,039,000. The FY88 C o n t i n u i n g R e s o l u t i o n was s i g n e d i n t o law on Dec. 2 2 , 1987 (P.L. 100-202). -- FY89 Budget The A d m i n i s t r a t i o n ' s FY89 b u d g e t r e q u e s t f o r AIDS i s $ 1 , 3 0 0 , 0 0 0 , 0 0 0 , which r e p r e s e n t s a $349,000,000 o r 37% i n c r e a s e o v e r . t h e FY88 appropriations. The budget r e q u e s t s f o r AIDS h a v e been c o n s o l i d a t e d i n a s i n g l e a p p r o p r i a t i o n a c c o u n t under t h e O f f i c e o f t h e A s s i s t a n t S e c r e t a r y f o r H e a l t h i n FY89 " i n o r d e r t o improve c o o r d i n a t i o n , f l e x i b i l i t y and v i s i b i l i t y f o r t h e high l e v e l of r e s o u r c e s being devoted t o t h i s t o p public health priority," a c c o r d i n g t o t h e HHS b u d g e t j u s t i f i c a t i o n . However, o p e r a t i o n a l r e s p o n s i b i l i t y w i l l c o n t i n u e t o r e s i d e i n t h e i n d i v i d u a l PHs a g e n c i e s i n v o l v e d , w i t h t h e c u r r e n t p l a n s f o r a l l o c a t i o n of N I H , $587,630,000; CDC, $400,719,000; ADAMHA, resources a s follows: $ 1 7 7 , 6 1 7 , 0 0 0 ; FDA, $65,420,000; HRSA, $40,016,000; and OASH, $ 2 8 , 5 9 8 , 0 0 0 ( s e e T a b l e s 1-4 i n A p p e n d i x ) . The sum a l l c c a t e d t o OASH i n c l u d e s a $ 1 5 , 0 0 0 , 0 0 0 c o n t i n g e n c y f u n d "which c o u l d be used t o r e s p o n d i n s t a n t l y t o a n y new o p p o r t u n i t i e s . t h a t may a r i s e d u r i n g 1989." In addition, the budget s p e c i f i e s t h a t t h e S e c r e t a r y may t r a n s f e r up t o 3% o f t h e f u n d s a p p r o p r i a t e d t o PHs f o r non-AIDS p u r p o s e s i n t o t h e OASH AIDS a c c o u n t , p r o v i d e d t h a t i t i s n o t t r a n s f e r r e d from t h e " ~ e t i r e d Pay and M e d i c a l B e n e f i t s f o r Commissioned O f f i c e r s " f u n d , and t h a t C o n g r e s s i s n o t i f i e d 30 days b e f o r e any t r a n s f e r occurs. LEG1 SLATION P.L, 100-71, H . R . 1827 S u p p l e m e n t a l A p p r o p r i a t i o n s , 1987. A p p r o p r i a t e s $77 m i l l i o n f o r AIDS: $20 m i l l i o n f o r a mass m a i l i n g of i n f o r m a t i o n t o e v e r y h o u s e h o l d , $27 m i l l i o n f o r t e s t i n g , c o u n s e l i n g , and m i n o r i t y e d u c a t i o n a c t i v i t i e s , and $30 m i l l i o n f o r AIDS d r u g s . Reported by House Committee on A p p r o p r i a t i o n s (H.Rept. 100-28) Mar. 2 5 , 1987. P a s s e d House, amended, Apr. 23. R e p o r t e d , w i t h amendments, by S e n a t e Committee on A p p r o p r i a t i o n s P a s s e d S e n a t e , amended, J u n e 2. Conference (S.Rept. 100-48) May 1. r e p o r t (H.Rept. 100-195) f i l e d i n House, J u n e 27. Conference r e p o r t a g r e e d t o by House on J u n e 30 and by S e n a t e on J u l y 1, 1987. S i g n e d i n t o l a w J u l y 11, 1987. P.L. 100-202, H . J . R e s . 395 C o n t i n u i n g ~ p p r o p r i a t i o n s A c t , 1988. Includes p r o v i s i o n s of t h e c o n f e r e n c e a g r e e m e n t f o r Labor-HHS-Education a p p r o p r i a t i o n s ( s e e H.R. 3058). R e p o r t e d by House Committee on A p p r o p r i a t i o n s (H.Rept. 100-415) O c t . 29, 1987. P a s s e d House, amended, Dec. 3. R e p o r t e d w i t h amendments by S e n a t e Committee on A p p r o p r i a t i o n s (S.Rept. 100-238) Dec. 8 . Passed S e n a t e , amended, Dec. 11. C o n f e r e n c e r e p o r t (H.Rept. 100-498) f i l e d and a g r e e d t o Dec. 21. S i g n e d i n t o law Dec. 22, 1987. H.R. 3058 ( N a t c h e r ) D e p a r t m e n t s of L a b o r , H e a l t h and Human S e r v i c e s , and E d u c a t i o n , and R e l a t e d A g e n c i e s A p p r o p r i a t i o n s A c t , 1988. R e p o r t e d by House Committee on A p p r o p r i a t i o n s (H.Rept. 100-256) J u l y 30, 1987. P a s s e d House, amended, August 5. R e p o r t e d w i t h amendments by S e n a t e Committee on A p p r o p r i a t i o n s Passed S e n a t e , amended, O c t . 14. House and (S.Rept. 100-189) Oct. 1. S e n a t e c o n f e r e e s a g r e e d Dec. 1 6 t o f u n d i n g l e v e l s which were t h e n i n c o r p o r a t e d i n t o t h e FY88 C o n t i n u i n g R e s o l u t i o n ( s e e H.J.Res. 3 9 5 ) . FOR ADDITIONAL REBDING C o l b u r n , Don. AIDS: t h e growing i m p a c t . J u n e 2, 1987: 10-14. Washington p o s t h e a l t h s e c t i o n , L o r d , Lewis J. The s t a g g e r i n g p r i c e o f AIDS. J u n e 1 5 , 1987: 16-18. U.S. news and world r e p o r t , Rovner, J u l i e . C o n g r e s s i s s t a l e m a t e d o v e r AIDS e p i d e m i c . q u a r t e r l y weekly r e p o r t , Dec. 5 , 1987: 2986-2988. Congressional U.S. General Accounting O f f i c e . AIDS p r e v e n t i o n : v i e w s on t h e a d m i n i s t r a t i o n ' s budget p r o p o s a l s . B r i e f i n g r e p o r t t o t h e Chairman, S u b c o m n i t t e e on L a b o r , H e a l t h and Human S e r v i c e s , E d u c a t i o n and Related Agencies, C o m m i t t e e on A p p r o p r i a t i o n s , U.S. Senate. HRD-126BR, Aug. 1 2 , 1987. 33 p. U.S. L i b r a r y o f Congress. Congressional Research Service. Acquired immune d e f i c i e n c y syndrome (AIDS): h e a l t h c a r e f i n a n c i n g and [Washington] 1987. (Updated r e g u l a r l y ) s e r v i c e s , by Mark Merlis. CRS I s s u e B r i e f 87219 ----- AIDS: a n o v e r v i e w o f i s s u e s , J u d i t h A. Johnson and Pamela W. coords. [Washington] 1987. (Updated r e g u l a r l y ) CRS I s s u e B r i e f 87150 Smith, TABLE 1 FEDERAL FUNDING FOR AIDS RESEARCH AND EDUCATION ( i n thousands of d o l l a r s ) FY81 Actual ------ FY84 Actual ------ FY85 Actual FY86 Actual FY87 Actual $3,355 $21,668 $44,121 $63,737 $134,667 $260,907 $587,630 200 2,050 6,202 13,750 33,298 62,133 136,007 400,719 ADAMHA 0 0 516 2,791 2,578 12,155 47,504 177,617 FDA 0 150 350 798 9,005 9,527 15,774 65,420 HRSA 0 0 0 0 0 15,311 11,900 40,016 OASH 0 0 0 0 0 0 30,363 28,598 b/ $200 $5,555 $28,736 ------ FY82 Actual ------ FY83 Actual NIH $0 CDC Agent Y TOTAL ------ ------ ------ FY89 Request a / ------- a / I n t h e FY89 P r e s i d e n t ' s Budget, a l l AIDS f u n d i n g i s proposed f o r c o n s o l i d a t i o n i n OASH. b/ I n c l u d e s a $15 m i l l i o n " c o n t i n g e n c y fund." N I H : N a t i o n a l I n s t i t u t e s of H e a l t h CDC: C e n t e r s f o r D i s e a s e C o n t r o l ADAMHA: A l c o h o l , Drug Abuse, and Mental H e a l t h Admini s t r a t i o n Source: P u b l i c H e a l t h S e r v i c e Budget O f f i c e , March 25, 1988. FDA: Food and Drug A d m i n s t r a t i o n HRSA: H e a l t h R e s o u r c e s and S e r v i c e s A d m i n i s t r a t i o n OASH: O f f i c e o f t h e A s s i s t a n t S e c r e t a r y f o r H e a l t h , HHS zz* on^ m a1 m m m c u m 2?i Ei r 0 a r PI m 3 000 1 c 00 P z m r m 0 m m c a a m S e 0 ROO m a'm cl m m m 1 I- % % ilg n r n 5 0 I P rt m r r n s n m n r m Im C n a ~ a - m 3PIa m n n r r n a n r' g m n I I a- 1 I I I I I U W P U Ln 6 a m a n in n o m a a 0 na' o m w I-' 0 w u u u I- m '4 10 l rtw l C - 4 I P W I I-N m H n i? 0 C 1 .. ID 'd C u r P- o g Ln 0 H 'd C m EI n 3 FH LC C a % m m t* n r 1 a 09 ID I-'. nt-3 P, 1 ID P, ID L R 5 ID 0 u a C P, r C % P0 m I-' m 3 0 t-3 1 cn c" cn t* 0 m 0 0 ID t-3 m cn n cn n 1 g 0 - ~ gpL: 3 p n n m e ' U P - R a\ w o @a 1 s n c m moo r \ r C s n n r r n 0 0 3 ID 0 p, IC moo rp r 3 ID I D - P I D ~ O 3 0 ~ ~ ~ n :: " t:K% n n ID m s 1 P, ID 5 F n R 3 0 ID P, m 5 3 n P- z. n 5 P, i- a z P, z.m n 0 ID m n 0 % n a w r m r r 5ID 3 ID m (3 1 0 P, 5 iL 0 -m o 'd P, n m 3 I 1 ID I-' a Ef1 2 m 3ID . C @ O 3 ID ID 0 m P- 1 z ID 1 ID a 0 P, R x m G 1 0 ' i? FP, L - ww 1n 3 1 a PP, P, Ei w ID ID n m H 1 r 3: ID P, n 2 n m C u P i? ID m C P' n 'd C P4 P* g H H a n m ID 1 H H H ?' 5 m H P ? P1 H H p, L I7 P- 0 z z ZZ . N Cn I-' w a3 03 u, -* 0 P N I- m * ( I , m w .s 03 N w Cn m N N W 0 01 I- . N 43 01 U U N w Cn .s s . 03 m w 0 O ' d u, w . I . m N cn w I-' . 0 N U I-' I- .s v I- Cn Cn 0 W N h) N I- I- 0 " I-' cn m .w r I-' Cn 0 u, m t- " 0 Cn I- m X m a 0 m r w r m -3 %cn H Z C, u, N W . I-' W Ln U Cn W Cn w u, Cn 0 N " * Cn Cn w - I- r m N N - o v N m P 0 U I- t- U 03 - Ll II- I- " m U I- Cn 0 N * - Cn I- 0 W w - h) w N t- cn I- VI .. w Cn m I-' CO v 0 e w - . Cn 0) I-' cn 0 I-' I- . . .w . I- V Ll W W N 0 N 0 0 0 W - P W W u, w u, . I- W vl " * 0 W 0 u l I-' I- ah) N Cn w m I-' r I . M .s U N u w 0 N Cn V * ..Cn** N I- W -a h) - A. m h) U w u, I- " W 0 0 " 0 0 0 m U w U W I-' N W .. h) I- cn - n.-= n I - N n n W P O P W U U *h)t-mow W W r N - w . . " . . - * 0 * W N . . . 0 0 w 4 w N m II-' * P N u, W cn U-I .s Cn V I-' W IB37028 A p r i l 1988 TABLE 4 GOVERNMENT-WIDE SPENDING ON AIDS (Obligations i n $ millions) FY 82 Actual FY83 Actual FY84 Actual FY85 Actual FY86 Actual FY8 7 Actual FY88 Estimate Public Health Service 6 29 61 109 2 34 502 951 Medicaid ( F e d e r a l s h a r e ) * * * * * 4 130 210 375 4 * 41 71 * * J* * 10 15 , ------ ------ ------ ------ ------ ------ -------- Medicare * * Veterans 2 5 6 12 24 30 52 Defense 0 0 0 0 79 74 52 Prisons * * * 0 1 3 6 State 0 0 0 0 0 1 2 Labor 0 1 1 Social Security 8 TOTAL * 0 0 0 0 - - - - - 34 67 12 1 467 872 No e s t i m a t e i s a v a i l a b l e f o r t h i s y e a r . -- Public Health Service PHs s u p p o r t s r e s e a r c h i n t o t h e c a u s e s , p r e v e n t i o n , and p o t e n t i a l c u r e s of AIDS. Through e d u c a t i o n , PHs a l s o a t t e m p t s t o p r e v e n t t h e f u r t h e r s p r e a d o f AIDS. -- Medicaid and S o c i a l S e c u r i t y D i s a b i l i t y I n s u r a n c e HHS deems AIDS p a t i e n t s t o be d i s a b l e d , which q u a l i f i e s them f o r S o c i a l S e c u r i t y D i s a b i l i t y I n s u r a n c e (SSDI) b e n e f i t s and i n c e r t a i n circums t a n c e s , f o r Supplementary S e c u r i t y Income ( S S I ) b e n e f i t s . I n many S t a t e s , SSI e l i g i b i l i t y may g u a r a n t e e them Medicaid e l i g i b i l i t y . -- Medicare Some AIDS p a t i e n t s a r e o v e r 65, some have been on S o c i a l S e c u r i t y D i s a b i l i t y l o n g enough ( 2 4 months) t o q u a l i f y f o r Medicare, and a few q u a l i f y f o r o t h e r r e a s o n s . -- Veterans Administration VA p r o v i d e s medical c a r e t o v e t e r a n s w i t h AIDS. The e s t i m a t e s f o r 1988-92 a r e s u b j e c t t o wide v a r i a t i o n . T h i s i s a c o n s e r v a t i v e e s t i m a t e which assumes t h a t t h e 1987-92 i n c r e a s e i n c a s e s w i l l n o t exceed t h e 1986-87 i n c r e a s e . -- Defense i s s c r e e n i n g c u r r e n t p e r s o n n e l and r e c r u i t s f o r e v i d e n c e of AIDS i n f e c t i o n . Defense backlog of c u r r e n t personnel a r e screened, required funding w i l l decline. As t h e Bureau o f P r i s o n s -- The Bureau of P r i s o n s randomly t e s t s asymptomatic inmates e n t e r i n g F e d e r a l p r i s o n s , and u n i f o r m l y t e s t s a l l p e r s o n s being r e l e a s e d from F e d e r a l p r i s o n s . Medical s t a f f t r e a t i n m a t e s w i t h AIDS. Beginning i n FY88, a l l p r i s o n e r s w i t h AIDS w i l l be o f f e r e d AZT. -- S t a t e Department S t a t e c o n d u c t s AIDS a n t i b o d y t e s t s a s p a r t o f r o u t i n e i n - s e r v i c e p h y s i c a l examinat i o n s o f F o r e i g n S e r v i c e O f f i c e r s and p h y s i c a l examinations f o r new employees, and h a s r e c e n t l y begun t e s t i n g r e f u g e e s and p e r s o n s s e e k i n g immigrant v i s a s . Department o f Labor infection. Source: -- DOL s c r e e n s c u r r e n t J o b Corps e n r o l l e e s and new a p p l i c a n t s f o r e v i d e n c e o f AIDS O f f i c e of Management and Budget, March 17, 1988.