AIDS Funding for Federal Government Programs: FY1981-FY2009

RL30731 -- AIDS Funding for Federal Government Programs: FY1981-FY2009

Updated April 23, 2008

CONTENTS

Summary

Introduction

HHS Discretionary Funding: NIH, CDC, and HRSA

NIH

CDC

HRSA

HHS Entitlement Funding: Medicaid and Medicare at CMS

Medicaid

Medicare

Funding for Other AIDS Programs

HIV/AIDS Minority Initiative

International HIV/AIDS Programs

Footnotes

<font size="+1">List of Tables</font>

Table 1. HIV/AIDS Minority Initiative

Table 2. HHS Discretionary Funding for HIV/AIDS

Table 3. HHS Discretionary Funding for HIV/AIDS, by Agency

Table 4. Total Federal Government Spending on HIV/AIDS, by Function

Table 5. Federal Government Spending on HIV/AIDS: FY1982-FY2009

Table 6. Federal Government Spending on International HIV/AIDS Programs, by Function

Summary

Federal government spending on HIV (the human immunodeficiency virus) and AIDS (acquired immune deficiency syndrome) is estimated at $23.3 billion in FY2008. Of the total, 63% is for treatment programs; research programs receive 13%; prevention programs receive 14%, and income support programs receive 10%. The Administration's government-wide request level for all HIV/AIDS programs in FY2009 is $24.1 billion.

AIDS programs within the Department of Health and Human Services (HHS) account for 66% of the total amount spent on HIV/AIDS by the federal government in FY2008, a total of $15.2 billion for both discretionary and entitlement programs. Within the HHS discretionary budget, funding for HIV/AIDS research, prevention, and treatment programs has increased from $200,000 in FY1981 to an estimated $6.586 billion in FY2008; the Administration's request for FY2009 is $6.592 billion.

This report provides an overview of HHS spending on HIV/AIDS as well as budget numbers for other federal government programs targeting HIV/AIDS. This report is updated once per year to reflect the new budget figures.

Introduction

Untreated HIV infection leads to a gradual deterioration of the immune system and leaves affected individuals susceptible to the opportunistic infections and cancers that typify AIDS. Since 1981, a cumulative total of 1,014,797 AIDS cases in the United States and dependent areas have been reported to the Centers for Disease Control and Prevention (CDC).(1) Of this total, 448,871 persons were reported to be living with AIDS as of the end of December 2006. In addition to the total number of people living with AIDS, another 233,079 persons were known to be infected with HIV (does not include data from five states and the District of Columbia; these areas have not been reporting name-based HIV infection case numbers to CDC since at least 2003).

Figure 1. Estimated Total Federal Spending on HIV/AIDS, by Function, FY2008

Source: HHS Budget Office, March 20, 2008.

Federal government AIDS spending is estimated at $23.3 billion in FY2008 (see Table 5). The Bush Administration request for FY2009 is $24.1 billion. Of the total amount spent by the federal government on HIV/AIDS in FY2008, the majority (63%) of funding is for treatment programs; funding for research receives 13% of the total (see Figure 1 and Table 4). The remaining amounts are for prevention programs (14%) and income support for persons with AIDS (10%).

AIDS programs within HHS (Health and Human Services) account for 66% of the total amount spent on AIDS by the federal government (see Figure 2). HHS entitlement funding supports the treatment of HIV/AIDS patients through Medicaid and Medicare, which are administered by the Centers for Medicare and Medicaid Services (CMS). HHS discretionary funding supports AIDS research and prevention programs, as well as treatment programs. Table 2 provides a history of HHS discretionary funding for HIV/AIDS from the beginning of the epidemic in FY1981 to the present.

Funding for HIV/AIDS programs within HHS has increased markedly over the past 15 years as measured in constant 2000 dollars, shown in Figure 4 near the end of this report. Even though HHS has revised its estimates of spending by Medicaid for FY2007 through FY2009, Figure 4 still shows that most of the overall rise can be attributed to increased spending on Medicaid, Medicare, and treatment programs in the discretionary budget, largely through the Ryan White program administered by the Health Resources and Services Administration (HRSA). The increase in HIV/AIDS research and prevention programs has been much less pronounced, and their portion of the total amount spent by HHS on HIV/AIDS has declined over the past 15 years (see Figure 5). For example, in FY1992 HIV/AIDS research and prevention programs at HHS accounted for 51% of the total amount spent by HHS on HIV/AIDS; by FY2008, such programs were about 27% of the total amount spent by HHS on HIV/AIDS, reflecting the growing amounts spent on treatment services under Medicaid and Medicare.

Figure 2. Estimated Total Federal Spending on HIV/AIDS, by Agency, FY2008

Source: HHS Budget Office, March 20, 2008.

Note: USAID, U.S. Agency for International Development. See Table 4.

About 90% of FY2008 HHS discretionary funding for HIV/AIDS is allocated to three HHS agencies: the National Institutes of Health (NIH), which supports HIV/AIDS research; CDC, which supports HIV/AIDS prevention programs; and, HRSA, which administers the Ryan White program, an HIV/AIDS treatment program (see Table 3 and Table 4). The budgets and activities of these three agencies are briefly described below, followed by a discussion of entitlement program spending on HIV/AIDS.

HHS Discretionary Funding: NIH, CDC, and HRSA

NIH

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 27 institutes and centers and supports more than 200,000 scientists and research personnel working at over 3,100 U.S. institutions. NIH funding for FY2008 was provided in P.L. 110-161 (H.R. 2764), and NIH estimates FY2008 funding for AIDS research at $2.913 billion. The Administration's request for FY2009 is $2.913 billion.(2) Funding for AIDS research is distributed among the NIH institutes in accordance with the scientific priorities identified in the annual comprehensive plan for AIDS research developed by the institutes along with the Office of AIDS Research (OAR).

OAR was established in statute by the National Institutes of Health Revitalization Act of 1993 (P.L. 103-43) and given substantially enhanced authority and responsibility beyond the office NIH had established under the same name. Congress appropriated funds to OAR in FY1995. However, since FY1996, Congress has not provided a direct appropriation for the OAR (aside from amounts identified for the operations of the office itself). For FY2008, the House and Senate do not specify a funding amount for AIDS research at NIH. Instead, funding for AIDS research is included within the appropriation for each Institute/Center/Division of NIH, with decisions as to specific projects to fund and levels of funding left to the Director of NIH and the Director of OAR.

CDC

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. CDC distributes much of its HIV funds to state and local agencies through cooperative agreements, grants, and contracts. CDC funding for FY2008 was provided in P.L. 110-161 (H.R. 2764). According to the HHS Budget Office, CDC will be spending $872 million on HIV/AIDS activities in FY2008; the Administration's request for FY2009 is $871 million.(3)

HRSA

The HIV/AIDS Bureau within HRSA administers the Ryan White program, a four-part federal grant program designed to provide emergency relief and essential health care services to patients infected with HIV. The program funds hundreds of grantees that serve 531,000 people each year. The Ryan White HIV/AIDS Treatment Modernization Act of 2006 (P.L. 109-415, H.R. 6143) reauthorized the Ryan White program through September 30, 2009.

HRSA funding for FY2007 was provided in P.L. 110-161 (H.R. 2764). According to the HHS Budget Office, HRSA will be spending $2.170 billion on Ryan White program activities in FY2008. The Administration's request for FY2009 is $2.171 billion.(4) (For further information on the Ryan White program, see CRS Report RL33279, The Ryan White HIV/AIDS Program, by Judith A. Johnson.)

HHS Entitlement Funding: Medicaid and Medicare at CMS

Medicaid

Medicaid is a federal-state matching entitlement program that provides medical assistance for eligible low-income persons and families and certain aged, disabled, and medically needy individuals. In order to obtain Medicaid coverage, persons must belong to one of the categories of persons who can qualify for coverage (such as families with children and disabled persons) and have low income or deplete their income on the cost of their care. Medicaid has played an important role in needed health care for persons with HIV and AIDS because of its coverage of prescription drugs.

Within broad federal guidelines, each state designs and administers its own Medicaid program, resulting in wide variations among the states in coverage, benefits offered, and payment for services. The portion of a state's Medicaid budget provided by the federal government varies from 50% in relatively affluent states to 80% in poorer states. Medicaid is one of the largest source of federal funding for AIDS treatment and health care services (see Figure 3).

For FY2008, the federal share of Medicaid spending on AIDS treatment is estimated at $4.1 billion, and for FY2009, the federal share estimate is $4.4 billion. Total FY2008 federal and state Medicaid spending for AIDS treatment will be an estimated $7.2 billion ($4.1 billion federal and $3.1 billion state).(5) CMS analysts have significantly lowered their estimate of the federal share of Medicaid spending on AIDS treatment due to two factors: (1) the impact of Medicare Part D prescription drug coverage and (2) lowered per capita health care costs based on internal CMS data and external data.(6) However, a study by analysts outside of CMS found that although "implementation of Medicare drug benefit resulted in a major shift of prescription drug spending from Medicaid to Medicare ... spending for antiretroviral medications decreased by a much smaller percentage than did spending for many other classes. People with HIV and AIDS continue to depend heavily on Medicaid to pay for their health care, as most do not qualify for Medicare."(7)

Figure 3. Estimated Federal Government Spending on HIV/AIDS Treatment, FY2008

Source: HHS Budget Office, March 20, 2008.

Notes: Other includes the following: Substance Abuse and Mental Health; Public Health Emergency Fund; Department of Defense; Bureau of Prisons; Federal Employee Health Benefits Program; Global AIDS Trust Fund. See Table 3.

Medicare

Medicare is a federal health care insurance program for the elderly and certain disabled persons. In general, in order to qualify for coverage under Medicare, a person must be age 65 or older, disabled, or suffering from kidney failure (end-stage renal disease or ESRD). According to one estimate, about 80% of beneficiaries with HIV/AIDS that qualified for Medicare did so because of a disability,(8) the remainder were eligible because they were 65 or older or had ESRD.(9) The elderly qualify the month they turn 65, and those with ESRD qualify within three months of being diagnosed with irreversible kidney disease requiring dialysis or a kidney transplant. However, disabled people, including those with AIDS, must wait for a total of 29 months after a determination that they are disabled before they become eligible for Medicare coverage.(10)

Early in the epidemic, few individuals with AIDS survived the long waiting period. With improved drug therapies, the life expectancy of individuals with HIV has increased, and it is expected that the number able to qualify for Medicare coverage will continue to rise.(11) The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (P.L. 108-173) provided for the implementation of a prescription drug program, often called Medicare Part D, which became effective January 1, 2006. CMS analysts have adjusted their estimate of Medicare spending on AIDS treatment based on two factors: (1) the impact of Medicare Part D prescription drug coverage and (2) lowered per capita health care costs based on internal CMS data and external data.(12) For FY2008, funding for the care of persons with HIV/AIDS under Medicare is estimated to be $4.5 billion, and the estimate for FY2009 is $4.8 billion.

Funding for Other AIDS Programs

HIV/AIDS Minority Initiative

In 1998 the White House announced a series of initiatives targeting appropriated funds for HIV/AIDS prevention and treatment programs in minority communities. The Congressional Black Caucus worked with the Clinton Administration to formulate the approach. For FY2008, a total of $403 million is provided to continue these activities. For FY2009, the Administration has requested $387 million. See Table 1 below for further details.

Table 1. HIV/AIDS Minority Initiative

($ in millions)

Program  | FY2005  | FY2006  | FY2007  | FY2008  | FY2009 
HRSA | $129 | $129 | $131 | $135 | 139
CDC | 94 | 96 | 96 | 96 | 76
SAMHSA | 112 | 112 | 111 | 112 | 112
Minority Communities Fund | 52 | 52 | 52 | 51 | 52
Office of Minority Health | 8 | 10 | 9 | 7 | 7
Office of Women's Health | 1 | 1 | 1 | 2 | 1
Total, Minority HIV/AIDS Initiative | 397  | 399  | 400  | 403  | 387 

Source: Table prepared by the Congressional Research (CRS) based on analysis from the HHS Budget Office, February 15, 2008.

Notes: Totals may not add due to rounding. FY2009 is based on the Administration's budget request.

International HIV/AIDS Programs

In January 2003, President Bush announced in the State of the Union speech a five-year $15 billion program, the President's Emergency Plan for AIDS Relief (PEPFAR).(13) The five-year program targets countries with a very high prevalence of HIV infection; its goals are to prevent 7 million new infections, provide treatment to 2 million HIV-infected people, and provide care for 10 million HIV-infected individuals and AIDS orphans.

The Global Fund to Fight AIDS, Tuberculous and Malaria, was first proposed at the July 2000 G-8 Summit in Okinawa.(14) Its purpose is to attract, manage and disburse funding through a public-private partnership dedicated to the reduction of infections, illness and death caused by these three diseases in countries in need. It was established in January 2002 as a charitable foundation in Geneva, Switzerland; the first round of grants was approved in April 2002. U.S. support of the fund occurs through USAID and HHS.

As indicated in Table 6, federal government spending on international HIV/AIDS programs in FY2008 is $5.8 billion; the Administration's request for FY2009 is $5.9 billion.(15)

Table 2. HHS Discretionary Funding for HIV/AIDS

($ in thousands)

Year 
Funding 
$ Increase over
prior year 
% Increase over
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
3,536,519
269,299
8%

FY1999
4,094,489
557,970
16%

FY2000
4,546,326
451,837
11%

FY2001
5,225,645
679,319
15%

FY2002
5,788,553
562,908
11%

FY2003
6,093,846
305,293
5%

FY2004
6,242,501
148,655
2%

FY2005
6,279,141
36,640
0.6%

FY2006
6,235,251
-43,890
-0.7%

FY2007
6,357,719
122,468
2%

FY2008
6,586,086
228,367
4%

FY2009 Request
6,592,399
6313
0.1%

Source: Table prepared by the Congressional Research Service (CRS) based on analysis from HHS Budget Office, March 20, 2008.

Note: FY2009 is based on the Administration's budget request.

Table 3. HHS Discretionary Funding for HIV/AIDS, by Agency

($ in thousands)

Agency  | FY2000  | FY2001   | FY2002  | FY2003   | FY2004a   | FY2005a  | FY2006   | FY2007  | FY2008  | FY2009 
FDA | $76,317 | $75,818 | $75,818 | $72,830 | $73,847 | $87,661 | $88,758 | $90,563 | $94,425 | $95,369
HRSA | 1,599,231 | 1,815,000 | 1,917,200 | 2,024,962 | 2,066,861 | 2,075,296 | 2,064,705 | 2,141,195 | 2,170,192 | 2,171,312
IHS | 3,770 | 3,810 | 3,886 | 3,940 | 4,013 | 4,074 | 4,261 | 4,437 | 4,587 | 3,629
CDC | 687,164 | 859,045 | 931,141 | 936,426 | 862,854 | 855,535 | 838,225 | 879,241 | 872,427 | 871,314
NIH | 2,004,428 | 2,247,015 | 2,499,458 | 2,716,218 | 2,849,952 | 2,920,551 | 2,901,859 | 2,905,788 | 2,913,345 | 2,913,345
SAMHSA | 110,347 | 156,677 | 169,034 | 170,614 | 171,205 | 173,024 | 171,872 | 171,545 | 172,226 | 172,907
AHRQ | 1,787 | 3,381 | 2,913 | 1,825 | 2,017 | 1,088 | 2,750 | 2,800 | 2,800 | 2,800
OS | 63,282 | 64,899 | 64,103 | 67,681 | 62,637 | 62,712 | 63,821 | 63,150 | 61,325 | 61,723
Global AIDS Trust Fund | -- | -- | 125,000 | 99,350 | 149,115 | 99,200 | 99,000 | 99,000 | 294,759 | 300,000
Total  | $4,546,326 | $5,225,645 | $5,788,553 | $6,093,846 | $6,242,501 | $6,279,141 | $6,235,251 | $6,357,719 | $6,586,086 | $6,592,399

Source: Table prepared by the Congressional Research Service (CRS) based on analysis from HHS Budget Office, March 20, 2008.

Notes: FY2009 is based on the Administration's budget request. FDA: Food and Drug Administration; HRSA: Health Resources and Services Administration; IHS: Indian Health Service; CDC: Centers for Disease Control and Prevention; NIH: National Institutes of Health; SAMHSA: Substance Abuse and Mental Health Services Administration; AHRQ: Agency for Healthcare Research and Quality; OS: Office of the Secretary (includes the Office of HIV/AIDS Policy, Office for Civil Rights, Office of Minority Health, Office of Women's Health and the Public Health and Social Services Emergency Fund/Minority Communities Fund); Global Aids Trust Fund: While budgeted in NIH, HHS contributions to the Global Fund to Fight HIV/AIDS, Malaria, and Tuberculosis are not reflected in the NIH HIV/AIDS spending figures, but are accounted for separately.

a. CDC reported funding for HIV/AIDS expenditures have been comparably adjusted downward to reflect the new budget structure at CDC that excludes administrative and management costs. The FY2004 adjustment was about $68 million, and the FY2005 adjustment was about $74 million.

Table 4. Total Federal Government Spending on HIV/AIDS, by Function

($ in millions)

Agency/Department 
FY2007 Actual 
FY2008 Enacted 
FY2009 President's Budget 

Research 
Prevent 
Treatmt 
Income
support 
Total 
Research 
Prevent 
Treatmt 
Income support
Total 
Research 
Prevent 
Treatmt 
Income
support 
Total 

FDA
HRSA
IHS
CDC
NIH
SAMHSA
AHRQ
OS
PH emergency fund
Global AIDS trust fund
$91
--
1
--
2,906
--
3
--
--
--
3
3
879
--
40
--
11
37
50
--
2,138
--
--
--
131
--
--
15
50
--
--
--
--
--
--
--
--
--
$91
2,141
4
879
2,906
172
3
11
52
99
$94
--
1
--
2,913
--
3
--
--
--
3
3
872
--
40
--
10
36
147
--
2,167
--
--
--
132
--
--
14
147
--
--
--
--
--
--
--
--
--
$94
2,170
5
872
2,913
172
3
10
51
295
$95
--
1
--
2,913
--
3
--
--
--
--
3
2
871
--
40
--
10
37
150
--
2,168
--
--
--
133
--
--
15
150
--
--
--
--
--
--
--
--
--
--
$95
2,171
4
871
2,913
173
3
10
52
300

HHS discretionary
$3,001
$1,024
$2,333
--
$6,358
$3,012
$1,114
$2,460
--
$6,586
$3,013
$1,114
$2,465
--
$6,592

CMS/Medicaid
CMS/Medicare
--
--
--
--
3,900
4,200
--
--
3,900
4,200
--
--
--
--
4,100
4,500
--
--
4,100
4,500
--
--
--
--
4,400
4,800
--
--
4,400
4,800

Subtotal, HHS
$3,001
$1,024
$10,433
--
$14,458
$3,012
$1,114
$11,060
--
$15,186
$3,013
$1,114
$11,665
--
$15,792

Social Security -- DI
Social Security -- SSI
Veterans Affairs
Defense Department.
Agency for Int. Dev.
Justice/Bureau of Prisons
State Department
Labor Department
Education Dept.
HUD
OPM-FEHB
Subtotal, Non-HHS
--
--
5
26
--
--
--
--
--
--
--
$31
--
--
35
10
466
2
1,147
--
--
--
--
$1,660
--
--
465
58
124
19
2,101
--
--
--
107
$2,874
$1,450
420
--
--
--
--
--
--
--
286
--
$2,156
$1,450
420
505
94
590
21
3,248
--
--
286
107
$6,721
--
--
5
30
--
--
--
--
--
--
--
$35
--
--
35
18
371
2
1,645
--
--
--
--
$2,071
--
--
500
58
--
19
3,017
--
--
--
114
$3,708
$1,484
479
--
--
--
--
--
--
--
300
--
$2,263
$1,484
479
540
106
371
21
4,662
--
--
300
114
$8,077
--
--
$3
23
--
--
--
--
--
--
--
$26
--
--
$35
10
342
2
1,626
--
--
--
--
$2,015
--
--
$607
58
--
19
3,153
--
--
--
123
$3,959
$1,519
490
--
--
--
--
--
--
--
300
--
$2,309
$1,519
490
645
91
342
21
4,779
--
--
300
123
$8,310

Total, federal government
$3,032 
$2,684 
$13,307 
$2,156 
$21,179 
$3,047 
$3,185 
$14,768 
$2,263 
$23,263 
$3,039 
$3,130 
$15,624 
$2,309 
$24,102 

Source: Table prepared by the Congressional Research Service (CRS) based on analysis from HHS Budget Office, March 20, 2008.

Notes: HHS: Department of Health and Human Services; CMS: Centers for Medicare and Medicaid Services; DI: Disability Insurance; HUD: Department of Housing and Urban Development; SSI: Supplemental Security Income; OPM-FEHB: Office of Personnel Management-Federal Employees Health Benefits.

Table 5. Federal Government Spending on HIV/AIDS: FY1982-FY2009

($ in millions)

Year  | HHS  | SS  | VA  | Defense  | AID  | DOJ-Prisons  | State  | Labor  | HUD  | OPM-FEHB  | Education  | Total 
Discretionary  | CMS 
Medicaid  | Medicare  | DI  | SSI 
1982 | $6 | -- | -- | -- | -- | 2 | -- | -- | -- | -- | -- | -- | -- | -- | $8
1983 | $29 | 10 | -- | -- | -- | 5 | -- | -- | -- | -- | -- | -- | -- | -- | $44
1984 | $60 | 30 | -- | 5 | 1 | 7 | -- | -- | -- | -- | -- | -- | -- | -- | $103
1985 | $109 | 70 | 5 | 10 | 3 | 8 | -- | -- | -- | -- | -- | -- | -- | -- | $205
1986 | $234 | 130 | 5 | 30 | 5 | 20 | 79 | -- | -- | -- | -- | -- | 5 | -- | $508
1987 | $502 | 200 | 15 | 55 | 15 | 51 | 74 | -- | 1 | -- | 1 | -- | 8 | -- | $922
1988 | $962 | 330 | 30 | 95 | 20 | 78 | 53 | 30 | 1 | -- | 1 | 1 | 13 | 1 | $1,615
1989 | $1,304 | 490 | 55 | 150 | 35 | 136 | 86 | 40 | 2 | 1 | 1 | -- | 22 | -- | $2,322
1990 | $1,592 | 670 | 110 | 184 | 55 | 220 | 124 | 71 | 5 | 1 | 1 | -- | 37 | -- | $3,070
1991 | $1,891 | 870 | 180 | 266 | 95 | 258 | 127 | 78 | 5 | 1 | 1 | -- | 61 | -- | $3,833
1992 | $1,967 | 800 | 400 | 372 | 150 | 279 | 125 | 94 | 5 | 1 | 1 | 48 | 103 | -- | $4,345
1993 | $2,079 | 1,000 | 600 | 481 | 200 | 299 | 155 | 117 | 5 | 1 | 1 | 100 | 175 | -- | $5,213
1994 | $2,569 | 1,300 | 800 | 568 | 250 | 312 | 127 | 115 | 6 | 1 | 1 | 156 | 193 | -- | $6,398
1995 | $2,700 | 1,500 | 1,000 | 631 | 250 | 317 | 110 | 120 | 6 | 1 | 1 | 171 | 212 | -- | $7,019
1996 | $2,898 | 1,800 | 1,100 | 684 | 250 | 331 | 98 | 115 | 6 | -- | 1 | 171 | 226 | -- | $7,680
1997 | $3,267 | 2,200 | 1,300 | 738 | 275 | 350 | 84 | 117 | 7 | -- | 2 | 196 | 241 | -- | $8,777
1998 | $3,537 | 2,600 | 1,400 | 787 | 305 | 378 | 95 | 121 | 7 | -- | 2 | 204 | 253 | -- | $9,689
1999   | $4,094 | 2,900 | 1,500 | 828 | 330 | 401 | 86 | 139 | 7 | -- | 2 | 225 | 266 | 1 | $10,779
2000a  | $4,546 | 3,300 | 1,700 | 870 | 370 | 345 | 97 | 200 | 8 | -- | 2 | 232 | 279 | 1 | $12,025
2001a  | $5,226 | 3,700 | 1,900 | 919 | 340 | 405 | 108 | 430 | 15 | -- | 11 | 257 | 292 | 1 | $14,184
2002 | $5,789 | 4,200 | 2,050 | 961 | 390 | 391 | 96 | 510 | 16 | -- | 11 | 277 | 297 | -- | $14,988
2003 | $6,094 | 4,800 | 2,400 | 1,019 | 395 | 396 | 82 | 774 | 17 | 141 | 11 | 290 | 321 | -- | $16,739
2004 | $6,243 | 5,400 | 2,600 | 1,050 | 415 | 402 | 105 | 963 | 17 | 638 | 11 | 295 | 343 | -- | $18,481
2005 | $6,279 | 5,700 | 2,900 | 1,250 | 450 | 445 | 110 | 633 | 20 | 1,376 | 2 | 282 | 370 | -- | $19,817
2006 | $6,235 | 3,600b  | 3,900b  | 1,365 | 440 | 468 | 102 | 621 | 21 | 1,977 | -- | 286 | 100 | -- | $19,116
2007 | $6,358 | 3,900b  | 4,200b  | 1,450 | 420 | 505 | 94 | 590 | 21 | 3,248 | -- | 286 | 107 | -- | $21,179
2008 | $6,586 | 4,100b  | 4,500b  | 1,484 | 479 | 540 | 106 | 371 | 21 | 4,662 | -- | 300 | 114 | -- | $23,263
2009 | $6,592 | 4,400b  | 4,800b  | 1,519 | 490 | 645 | 91 | 342 | 21 | 4,779 | -- | 300 | 123 | -- | $24,102

Source: Table prepared by the Congressional Research Service (CRS) based on analysis from HHS Budget Office, March 20, 2008.

Notes: FY2009 is based on the Administration's budget request. May not add due to rounding. HHS: Department of Health and Human Services; Discretionary AIDS budget; CMS: Centers for Medicare and Medicaid Services; SS: Social Security; DI: Disability Insurance; SSI: Supplemental Security Income; VA: Veterans Affairs; AID: U.S. 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.

a. FY2000 total includes $75 million for the HRSA Ricky Ray Hemophilia program, and FY2001 total includes $580 million for the HRSA Ricky Ray Hemophilia program.

b. Medicaid and Medicare amounts have been revised due to the impact Medicare Part D prescription drug coverage and lowered per capita health care costs.

Figure 4. HHS Spending on HIV/AIDS Programs

Source: HHS Budget Office, March 20, 2008.

Note: FY2009 is based on the Administration's budget request.

Figure 5. HHS HIV/AIDS Spending, by Program/Function, as a Percentage of Total

Source: HHS Budget Office, March 20, 2008.

Note: FY2009 is based on the Administration's budget request.

Table 6. Federal Government Spending on International HIV/AIDS Programs, by Function

($ in millions)

Agency/Department  | FY2007 Actual  | FY2008 Enacted  | FY2009 President's Budget 
Research  | Prevent  | Treatment  | Total  | Research  | Prevent  | Treatment  | Total  | Research  | Prevent  | Treatment  | Total 
Centers for Disease Control | -- | 121 | -- | 121 | -- | 119 | -- | 119 | -- | 119 | -- | 119
National Institutes of Health | 362 | -- | -- | 362 | 364 | -- | -- | 364 | 366 | -- | -- | 366
Global AIDS trust fund | -- | 50 | 50 | 99 | -- | 147 | 147 | 295 | -- | 150 | 150 | 300
Subtotal, HHS   | $362  | $170  | $50  | $582  | $364  | $266  | $147  | $777  | $366  | $269  | $150  | $785 
Defense Department | -- | -- | -- | -- | -- | 8 | -- | 8 | -- | -- | -- | --
Agency for International Development | -- | 466 | 124 | 590 | -- | 371 | -- | 371 | -- | 342 | -- | 342
State Department | -- | 1,147 | 2,101 | 3,248 | -- | 1,645 | 3,017 | 4,662 | -- | 1,626 | 3,153 | 4,779
Labor Department | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | --
Subtotal, Non-HHS  | --   | 1,613  | 2,225  | 3,838  | --   | 2,024  | 3,017  | 5,041  | --   | 1,968  | 3,153  | 5,121 
Total  | $362  | $1,784  | $2,275  | $4,420  | $364  | $2,290  | $3,164  | $5,818  | $366  | $2,237  | $3,303  | $5,906 

Source: Table prepared by the Congressional Research Service (CRS) based on analysis from HHS Budget Office, March 20, 2008.

Notes: May not add due to rounding. HHS: Department of Health and Human Services.

Footnotes

1. (back) Data in this paragraph are from Table 3, p. 13 and Table 12, pp. 24-25 of the CDC, HIV/AIDS Surveillance Report, 2006, vol. 18, at http://www.cdc.gov/hiv/topics/surveillance/resources/reports/.

2. (back) For additional information on OAR budget and research activities for FY2009, see "Department of Health and Human Services, Fiscal Year 2009, Justification of Estimates for Appropriations Committees, National Institutes of Health, Volume I, Overview," pp. 1-17, at http://officeofbudget.od.nih.gov/ui/2008/OAR.pdf.

3. (back) For further information on the CDC HIV/AIDS budget and program activities, see "Department of Health and Human Services, Fiscal Year 2009, Justification of Estimates for Appropriations Committees, Centers for Disease Control and Prevention," pp. 61-78, at http://www.cdc.gov/fmo/PDFs/FY09_CDC_CJ_Final.pdf.

4. (back) For more information on the HRSA Ryan White budget and program activities, see "Department of Health and Human Services, Fiscal Year 2009, Justification of Estimates for Appropriations Committees, Health Resources and Services Administration," pp. 163-193, at ftp://ftp.hrsa.gov/about/budgetjustification09.pdf.

5. (back) Estimate based on average federal Medicaid assistance percentage (FMAP) for the nation as a whole.

6. (back) Personal communication, HHS Budget Office, April 17, 2008.

7. (back) Brian K. Bruen and Laura M. Miller, "Changes in Medicaid Prescription Volume and Use in the Wake of Medicare Part D Implementation," Health Affairs, January/February 2008, v. 27, pp. 196-202.

8. (back) An HIV-positive individual must have a recognized AIDS-defining illness in order to meet the disability classification.

9. (back) Nancy Fasciano et al., Profile of Medicare Beneficiaries with AIDS: Application of an AIDS Case Finding Algorithm, Executive Summary, October 14, 1999. Submitted by Mathematica Policy Research, Inc.

10. (back) Disabled people begin collecting Social Security disability cash benefits five months after a determination that they are disabled and then must wait an additional 24 months for a total of 29 months before becoming eligible for Medicare.

11. (back) Combination drug therapies do not work for everyone with HIV. However, for individuals who are successfully treated, the drug therapies will keep them healthy longer, thereby preventing some from qualifying for disability.

12. (back) Personal communication, HHS Budget Office, April 17, 2008.

13. (back) The U.S. Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003 (H.R. 1298, P.L. 108-25), signed into law on May 27, 2003.

14. (back) Fact Sheet, Office of the Spokesman, U.S. Department of State, December 13, 2002, at http://www.state.gov/r/pa/prs/ps/2002/15583.htm.

15. (back) For additional information, see CRS Report RL33771, Trends in U.S. Global AIDS Spending: FY2000-FY2008, by [author name scrubbed]; CRS Report RL33485, U.S. International HIV/AIDS, Tuberculosis, and Malaria Spending: FY2004-FY2008, by [author name scrubbed]; CRS Report RL31712, The Global Fund to Fight AIDS, Tuberculosis, and Malaria: Background, by [author name scrubbed]; CRS Report RL34192, PEPFAR: From Emergency to Sustainability, by [author name scrubbed]; CRS Report RL32001, HIV/AIDS in the Caribbean and Central America, by [author name scrubbed]; and CRS Report RL33584, AIDS in Africa, by [author name scrubbed].

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