Sen. Coburn Says He Might Block PEPFAR Reauthorization Bills

Main Category: HIV / AIDS
Article Date: 07 Apr 2008 - 6:00 PDT

email to a friend   printer friendly   view / write opinions   rate article

Sen. Tom Coburn (R-Okla.) has said in a letter that is circulating among senators that he might block attempts to pass both House and Senate bills (HR 5501, S 2731) that would reauthorize the President's Emergency Plan for AIDS Relief, CQ Today reports. Coburn plans to send the letter, which asks for support from other senators, to Senate Minority Leader Mitch McConnell (R-Ky.).

Coburn in the letter wrote that the PEPFAR reauthorization bills "contain dramatic policy reversals coupled with irresponsible spending levels," adding that the "combination prevents our support for reauthorization of the program that, until now, has been a rare model of foreign aid success." Coburn added that he wants to preserve a requirement in the existing law that 55% of PEPFAR funding be spent on treatment for HIV/AIDS and prevention of mother-to-child transmission. He has introduced a bill (S 2749) that would maintain the requirement and expand HIV testing.

Sen. Jim DeMint (R-S.C.), who signed the letter, said he believes the PEPFAR reauthorization measures represent the "height of irresponsibility in the middle of a war and surging debts" because they "dramatically increas[e] the cost and scope of the program." Coburn's spokesperson John Hart emphasized that Coburn is committed to reauthorizing the program but "wants to ensure that they money is directed to people that need the assistance." Hart added that the new versions would "take the focus off of widows and orphans and put it on consultants and program officers."

An unnamed congressional aide added that the senators who are supporting Coburn's letter are more concerned about a lack of accountability and "mission creep" in the new versions than the spending levels. The aide said the letter's support is not driven by a "knee-jerk opposition to foreign aid" (Graham-Silverman, CQ Today, 4/3).

House, Senate Bills
The Senate version of the bill passed the Foreign Relations Committee last month and is awaiting floor consideration. The House version was approved 308 to 116 earlier this week (Kaiser Daily HIV/AIDS Report, 4/3). Both the Senate and House versions of the bill would reauthorize PEPFAR at $50 billion over five years. President Bush had called on Congress to reauthorize the program at $30 billion over five years.

Both bills would remove a requirement that at least one-third of HIV prevention funds that focus countries receive through PEPFAR be used for abstinence-until-marriage programs. They also would retain the requirement that PEPFAR recipients pledge opposition to commercial sex work. Both versions would require a report to Congress if abstinence and fidelity programs account for less than 50% of prevention spending in each PEPFAR focus country.

In addition, the Senate version includes a requirement that 10% of funds be allocated for services aimed at AIDS orphans and other vulnerable children. It also includes a provision that would lift some U.S. HIV/AIDS-related travel restrictions. Included in the $50 billion allocated by the Senate version are $4 billion for tuberculosis programs and $5 billion for malaria efforts worldwide. The House bill would allow groups to use PEPFAR funding for HIV testing and education in family planning clinics but not for contraception or abortion services. The Senate version does not mention family planning (Kaiser Daily HIV/AIDS Report, 3/14). The House version would add Lesotho, Malawi and Swaziland as PEPFAR focus countries; include clean water programs; encourage countries to work with historically black colleges to improve their health infrastructures; and expand inspector general authority. In addition, the bill would add 14 Caribbean countries to the program and include $9 billion for TB and malaria efforts. That amount also would underwrite food supplements for people living with HIV/AIDS. The bill would provide loans to women widowed by the disease or ostracized because of their HIV-positive status. Of the $41 billion specifically allocated for HIV/AIDS under the House measure, up to $2 billion would be included annually for the Global Fund To Fight AIDS, Tuberculosis and Malaria. The bill limits U.S. contributions to the Global Fund to one-third of total contributions (Kaiser Daily HIV/AIDS Report, 4/3).

Related Editorial
Bush's "leadership in fighting disease and poverty" in Africa "culminated" Wednesday when the House passed its version of the PEPFAR reauthorization bill, a Los Angeles Times editorial says. The House's approval "marks a dramatic shift in the United States' attitude toward foreign aid," the editorial says.

According to the Times, the U.S. has "supported big international disease-eradication in the past," but "never with such an enormous financial commitment." Although there are a "few flaws" in the bill, it "gives Americans a good reason to be deeply proud of their country, a feeling" many U.S. citizens have not "experienced in a while," the editorial concludes (Los Angeles Times, 4/4).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.