seven committee on health will come to order today hey this committee will consider h r three seventy nine to the ryan white hiv aids treatment extension act of two thousand and nine sponsored by myself ranking member deal chairman waxman and ranking member barton let me start with the opening statement from myself and then will wreck recognize other members for an opening statement in early september th subcommittee met to review a discussion draft of the bill that was released by chairman waxman and myself and during that hearing we pledge to work with our republican colleagues as we move forward and i'm pleased to say that we have before us today a bipartisan buy cameral piece of legislation the ryan white program was scheduled to sunset on september thirtieth of this year and fortunately we were able to include an extension of the program in the continuing resolution that was passed just a few weeks ago so all the individuals who rely on this important program can continue to have access to the critical medical services they depend on every day meanwhile we were working hard to reach consensus and the result of that work is before us today first this bill eliminates the sunset provision so that will never again face the drop dead deadline so it's important to revisit programs to ensure that they're all still achieving their established goals these types of sunset provisions can put patient care at risk all the ryan white programs have been in desperate need of increased funding for the past three years modern medical advancements have made it possible for more individuals to live full lives despite an h i b aids diagnosis which means that there are more individuals living with it cs and in need of services at the same time we're experiencing a steady increase in the cost of providing that medical care so in order to respond to this growing level of need h r three seven nine two provides a five percent authorization increase for all parts of the ryan white program this includes part d which has been flat funded for the past three years and part f which encompasses minority aids initiative hiv aids communities and schools and centers we've also extended the exemption for those states who are still reporting code based data directly to her so when we reauthorize the ryan white program in two thousand and six we included a provision that would require all states report their age hiv cases to the c d c through a name based system this system is more accurate in capturing true cases of hiv aids and decreases the chance of duplications or double counting so all states have made progress towards this goal there are still eight states whose data is not yet considered mature according to the c d c to give them time to get their systems fully operational we extend the exemption that allows them to report code based data block keeping in place the penalties that were stablish in two thousand and six and this includes a five percent decrease in counts to account for potential duplications and a five percent cap on the possible increase in h i b numbers now along those lines we also established a margin of error for the eligible metropolitan areas transitional grant areas or not meet these conditions we have created a new transfer of funds process that will provide a soft landing for the former t g i and ensure that the patients who rely on the services once provided by that t d i will continue to receive those services the bill repeats the whole harmless pattern that was established in the last reauthorization this was done to ensure that no area experience is too drastic a cut in funding from one year to the next thereby destabilizing the provision of care to patients in that area and this will guarantee that the provision of care is not disrupted while at the same time slowing shifting funds away from areas that do not have the same number of patients that they once had and finally we included a few very technical changes to the current ryan white program the small changes we made ensure that patients continue to be able to access these lifesaving and life sustaining treatments and services i point out that despite huge advancements in prevention detection and early treatment of hiv aids there are still nearly forty thousand new hiv aids infections reported each year and according to the c d c approximately one point one million americans are currently living with the disease given these high numbers it's all the more important that we continue the ryan white program to ensure that these patients receive the treatment that they need and deserve and i believe that the bill the force today just just that i want to thank our chairman mr waxman ranking member barton ranking member deal and my colleagues in the senate for their work on this bill i also want to thank the numerous community groups and stakeholders for the effort they made up front in putting together the consensus document i think the bill before us today is an important step forward and making sure this critical program remains in place and people with hiv and aids can continue to access the services and treatments that they need let me say i mean obviously we still have want to expedite because we face a october thirtieth deadline once again even with the with the c r we i think there's a good chance we could also have this in full committee tomorrow if it's reported out today and as i said the senate is moving as well so we could it is important to move quickly and i appreciate the fact that everyone has been so  helpful and in the chair having that and with that i recognize mr deal like mr chairman i want to express my appreciation to you and chairman waxman and to the members of this committee as well as our mutual staff for working cooperatively on this undertaking also want to thank the advocacy community for their efforts and working with us as well i will submit my complete statement for the record but just to simply say that i was one of those who had hoped that we could move to a name based reporting system unfortunately the states have not been able to get their records in that order yet the three years that we allow them to do that hopefully will be more than enough time and at the fourth year the nine base reporting will take place under this legislation i think it results in a more equitable distribution of the resources that are available for dealing with the age with that i'll submit my statement for the record now you thank you mr d a let me mention that if other members of this committee would still like to co sponsor this that's you know you can do that and you should just indicate that you know either today when you're speaking or just staff and we'll put you down as the and everybody who has been involved in working on a bipartisan by camel fashion to present the bill to us today and we hope to enact into law very soon the ryan white program has been serving people living with hiv aids for nearly two decades it provides care treatment and support services to nearly half a million people most of whom are low income without this critical safety net some of our nation's most vulnerable populations would not receive the care and treatment they need and rightfully deserve  different concerns have been raised about the reauthorization but one unifying commitment was there from the start the ryan white program must not and we all agree that the hiv aids epidemic is not a partisan issue it is a human issue to reach consensus we all had to compromise we receive recommendations from the congressional black hispanic and asian pacific american caucus is the hiv aids epidemic continues to have a  hugely disproportionate impact on racial and ethnic minority populations in that from the tri caucus was not only important it was vital and i want to thank you again mr chairman are strongly urge and i vote for this bill i have a longer statement i'd like to put into the record so what it will put the statement the record and mr shimkus recognize for an opening statement thank you chairman as you know competing markups and i don't know where body else is but i'm happy to be here i'm glad we're moving expeditiously to get this reauthorized and i yell back thank you gentleman from california ms issue for holding this up markup is an important one i'll put my full statement in the record but suffice it to say that this legislation has earned a very fine reputation with people across the country and so what we're doing is so important in the lives of those that live with hiv and aids in the services that are provided and i think that we've worked out a very good bill and  i look forward to it becoming law so that people will be continued to be served well into the future and god willing we'll win the battle and we won't have to do this legislation anymore because there will  thank you recognize the gentleman from new york and let me mention that both mr engel and mr waxman of course have both been instrumental in putting this bill together and also in working on the ryan white act for many years mr and thank you thank you mr chairman and certainly you have been the most instrumental under your leadership and we all appreciate the cooperation and the collegiality and the important work you've done on this bill the ryan white care act holds a very special significance to new york unfortunately we are home to sixteen percent of the nation's aids population and new york remains the epicenter of the hiv aids crisis new york has nearly a hundred twenty thousand residents living with hiv aids and our state and cities have been proud to partner with the federal government in providing care for many of these individuals new york state receives more than three hundred million dollars in ryan white funds under all parts of the act to provide a range of health care and support services through y and right programs twenty two thousand uninsured new yorkers receive medications and ambulatory care services and thousands more receive other essential services such as mental health case management nutrition and treatment here and support services it's critical that congress acts swiftly on the reauthorization of the ryan white program which national nationwide provides life saving medications health care and support services to over half a million people as you know unlike most most reauthorization congress inserted a sunset provision to the act in two thousand and six requiring congressional action by september thirtieth two thousand and nine while we and i remember this well this reauthorization with the subject of much disagreement and we're in a different place today fortunately members on both sides of the aisle and more than two hundred fifty organizations in the united states have worked hard over the past year to develop legislative principles with as much agreement for the most part we have a bipartisan a bi cameral agreement i applaud the work of the chairman of the underlying draft we have before us this will provide measurable years and years and years and it's nice that a lot of this is coming to fruition is an issue hopefully one day we'll have a cure for aids and we won't have to keep doing this thank you thank you recognize the gentleman the gentlewoman from wisconsin ms baldwin thank you thank you mr chairman for calling this markup it's a real honor to be on the authorizing committee for this lifesaving legislation you know as chairman wax and senator kennedy were writing this legislation almost twenty years ago i was serving in the local government on the day and county board of supervisors and i was chairing the dane county human services board and chairing also the dane county task force on aids and h just as the first individuals with hiv and aids were arriving in our community and seeking health care and other support services and many of my colleagues would call those early years of the aids epidemic and its devastating impact on the gay community that devastating impact health impact was compounded by misunderstand about the disease and stigmatisation of it sufferers and in the early years our policies and our health care system really utterly failed to rise to the challenge of hiv aids much has changed since the early one nine hundred eighty s we've had significant medical advances and significant policy advantage advances and the passage of the ryan white care act in one nine hundred ninety represented a tremendously important breakthrough while we have come so far in treating the disease and caring for those who are infected the crisis is far from over as the life spans of people with hiv continue to increase so does there need to access for access to continuous quality medical care and vital support services the ryan white program has grown and adapted to provide this vital safety net in my district this care is provided by a clinic at the university of wisconsin which receives a ryan white part c grant staffed by very dedicated health professionals this  clinic provides a broad range of services to hiv positive individuals that don't have health insurance many clients travel from all parts of our state to access the state of the art care and the program provides medical care social worker case management and mental health and substance abuse services but most importantly they provide a portal to the health care system that is safe confidential and supportive i worked with two of my friends and colleagues on  this committee to introduce legislation called the ryan white grantee equity act that would increase medicaid reimbursement for parts clinics like the one in my district congresswoman caps and congressman matsui and i share the concern that these clinics are struggling under the weight of this public health crisis and many organizations receiving grants through part c ryan white care act serves a large number of medicaid patients as well as indigent patients who have no health care coverage unfortunately these are organizations often struggle with insufficient funding through medicaid our legislation is meant to work with states to create funding streams to stabilize parallel fashion moving forward and i look forward to that work with you and my colleagues on the committee to strengthen our nation's response to hiv aids thank you mr chairman i yield back thank you recognize the gentleman from texas mr burgess and i'll keep my remarks short this reauthorization make several improvements to the or i won't care act but just face the uncomfortable fact that we don't have as much money as we would like  hard balance to maintain but i believe several of the provisions of this bill will be helpful for the population that this program serves i admit i wish we had the opportunity for a more vigorous debate surrounding the reauthorization understand that we were under a tight time frame but it is my hope that we will not wait until the final our next time around as i've mentioned before the face of this disease has changed and will continue to change and we have the responsibility to update and evaluate this program to meet those new challenges as they evolve as far as we have come in the past few years i remain of the belief that our approach to this program also needs to continue to evolve i do thank you for bringing a bipartisan bil that addressed some of the concerns expressed by the minority that are hearing in our hearing on this issue i do hope the committee will be provided data runs from what i that will not be possible because of the short time frame i had hoped we would have matured data from her so before we begin the markup of this legislation and it is important to do that so we have a full picture of what these funding adjustments and policy changes the true effect that they will have in our district as chairman i thank you for the consideration i'll yield back the balance of my time thank you the gentleman from california ms harman thank you mr chairman it's a pleasure to sit here and contemplate the fact that we're about to pass very good legislation on a bipartisan basis in  this committee sometimes it's easy to forget that that's why we all came to congress the face of aids any face in los angeles one of those faces who was a good friend of mine was elizabeth glaser who  like that and is truly a safety net ryan white as we know is a payer of last resort so the program only picks up the cost after other sources of funding are exhausted and it helps the needy as patients we heard  mr angle that new york is a huge source of hiv aids patients so as california the need is acute in northern california but it is also very substantial in los angeles county where ryan white is absolutely essential salute you and all the members of this committee for being serious about this and for probably offering a public fallen and thank you ranking member deal there was a time when i doubted that we would be able to reauthorize ryan white this year but you made sure we could do it on a bipartisan and bicameral basis and as a delegate from the region with the second highest rate in the country i thank you for your leadership and i thank the chairman and the ranking member of the committee as well it's important also to thank the staff especially in siler who work closely with my staff and others to ensure that the congressional caucus concerns  assistance a large and mid sized cities with high incidence and are prevalent supporting states and territories with their related programs expanding access early intervention family centered care and support services to women infants and children and youth with hiv and aids by retaining the grant programs for the community clinics and other nonprofit entities that provide those services at the same time this extension strengthens funding levels with the five percent increase although it could be more improve the clause that it might not a provide adequate funding to states which have a growing epidemic but i think we've adequately addressed that for the time being and after that we want to ensure that after the thirty year that funding does begin to finally follow concerned about the level of funding and commitment to the national minority aids education and training on it can i just issue yield there is a vote in the energy subcommittee i'm going to stay but if there are members that would like to go down there and vote you probably can get sixty five percent of new infections more than seventy percent of new aids cases and sixty seven percent of people currently living with aids need more support but overall i'm pleased that this four year extension is a sound thoughtful a well supported effort to keep in caramel agreement forward with this bill i want to talk just acknowledge the advocacy community which is been doing such a great job both nationally and locally and chicago the aids foundation of chicago is been tireless and making sure that my office and so many others are informed about all the details and the discussions and the concerns that are in  was a death sentence usually was the public was often misinformed about modes of transmission and the science behind treatment was far more limited than it is today however we have seen decreases in the care act resources needed to assist health care providers and service projects and people living with the does disease over the last few years to decrease funding coupled with recent data indicating the rates of hiv aids in cities like washington d c with are comparable to that of developing nations or news from montana that the number of infections rates in the month of september was higher than the numbers reported an olive last year is proof positive that we need to invest more resources action on the part of this committee and this congress to pass a strong ryan white care act reauthorization and i look forward to voting for this bill i yelled back thank you gentleman from ohio m palauan and thank you for bringing this bipartisan legislation to the subcommittee today for a vote the legislation makes great strides towards improving the capabilities of providers within the ryan white program but also proof the lives of individuals who use a program for life saving care and support it will strengthen the minority aids initiative to make sure the funds in that program are going where they're most needed and the bill will protect funding for transitional regions dealing with fluctuating hiv aids population this bill will also give greater flexibility to ryan white grantees in the way they obligate fund currently grantees face harsh penalties for not accounting for all but two percent of their funds and this legislation will increase that threshold to five percent which will be helpful grantees must deal with the basic grant management activities but they also must deal with the state budget factors such as hiring freezes that make it difficult for granted to account for funds down to very very small margins due to these rules between two thousand and eight and two thousand and nine ohio experienced a loss of over two point two million dollars in funds and in these tough economic times we have to do all that we can to give ryan white grantees a chance to succeed while making sure that they are using the funds appropriately and finally i want to speak briefly on a subject that's important to the ohio aids community but is not part of this reauthorization and estimated one hundred thousand people living with hiv and aids rely on medicare for their services and drugs hiv aids drugs rarely have loveland's and are extremely expensive for that reason medicare beneficiaries quickly find themselves in the party donut hole where they must pay for one hundred percent of their entire drug costs until they hit the other side these patients often turn to state aids drug assistance programs for help purchasing their medications while in the coverage gap unfortunately patient payments under these programs are not included when calculating medicare out of pocket costs and as a result patients cannot access their medicare prescription drug coverage for the remainder of the year and they have to rely on these state programs to afford their prescription under america's affordable health choices act h r thirty two protect medicare beneficiaries in this situation and i hope that these provisions will remain in the health care initiative that we will enact this year and with that said today i look forward to the passage of the r white reauthorization in the subcommittee and backed by time thank you i think that completes the opening statements and unless there's anyone else out there ok let's move to the bill that the chair now calls up h r three seventy nine to the ryan white hiv aids treatment extension act of two thousand and nine in the clinical report the title of the bill h r thirty seven ninety two two i'm entitled twenty six of the public health service act to revise then the program for providing lifesaving care for those that objection the first reading the bill will be dispensed with without objection the bill is now open for amendment does anyone  wish to offer an amendment this time hearing none will move to voting on the bill i now move that the subcommittee on health forward h r three seven nine two to the full committee with the recommendation that the bill passed all those in favor will say all those opposed say no in the opinion the chair the eyes have it in the bill is favorably forwarded to the full committee i just would ask unanimous consent that the staff be authorized to make any technical conforming corrections of the bill moves forward and without objection that would be ordered the we do intend my understanding to hear this remark this up in full committee tomorrow at ten so i just want everyone to know that and unless there is any further you vote i can we include mr burgess in the  vote anyone else but we didn't have it we didn't have a recorded vote we didn't have a recorded vote so i guess there's really no reason to include you but we will mention that you were here mr this or very just said mr bates we're here along with everyone else ok without objection the meeting