March 6, 2024

The Federal Budget and Threat to Funding

Congressional leaders have agreed to a funding deal that prevented a partial shutdown of the federal government last weekend, extending dates for FY 2024 until later in March as lawmakers decide the final details of a $1.7 trillion plan.

Congress has passed four short-term spending bills since September of last year. Under a new agreement between leadership, funding for six departments–including Commerce, Justice, and Interior–would expire on March 8, a week later than originally planned. Funding for the rest of the government would be extended until March 22.

The current makeup of Congress has made compromise on a budget almost impossible to achieve. A slim majority of Republicans control the House of Representatives, while a razor-thin majority of Democrats control the Senate. This has set up a clash between houses and their respective versions of appropriations bills. The Senate’s proposed bill for Labor, Health, Human Services and Education maintains the Ending the HIV Epidemic (EHE) initiative and other HIV funding. The House-proposed bill would make draconian cuts to domestic programs, zeroing out the Centers for Disease Control and Prevention’s (CDC) portion of the EHE funding and drastically reducing HIV funding for the Health Resources and Services Administration.

Choose the Right Strategy for Advocacy  

It appears less and less likely that there is any middle ground between hardline conservatives advocating for massive cuts and progressives fighting to maintain access to social services, vital health care and other programs. HIV funding is at risk in this political climate and health care providers must advocate to pressure their congressional representatives to maintain level funding for HIV programs.

If reluctant representatives are to be effectively engaged, advocates must be deliberate in choosing their messaging strategy. The nature of communications with representatives should take into consideration the political realities of each local and state constituency. Here are three strategies for three different realities.

Economics Strategy (“HIV care is a good investment”)  

For those in very conservative districts, economic arguments appear to be most effective. These narratives should take a dollars and sense approach to domestic policy. For example:

• The value of preventing disease far surpasses our investment in health infrastructure. The COVID-19 pandemic exposed the inadequacies in our public health system and demonstrated the need for stronger and more stable funding streams. If our local, state and federal health professionals were better funded, they could better prevent and treat HIV/AIDS in our country.
• Treatment of chronic disease constitutes a significant portion of public insurance. And improving prevention would result in significant cost savings.
• Chronic disease also impacts the affordability of private health care coverage. Since 2000, health insurance premiums for employer-sponsored family coverage have increased by 87 percent. Health care costs for people with a chronic condition average $6,032 annually–five times higher than those without such conditions.

Public Health Strategy (“Ending the Epidemic is working”) 

For those in moderate districts, public health approaches are likely to be effective. In this strategy, advocates should be prepared to demonstrate how EHE and other HIV programs are preserving our general health and keeping Americans out of the emergency rooms. These conversations should center on general health, access and general health outcomes:

• To achieve the goals of the EHE established by former President Donald Trump, the domestic HIV programs must have solid funding in Fiscal Year 2024.
• To make progress in ending the epidemic, greater investments are needed to reduce the rate of new HIV infections, to reduce hospital and emergency room visits and to improve treatment outcomes.

Social Justice Strategy (“Slashing HIV funding is unethical”) 

For those in more progressive districts, all options are available, but also consider that these areas may be where new health equity champions are found. Advocates who have the ability to show how their work has helped reduce stigma and health disparities and improve social justice are likely to be heard. These conversations should center marginalized populations and communities that are highly affected by health disparities.

• The proposed cuts to domestic HIV programs that were included in the House Labor, Health and Human Services (LHHS) Appropriations bill for FY 24 would eliminate several necessary programs.
• These proposed $767 million in cuts would eliminate funding for the Minority AIDS Initiative, Part F of the Ryan White HIV/AIDS program and the entire EHE initiative.
• There are an estimated 1.2 million Americans with HIV. But the health impact on minorities is heavier than any other group.
• The proposed House LHHS bill also calls for the funding of the Minority HIV/AIDS fund to be reduced by 53 percent, while Black Americans account for 40 percent of all new HIV diagnoses. Minorities now represent the majority of new HIV diagnoses, people with HIV and deaths among people with HIV.

HIV Health Care is Public Health Care

The COVID-19 pandemic interfered with our ability to reach our EHE goals as planned. However, missed preventive screenings and delayed treatment of existing diseases have created a debt in our national health that will come due soon, especially for those with HIV or other chronic conditions.

Today only a fraction of our health care funding supports prevention. We need more diverse, cost-effective strategies that work for prevention and early detection of HIV and all chronic diseases, including diabetes, heart disease and stroke. We cannot afford to lose substantial investment in the CDC, state health departments or Health and Human Services agencies.

Slashing public health funding will also increase the wealth gap while worsening racial disparities in our country. Further, abolishing the EHE initiative could leave thousands of people without HIV care and tens of thousands without access to pre-exposure prophylaxis.

This is not the time for us to retreat in our battle against HIV. Congressional representatives are often unaware of how their decisions affect people on the ground. Proposed funding cuts to HIV programming are no exception. It is imperative that each of our members who are concerned about how their work will be affected reaches out to their representatives; each member should tell their story and show how these funding cuts will directly affect policy makers’ constituents. This will help garner the attention of Congressional representatives.

This budget crisis presents an opportunity for stakeholders on the sidelines of this political process to get involved and reach out to their representative at this important time. The Public Policy Department can offer whatever assistance you require in order to make this process as simple as possible. Please reach out at your earliest convenience so that your representatives can hear directly from you.