Testimony on FY 2000 Budget Request
for the D.C. Department of Health
Committee on Human Services
APRIL 1, 1999
Councilmember Allen, Members of the Committee, and Fellow Citizens:
My name is Craig Howell. I am President of the Gay and Lesbian Activists Alliance (GLAA), the oldest continuously active gay and lesbian rights organization in this country. GLAA was founded 28 years ago this month. To celebrate the occasion, we are sponsoring our 28th Anniversary Reception on Thursday evening, April 22, from 6:30 to 8:30 p.m. at the Charles Sumner School. I hope you all will be able to attend.
Thank you for this opportunity to present some perspectives on the FY 2000 budget request for the D.C. Department of Health. Most of my remarks will be directed towards the budget for the Agency for HIV/AIDS (AHA) and for other agencies whose work is related towards AIDS prevention or treatment.
To start with a positive note, we congratulate Mayor Williams on his efforts to expand Medicaid coverage to some 39,000 D.C. residents without health insurance. That expansion should benefit many uninsured District residents who are HIV positive. This is the kind of reform that AIDS activists have been espousing for many years, and by taking this much-needed step the Williams Administration is certainly off to a good start.
Turning specifically to AHA, we would like to get a copy of AHA's budget line by line, detailing every federal dollar they anticipate getting, what the money is for, the anticipated amounts of each item, and when they expect to get that money out into the community for services with signed contracts and programs up and funded. AHA, in fact, should provide this committee with this very same information for FY 1998, and for at least the first quarter of FY 1999, if it has not already. We would also like to have the Committee make that information available to the public once it is received.
Like many others, we are puzzled by the proposed cut of $180,000 in the local AIDS budget for FY 2000. Even the Mayor himself was not aware of this proposal when questioned about it at his town meeting for the gay and lesbian community on March 24. As Mr. Williams said then: "I certainly don't want to undermine and reduce funding for HIV/AIDS. My whole career here in Washington has been about supporting and expediting services."
But according to the March 26 edition of The Washington Blade, AHA director Ron Lewis claims that, in the Blade's paraphrase, "the cuts were slated to come from funds earmarked for city contracts with community-based AIDS service groups.... Lewis said budget writers had yet to decide which contracts would be cut or reduced."
This simply will not do. The federal Ryan White Act requires that local jurisdictions uphold their "maintenance of effort" of local funds so that federal funds are not used to make up for cuts in local funds. In other words, any cutbacks in D.C.'s own funding will jeopardize our federal funding stream. And more fundamentally, there are many unmet goals at the local level that justify increases in D.C. funding for AIDS prevention and treatment, not decreases.
Thus, we hope this committee will step in to rectify the cutback in AIDS funding if, in fact, the Mayor himself doesn't step in and fix it first, as we suspect he will.
On a related matter, the AHA budget for FY 2000 foresees an increase of $970,000 in federal funding without explaining where that money is supposed to be coming from or what it is supposed to be used for. This Committee should get some answers on this point.
We are also wondering about the reasons for a proposed decrease in funding of about $430,000 from FY 1999 levels at Preventive Health Services for the prevention of sexually transmitted diseases. STDs are a co-factor for the spread of HIV/AIDS and are at epidemic levels in their own right. Does the funding cut reflect a failure by the Health Department to spend its available funds in prior fiscal years, a problem that has repeatedly beset the Department in recent years? This Committee should request data on how much was actually spent on this category, versus how much was appropriated, over the last several years to see if this is the source of the problem; if so, appropriate follow-up will be in order.
We also note an anticipated drop of $3,338,000 in AIDS prevention services. Are these cuts largely in federal funds? Combined with the cutbacks previously noted in STD prevention, this looks like a double whammy. While there have been great strides in treatment with protease inhibitors, we have not made corresponding strides in HIV/AIDS prevention at all; in fact, we are barely holding our own.
Turning to other AIDS-related issues within the Department of Health, we want to commend the Mayor for his evident determination to reverse the long-standing budgetary neglect of substance abuse prevention and treatment. As you know, substance abuse is an important co-factor in the spread of HIV/AIDS and is a factor in the relative health of people living with HIV/AIDS. Mr. Williams' commitment marks a refreshing contrast to the disinterest of his predecessor, who of all people should have appreciated the vital role of prevention and treatment of substance abuse.
At the same time, we note with alarm that the anticipated federal component of the Addiction Prevention and Recovery Administration is slated to decline by $1,519,000 in FY 2000. It is not clear why a cutback in federal funding is expected. Are there federal grants that we do not expect to get or to be eligible for? Or have there been cuts in federal funding availability that are now impacting the District? The Department of Health should be pursuing federal funds as aggressively as possible, and we trust this Committee will exercise appropriate oversight to ensure that this happens.
One final issue I want to address is the need to allow for the funding and implementation of a needle exchange program in FY 2000 with the District's own money. This was to have been started in the current fiscal year under the terms of the District's FY 1999 budget submission to Capitol Hill, but then Congress arbitrarily cut it out. A major battle was fought last fall to keep that needle exchange program intact, involving many groups at both the local and national levels. We are prepared to fight that battle again, with renewed hope for success in light of the accumulating mountain of evidence that needle exchange programs effectively limit the spread of AIDS without encouraging drug abuse in the process. The latest study verifying this was published within the last week from Baltimore.
Nothing is explicitly said about a needle exchange program in the proposed FY 2000 budget. This Committee, and the Council as a whole, should make its endorsement of such a program explicit; whether it requires a separate line item is not clear to us at this point. We urge you to look at last year's budget submission to make sure that the FY 2000 budget going to Congress will allow for a needle exchange program in the same way that last year's did.
Thank you. I would be glad to answer any questions you may have.