July 21, 2021

U.S. House Appropriators Prioritize Investments in HIV Prevention and Care

Appropriators in the U.S. House of Representatives began debate on individual spending bills, and are signaling an even larger investment in ending the HIV epidemic than what is currently in the President’s budget proposal. Readers will recall that the Biden-Harris administration requested historic investments in public health. House appropriators responded with even more boosts in critical funding.

Some key differences:

• Centers for Disease Control and Prevention (CDC): The House Labor, Health and Human Services, and Education Appropriations Subcommittee bill allocates $69.5 million – a $56.5 million increase – to CDC’s Infections Diseases and Opioid Epidemic program to expand access to syringe services programs (SSPs). If passed in the final budget, this funding would be the first time SSPs are funded explicitly in an annual federal appropriations bill, and it would be the largest amount of funding ever allocated by the federal government to SSPs. The House kept with the President’s budget by also removing the dangerous and antiquated “syringe rider” – allowing for the use of federal funding for syringes and other safe-injection equipment.
• The House appropriations bill also includes $44.5 million for viral hepatitis within the CDC budget, which represents a $5 million increase over FY’21. While this increase is somewhat nominal, it is larger than the level funding proposed in the President’s budget.
• Health Resources and Services Administration (HRSA): The House bill calls for an increase of $231 million in the Ryan White Program, an increase of $100 million more than the President’s budget. The $231 million accounts for funding increases in Parts A ($42 million), B – Care ($72 million), D ($5 million), and F (AETCs: $11 million, Dental: $2 million, Special Projects of National Significance: $5 million).
• Appropriators added “report language” on the 340B Drug Discount Program to the bill which offers more detailed guidance to departments and agencies than just the spending bill alone. Specifically, the language is intended to address the current uncertainty that exists within the program by directing HRSA to use all its available authority to rein in drug company overcharges.
• National Institutes of Health (NIH): The House bill requests another $200 million for the NIH-sponsored Centers for AIDS Research, an increase of $3.29 billion.
• Housing and Urban Development (HUD): The House Transportation, Housing and Urban Development Appropriations Subcommittee bill requests $600 million for the Housing Opportunities for Persons With AIDS (HOPWA) program. Readers may recall that the President’s budget requested a disappointing increase of just $20 million. House Appropriators have recommended an overall increase of $170 million over last fiscal year.

These appropriations bills are truly historic in their investment in ending the HIV epidemic. However, it’s also important to remember that there is still a long road ahead before passage. In the backdrop are issues such as the debt ceiling (the limit on the government’s spending authority), which will either need to be raised or suspended, and the Democrats’ plan for a reconciliation bill that will likely include a number of healthcare related items such as drug pricing reform. Also forthcoming are the Senate’s appropriations bills, which we anticipate will be more conservative. While deadlines loom and political pressures mount, the Academy will continue to be vocal advocates on behalf of our members to ensure that funding increases to levels necessary to effectively end the HIV epidemic.