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Congressional Testimony
March 02, 2000
SECTION: CAPITOL HILL HEARING TESTIMONY
LENGTH: 2760 words
HEADLINE:
TESTIMONY March 02, 2000 SANDRA THURMAN DIRECTOR OFFICE OF NATIONAL AIDS POLICY
SENATE HEALTH, EDUCATION, LABOR & PENSIONS AIDS FUNDING
BODY:
Testimony by Sandra Thurman Director, Office
of National AIDS Policy Before the Senate Committee on Health,
Education, Labor, and Pension (HELP) March 2, 2000 Chairman Jeffords, Senator
Kennedy, and Members of the Committee. It is with mixed emotions that I appear
before you today. More than ten years ago - when we embarked on this journey
together - we had all hoped that this hearing would not be necessary. We yearned
to believe that a decade of slow but steady progress would produce a cure or a
vaccine - or that effective prevention efforts would reduce the rate of new
infections to nearly none. But the fact of the matter is - that while we have
much to celebrate today - our Surgeon General has just reminded us that the AIDS
pandernic is far from over. And in many ways - our job now grows more difficult,
as HIV/AIDS moves most rapidly among traditionally hard to reach populations -
women, young people, people of color, and the poor. HIV and AIDS has touched
communities in each and every state across this country. And in big cities and
rural towns - AIDS continues to devastate individuals, families, and
communities, leaving them impoverished, suffering and in dire need of medical
care and support. It is for this reason - and a host of others - that I come to
offer the strongest possible support from the President and the Administration
for this Committee's bipartisan effort to reauthorize the Ryan White CARE Act.
Since its inception, the CARE Act has literally been a lifeline for hundreds of
thousands of Americans in need. And over the years I have had the privilege to
witness its programs at work from a variety of different vantagepoints. As the
executive director of AID Atlanta, the oldest and largest AIDS service
organization in the South, I was honored to work with this Committee in 1989 on
the development of this vitally important legislation. As a recipient of Title I
and Title 2 CARE Act funds, I was proud to testify before this Committee in 1993
on the successes already taking hold as a result of your thoughtful action. And
now, as director of the White House Office of National AIDS Policy, I am pleased
to be able to come before you again as we chart our course forward - one which
seeks to make this great effort even better. The CARE Act has become a model for
health care delivery not only in the United States, but around
the world. It is a shining example of the good that can come from collaboration,
coordination, and concerted action. The CARE Act has brought together
Republicans and Democrats, cities and states, hospitals and community-based
organizations, providers and people living with AIDS - and the results are a
tribute to the power of public- private partnerships. It has created a continuum
of care that is both compassionate and cost-effective - one that saves both
lives and money. The CARE Act, taken as a whole, stitches together a tapestry of
services that enables us to not only respond to locally driven needs - but to
reflect the ever-changing face of AIDS. - Title 1 focuses on cities hardest hit
by this pandernic - providing relief to reduce pressure on already overburdened
public health systems and to create community-based and locally
controlled systems of care and support for thousands of individuals and
families. When the CARE Act was first passed there were 16 such hard hit cities.
Today there are 51; - Title 2 acknowledges that AIDS knows no geographic
boundaries. This title has enabled all states to develop consortia or systems of
care, to provide private health insurance, and to expand access
to essential drug therapies. - Title 3 helps to make primary care and early
intervention services available to particularly disenfranchised populations in
both rural and urban communities in cooperation with health
centers, hospitals, and health departments; - Title 4 focuses
much needed attention on the unique care and support needs of women, children,
and families; and, - Title 5 allows for special projects of national
significance, acting as a laboratory for demonstrating new and improved model
efforts. But this Act is so much more than the sum of its parts. As a whole, it
serves individuals and families in the most efficient and effective way
possible. This is not a one size fits all effort. The CARE Act gives each state
and community the flexibility they need to weave together a means of caring for
their own in a manner that is tailored to indigenous strengths and
circumstances. When the CARE Act was originally created we were sadly unable to
do much for those who were sick - and many of the services provided were
designed to help people die with dignity. Thankfully, much has changed. The CARE
Act is now solidly about lying with HIV and AIDS. Since the last
reauthorization, biomedical research has brought hope and renewed optimism with
the discovery of protease inhibitors and combination therapies. But without the
CARE Act, these cutting-edge therapies would have been about as meaningful to
many in Selma or the South Bronx as they currently are in South Africa. The CARE
Act has made the promise of biomedical research a reality in the lives of people
living with HIV and AIDS in every comer of this country. Last year alone,
approximately one hundred thousand people living with HIV and AIDS received
access to drug therapy because of the CARE Act. This is particularly important
given that half of the people served by the Act have family incomes of less than
$ 1 0,000 a year - and the new drug "cocktails" cost more than $12,000 annually.
And we know all too well, that the drugs alone are not enough. Primary care and
support services are vital to ensuring both access and adherence to these
complex drug regimens. It is this comprehensive package of essential services
that the CARE Act provides - and with impressive results. The CARE Act has
helped to: - reduce both the frequency and length of expensive in-patient
hospitalizations by at least 30%; - reduce AIDS mortality by 70%; - reduce
mother-to-child transmission of HIV by 75%; and, - enhance both the length and
quality of life for people living with AIDS. According to a study done by the
National Center for Health Statistics, between 1995 and 1997,
the nation has seen a 30% decline in HIV related hospitalizations - resulting in
nearly one million fewer HIV related hospital days. This represents a saving of
more than $1 billion - money much more effectively invested in enabling people
with HIV to live healthier and more productive lives. These positive outcomes
highlight why the Ryan White CARE Act reauthorization is so imperative. We stand
at a critical juncture in this pandemic - and we must be sure that the success
of the CARE Act does not breed complacency but constructive action.
Increasingly, the AIDS epidemic in the United States parallels the pandemic
globally - with more and more disenfranchised people caught in the crossfire.
Last year. the CARE Act served an estimated half million people living with HIV
and AIDS - and affected the lives of millions more. Nearly 6 in 10 of these
people were poor. They were also five times more likely to be
uninsured than those receiving care elsewhere, nearly 3 times
more likely to be African American, and 50% more likely to be women. Clearly the
CARE Act has followed the path paved by this epidemic - but challenges remain as
HIV and AIDS moves deeper into underserved communities already plagued by
poverty, homelessness, and substance abuse, and as treatment demands and costs
continue to rise. I am heartened to see that the Committee's bipartisan
reauthorization effort currently being developed is designed to retool and
upgrade existing CARE Act mechanisms to: - expand access to essential services,
particularly for vulnerable populations, - improve the quality of care; and, -
increase the accountability of the overall program. Surgeon General Satcher has
talked at length about existing health disparities - and this
Administration is firmly committed to moving on multiple fronts to eliminate
these disparities. Certainly, the CARE Act has a vitally important role to play
in that effort. I applaud the Committee for moving forward with proposals which:
- increase program planning and responsiveness; - create better CARE Act
provider linkages with emergency rooms, drug treatment programs and other places
that people in need may enter a system of care - and with Medicaid, CHIP, and
other potential payers; - develop capacity to deliver essential services in hard
to reach rural and urban areas; - create an incentive fund in the drug
reimbursement program to help remove existing barriers to drug therapy; and, -
move toward a more performance based - outcome oriented system. I believe that
these program enhancements - built on the CARE Act's firm foundation will lead
this vital effort - and the millions whose lives depend on it -- safely into the
future. We in the Administration look forward to working closely with all of you
to secure the swift reauthorization of this landmark legislation. In 1990,
shortly after Ryan White's death, this Committee chose to build a legacy in his
name. In so doing, the Committee Report read: "By dedicating this legislation to
Ryan, the Committee affirms its commitment to provide care, compassion, and
understanding to people with AIDS everywhere. Ryan would have expected no less."
Mr. Chairman and Members of the Committee - Ryan White changed our world - and
so has your gift in his name. As the Reverend Dr. Martin Luther King, Jr. once
said: "Everybody can be great, because anybody can serve. You don't have to know
about Plato and Aristotle to serve. You don't have to know Einstein's theory of
relativity to serve. You don't need to know the second theory of thermodynamics
to serve. You only need a heart full of grace and a soul generated by love." Mr.
Chairman, this Committee has demonstrated a heart full of grace in formulating.
passing. and now sustaining the Ryan White CARE Act. It is an act of service -
to people living with HIV and AIDS, to all-enduring American family values, and
to good government at its best. Thank you very much.
LOAD-DATE: March 7, 2000 
