What the New Republican Congress Will Mean for AIDS Prevention, Treatment and Research
The Horror of ‘Block Grants’
On November 8, 1994 less than 25% of the American electorate voted for a new Congress dedicated to radically reducing the size of the federal government, attenuating its regulatory authority, and severely restricting its leadership role in our society. It is an understatement, and perhaps even inaccurate, to characterize the election as simply a shift in power from the center to the right; rather, it portends a shift in power from the federal government to the fifty states. This may be the most far-reaching result of electing an activist Republican majority in Congress. It remains unclear whether the electorate simply voted out of frustration with the perennial gridlock in Washington or if it truly wants to radically change the role of the federal government in our society. In either case, the consequences of this election are profound – and will be felt for years to come.
Led by Newt Gingrich and Bob Dole, the Republican leaders will move swiftly to enact their fiscal and social agenda before the electorate has a chance to assess the full significance of its actions. To reduce the size of the federal bureaucracy, rapid defunding of projects or even the wholesale elimination of entire departments and agencies will take place. The regulatory authority of the federal government in many areas may be turned over to the individual states or even privatized. Conservative think tanks are tripping over each other in their rush to think up ways to restructure the FDA, an early target for “streamlining.” (Imagine giving the Pharmaceutical Manufacturers Association oversight for drug testing and approval!) Indeed, the very process of law-making and budgetary approval in Congress is being restructured.
What does this mean for AIDS research, as well as prevention, care, and housing? Clearly, any program that does not fall under defense will come under close scrutiny. With the exception of social security, most entitlements will be targeted for major cuts. In the near-term, maintaining current funding levels for housing for people with AIDS will be difficult. Funding for prevention could be subjected to a litmus test emphasizing abstinence or some other moral code. While funding for AIDS care programs will probably be reduced, research could escape relatively unscathed for the next year or two.
To successfully protect federal AIDS funding, advocates and activists will need to pay close attention to the arcane rules of lawmaking, monitor the activities of Congress, from the committees to the floor votes, form coalitions with other disease advocacy groups, and be willing to rapidly respond to a hostile congressional majority. Of critical importance will be the changes to the congressional committee system. Most of the gritty work of Congress is conducted by the staff and takes place at the committee level rather than on the floor of the Senate or House. The greatest changes have occurred in the House of Representatives, where the conservative fervor has risen to a more fevered pitch than in its more deliberative counterpart. Committees are now chaired by Republicans. This is especially significant because it is the committee chair who excercises the leadership role in proposing and passing legislation. Usually, the majority party on the floor of the House will follow the lead of their respective committee chairs when voting on new legislation and appropriations.
Besides staff for each representative, there are staff of both parties assigned to each committee and subcommittee. Since the Democrats were the majority party and had more members on each committee, the staff hired by the Democrats was larger than the Republican committee staff. In the new 104th Congress, the staff for the Democrats has been greatly reduced and will have a weaker role in contrast to the newer, and sometimes inexperienced, staff selected by the Republican leadership. Thanks to Republican efforts to streamline Congress, committee membership will also be reduced. The ratio now favors Republicans, and because the committees are smaller, even fewer Democrats will serve on key committees. AIDS advocates have lost several allies in this process.
A potentially volatile change in House procedures is a rule change which would allow any proposed law to be challenged or amended on the floor of the House. In other words, any program that has made it through the arduous committee process can be changed by a mere voice vote on the floor of the House, or can have hostile amendments attached to it. Previously, most bills would not be challenged on the floor of the House after gaining subcommittee and full committee approval. This means that every program supported by remains vulnerable right up to the vote by the full House.
It is unclear how this rule will affect our efforts to influence legislation. The Republicans view the election as a mandate to reduce the size of the federal government by any means necessary and will move as quickly as possible in the first quarter of 1995 to do so. Under the ruse of cost-cutting their way to a balanced budget, the new congressional leadership has targeted a host of programs deemed unworthy of our tax dollars. The usual suspects on the list slated for reduction, restructuring or elimination are Education, EPA, NEA, DOE, HUD, FDA, among others. Of prime concern to the AIDS research, prevention, care and housing advocates are the NIH, the CDC, and HHS and HUD.
The methods for achieving their goals will vary, but priority will be placed upon quickest method that uses the least amount of political capital. Outright elimination of programs, agencies or departments will be attempted but may be politically the most difficult. The favored method will be to simply defund an agency. This avoids the nasty and time-consuming process of canvassing the votes for elimination while achieving the desired result. A third, and widely-used method, is “death-by-starvation.” The targeted program is funded at such a reduced level that it cannot fulfill its mandate. This is a time-tested method favored by politicians since they can “honestly” say to their constituents that they voted for a program knowing full well they cleverly found a way to quietly kill it.
A fourth, and perhaps most disruptive method, is to deregulate a program while maintaining hollow support for its mandate; the program continues to exist, but is stripped of all regulatory powers. The idea that health, safety or environmental regulations should be put to local “means testing” flies in the face of the reality of our shared needs as a species. Will viruses or other human pathogens behave differently from state to state?
A fifth method, currently in vogue, is the notion of divesting federal responsibilities by transferring funds to states via what are known as “block grants.” One popular proposal is to take the entire budget for a given department deemed worthy of retention, reduce it by at least 20%, then divide the remaining funds between the states. Each state can spend the money as it sees fit as long as it falls under a general category such as health, transportation, etc.
The Republican dominated Congress particluarly likes this approach because it can immediately reduce government spending and eliminate federal departments simultaneously. In general, the state governors, both Democratic and Republican, find aspects of this proposal appealing since it gives them more control without having to follow federally mandated guidelines. There is bipartisan ambivalence, however, about reducing federal grants to the states. In many cases, where federal programs were converted to block grants to the states, these grants remained static over the years while actually shrinking in real dollars because of inflation.
What must be done? The various AIDS advocacy groups must closely coordinate their efforts to avoid opposition tactics designed to set them against each other. It is vitally important that advocacy groups work together to maintain or increase funding for the various programs while knowing that some of the programs will be hit harder than others. AIDS housing and research funds come from different pots of federal money and cannot be played off against one another in the appropriation cycle. AIDS prevention and care, however, do come from the same federal source and often are pitted against one another. Also, different disease research programs compete from the same source for research dollars and can easily be set against one another. This tactic has been used in the past, and will likely be used again.
Grassroots support, centered in key congressional districts, can influence important legislation. Representatives will respond to their constituents and rely on their home district staff for input. Fortunately there is strong bipartisan support for biomedical research. Efforts of AIDS advocacy groups must insure that AIDS research spending increases by 5%, the same overall increase proposed for the NIH. Additionally, the Office of AIDS Research budgetary authority must be protected.
Under Newt Gingrich, the House Republicans are led by a forceful, articulate and experienced politician who unflaggingly expounds upon his vision of America’s future. Unfortunately, that future does not include as full citizens lesbians, gay men, people of color, the HIV infected, or welfare mothers… (the list goes on). In the Senate Republican leadership position, Bob Dole is equally articulate and experienced, with a polished, yet no less threatening demeanor. Meanwhile, Democrats remain in disarray with little coordination between Congress and the White House, and have embarked on a dangerous game of one-upmanship with the Republicans on tax cuts, while failing to see how utterly transparent their actions appear to the average American.
Interest groups will be pitted against one another during the coming months. Many other programs besides AIDS will take harder hits or be eliminated outright. Now is the time for clear thinking, cooperation, and a consistent but flexible strategy.