Promises in the Plague: Passage of the Ryan White Comprehensive AIDS Resources Emergency Act as a Case Study for Legislative Action

Social work has many legitimate pursuits and fields of practice in which practitioners should be proficient. However, one of the profession's most important activities, legislative advocacy, is often neglected, in spite of the fact that the accrediting body for social work education, the Council for Social Work Education (CSWE), describes the profession's purpose as including political action, empowerment of groups at risk, organizational advocacy, and the pursuit of social and economic justice (CSWE, 1995). Several social workers have written about the need for the profession to embrace more fully its activist mission and its values concerning social and environmental change (Brieland, 1990; Ezell, 1994; Freire & Mock, 1990; Specht & Courtney, 1994; Wagner, 1990; Weick, 1993). Although social action was used successfully in the 1960s (Figueira-McDonough, 1993), policy analysis and legislative advocacy fell out of favor as a social work intervention in the 1970s and 1980s (Jansson, 1994). This may be because social workers are ambivalent about politics, naive about the lawmaking process, in awe of legislators, impatient with the slow rate of policy change, reluctant to engage themselves in political matters because they see these issues as diversions from microlevel practice, or uncertain that they can be effective in the confusing arena of politics (Alexander, 1982; Brieland, 1982; Mahaffey, 1982). Regardless of the causes, this hesitancy is unfortunate because progress in the direction of social justice and resource access requires that social workers be directly involved in the formation and modification of social policy and that policy practice be an intrinsic part of the social work identity. Because the construction of social welfare policy is often a political process, social workers must know how to successfully use legislative advocacy as an intervention, especially in the current conservative political climate (Dear & Patti, 1981; Ewalt, 1996; Figueira-McDonough, 1993; Jansson, 1994). This article presents a case study to illustrate a success story in this arena - that is, the passage of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 (P.L. 101-381). The strategies that contributed to securing federal funds for an issue which was then very controversial and unpopular can be used for other pressing social and political issues, such as the "reform" of welfare reform. OVERVIEW OF THE RYAN WHITE CARE ACT OF 1990 The Ryan White CARE Act of 1990 (P.L. 101-381) was the first and only comprehensive services delivery package addressing social services and medical care for people with HIV disease in the United States. The legislation created programs to enhance inpatient and outpatient care and to coordinate social services in the community (Congressional Information Service, 1990b). This government program began with a bill cosponsored by Senators Edward Kennedy (D-MA) and Orrin Hatch (R-UT), called the Comprehensive AIDS Resources Emergency (CARE) Act of 1990, which was introduced into Congress on March 7, 1990, (136 Cong. Rec. 1990, HR1) and signed into law by President Bush on August 18, 1990, only five months later (Congressional Quarterly [CQ] Almanac, 1990). Naming the act for Ryan White, an 18-year-old Indiana boy who was critically ill with AIDS at that time, was proposed on April 4, 1990, in a meeting of the Senate Committee on Labor and Human Resources (CQ Almanac, 1990). The measure, which was presented as a response to a national disaster or emergency, was passed quickly by both the House and Senate, authorized for five years, and appropriated approximately $220,500,000 per year (CQ Almanac, 1990). The strengths of the act include a community-based approach to decision making and authority, flexibility in delivery of services, services eligibility criteria that were above the poverty guideline, involvement of consumers in planning, access for low-income people, demonstration projects, support of the existing health care and services delivery system, and case management and advocacy (Congressional Information Service, 1990a). …