Part I: Federal HIVAIDS Funding

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Part I Federal HIV/AIDS Funding The First
Obama Budget Request Part II Where is America on
HIV/AIDS? Results of a National Survey
Presentation at Annual ConnectHIV Grantee
Conference Sponsored by The Pfizer
Foundation Baltimore, MD May 27, 2009 Jen
Kates, Kaiser Family Foundation
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The Federal Budget for HIV/AIDS
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FIGURE 1
The Federal Budget Process

• Presidents Budget Submitted to Congress
• First Monday in February

Congressional Budget Resolution
OR
Discretionary spending allocated to the
Appropriations committees

• Budget Reconciliation
• - Senate Finance, House Commerce, House Ways
  Means, and other committees report changes to
  House/Senate budget committees
• - Changes compiled into one bill
• - Bill considered by House/Senate and negotiated
  in conference
• - Bill signed by the President

• Annual Appropriations
• - House and Senate Appropriations committees
  sub-allocate spending to their subcommittees
• - Bills considered by House/Senate and negotiated
  in conference
• - Bills signed by the President

Fiscal Year begins October 1
Sources Congressional Budget Act of 1974, as
amended Oleszek, Congressional Procedures and
the Policy Process, 2001
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FIGURE 2
Discretionary Spending

• Spending that is up to the Congress to decide
  each year provided through annual federal
  appropriations bills (appropriations committees
  have jurisdiction over spending)
• In any single year, it can be from zero to 100
  of the level authorized in law for each program.
• The presumption is that the money will not be
  there unless the Congress acts to provide it.
• Funding does not necessarily match number of
  people in need or cost of services capped
  budgeting by dollars

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FIGURE 3
Mandatory Spending

• Spending that is promised in statute for an
  ongoing period, part of permanent law,
  automatic (entitlement spending), legislative
  committees have jurisdiction over spending)
• In any single year, it will be enough to meet the
  promise of the statute.The presumption is that
  the money will be there unless the Congress acts
  to change the promise in statute.
• Funding matches number in need of care and their
  cost of care not capped Budgeting by goods and
  services

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FIGURE 4
The First Obama Budget Request to Congress

• Unusual year change in Administration
• FY 2010 budget request outline introduced in
  February 2009, but no detail
• Detailed FY 2010 budget request introduced in May
  2009
• Congressional budget resolution already passed in
  April (before detailed budget was released)
• Now, appropriations funding levels will be
  determined 302(b) allocations to each
  sub-committee determines how much each has to
  spend
• Final spending levels? Fall 2009? Early 2010?

Sources OMB CBO Westmoreland T, Health Policy
and the Federal Budget Process (kaiseredu
Tutorial), 2006.
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FIGURE 5
Federal Funding for HIV/AIDS, FY 2006- FY 2010
US Billions
Source Kaiser Family Foundation analysis of data
from OMB. FY 2010 is proposed budget request
only and does not reflect final amounts.
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FIGURE 6
Federal Funding for HIV/AIDS by Category, FY 2010
Budget Request
US Billions
Total 25.9 billion
Source Kaiser Family Foundation analysis of data
from OMB. FY 2010 is proposed budget request
only and does not reflect final amounts.
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FIGURE 7
Federal Funding for HIV/AIDS Mandatory
Discretionary, FY 2010 Budget Request
US Billions
Total 25.9 billion
Source Kaiser Family Foundation analysis of data
from OMB. FY 2010 is proposed budget request
only and does not reflect final amounts.
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FIGURE 8
What are the Discretionary and Mandatory Programs?
Discretionary
Mandatory

• Global
• Domestic
• Prevention (CDC, other agencies)
• Some care/treatment (Ryan White, VA, SAMHSA)
• Housing
• Minority AIDS Initiative
• Research
• Other

• Medicaid
• Medicare
• SSI
• SSDI
• FEHB

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FIGURE 9
Discretionary Federal Funding for HIV/AIDS,
Domestic Global Shares, FY 2006- FY 2010
US Billions
9.7
11.1
12.7
13.5
13.8
Source Kaiser Family Foundation analysis of data
from OMB. FY 2010 is proposed budget request
only and does not reflect final amounts.
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FIGURE 10
Federal Funding for Ryan White, FY 2006- FY 2010
US Billions
Source Kaiser Family Foundation analysis of data
from OMB. FY 2010 is proposed budget request
only and does not reflect final amounts.
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FIGURE 11
Federal Funding for Prevention at CDC (NCHHSTP),
FY 2006- FY 2010
US Millions
Source Kaiser Family Foundation analysis of data
from OMB. FY 2010 is proposed budget request
only and does not reflect final amounts.
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FIGURE 12
Federal Funding for SAMHSA, FY 2006- FY 2010
US Millions
Source Kaiser Family Foundation analysis of data
from OMB. FY 2010 is proposed budget request
only and does not reflect final amounts.
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FIGURE 13
Federal Funding for HOPWA, FY 2006- FY 2010
US Millions
Source Kaiser Family Foundation analysis of data
from OMB. FY 2010 is proposed budget request
only and does not reflect final amounts.
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Part II Select Findings from the Kaiser Family
Foundations 2009 National Survey of Americans on
HIV/AIDS
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FIGURE 14
Trend in Share Naming HIV/AIDS as Most Urgent
Health Problem
Percent of the public naming HIV/AIDS as the most
urgent health problem facing the nation in an
open-ended question
Source Kaiser Family Foundation surveys
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FIGURE 15
Trend in Share Naming HIV/AIDS as Most Urgent
Health Problem By Race/Ethnicity
Percent naming HIV/AIDS as the most urgent health
problem facing the nation
Source Kaiser Family Foundation surveys
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FIGURE 16
Trend in Perceptions of AIDS as an Urgent Health
Problem Facing Community
Percent saying AIDS is a MORE URGENT problem for
their community now than it was a few years ago
Source Kaiser Family Foundation surveys
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FIGURE 17
Trend in Personal Concern About Becoming Infected
Percent who say they are personally very
concerned about becoming infected with HIV, and
percent of parents who say they are very
concerned about a son or daughter becoming
infected with HIV
Source Kaiser Family Foundation surveys
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FIGURE 18
Trend in Personal Concern by Race/Ethnicity
Percent who say they are personally very
concerned about becoming infected with HIV
Source Kaiser Family Foundation surveys
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FIGURE 19
Percent of All Groups Who Say They Have Heard A
Lot About AIDS in the U.S. Has Fallen Since 2004
Percent saying they have seen, heard, or read a
lot/some about the problem of AIDS in the United
States during the last year
A lot
Some
2004
83
African Americans
65
2009
2004
74
Latinos
2009
54
2004
68
Whites
40
2009
Source Kaiser Family Foundation Survey of
Americans on HIV/AIDS (conducted Jan. 26-March 8,
2009)
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FIGURE 20
Percent Who Report Knowing Someone With HIV/AIDS
Do you personally know anyone who now has AIDS,
has died from AIDS, or has tested positive for
HIV? Is that a family member, a close friend, an
acquaintance or co-worker, or someone else?
No
Yes, close friend or family member
Yes, acquaintance, co-worker, someone else
Total
African American
Latino
White
Note Dont know responses not shown
Source Kaiser Family Foundation Survey of
Americans on HIV/AIDS (conducted Jan. 26-March 8,
2009)
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FIGURE 21
Trend in Perceptions of U.S. Progress on HIV/AIDS
Thinking about the way the problem of HIV/AIDS
affects the United States today, do you think the
problem is about the same as it has been, that
the U.S. today is making progress in this area,
or that the U.S. today is losing ground?
Source Kaiser Family Foundation surveys
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FIGURE 22
Trend in Views of U.S. Spending on Domestic
HIV/AIDS
Thinking about the HIV/AIDS epidemic in the
United States specifically, in general, do you
think the federal government spends too much
money on HIV/AIDS, too little money on HIV/AIDS,
or about the right amount?
Note Dont know responses not shown.
Source Kaiser Family Foundation surveys
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FIGURE 23
Misconceptions About HIV Transmission
Percent who do not know that HIV CANNOT be
transmitted by (incorrect answers)
Sharing a drinking glass
Touching a toilet seat
Swimming in a pool with someone who is HIV
positive
Incorrect answer to at least one of the above
Includes True and Dont know responses.
Source Kaiser Family Foundation Survey of
Americans on HIV/AIDS (conducted Jan. 26-March 8,
2009)
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FIGURE 24
Misconceptions About HIV Prevention and Treatment
Percent who do not know the following statements
are true (Incorrect answers)
A pregnant woman with HIV can take drugs to
reduce the risk of her baby being born infected
There is no cure for AIDS at present
There are drugs that can lengthen the lives of
people with HIV
Percent who do not know the following statements
are false (Incorrect answers)
Magic Johnson has been cured of AIDS
There is a vaccine available to prevent people
from becoming infected with HIV
There are drugs available that can cure HIV and
AIDS
Includes False and Dont know responses.
Includes True and Dont know responses.
Source Kaiser Family Foundation Survey of
Americans on HIV/AIDS (conducted Jan. 26-March 8,
2009)
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FIGURE 25
Comfort With People Who Have HIV/AIDS
In general, how comfortable would you personally
be
Very comfortable
Somewhat comfortable
Somewhat UNCOMFORTABLE
Very UNCOMFORTABLE
Working with someone who has HIV or AIDS
If you children had a teacher who was
HIV-positive
Having a roommate who is HIV-positive
Having your food prepared by someone who is
HIV-positive
51
Asked of those who have children ages 21 or
younger. Note Dont know responses not shown.
Source Kaiser Family Foundation Survey of
Americans on HIV/AIDS (conducted Jan. 26-March 8,
2009)
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FIGURE 26
Relationship Between Stigma and Knowledge
Very or somewhat COMFORTABLE
Very or somewhat UNCOMFORTABLE
Percent saying they would be comfortable/uncomfort
able working with someone with HIV
Those who give correct answers about HIV
transmission
Those with any INCORRECT answer about HIV
transmission
Percent saying they would be comfortable/uncomfort
able having their food prepared by someone who is
HIV-positive
Those who give correct answers about HIV
transmission
Those with any INCORRECT answer about HIV
transmission
Source Kaiser Family Foundation Survey of
Americans on HIV/AIDS (conducted Jan. 26-March 8,
2009)
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FIGURE 27
Sources of Information About HIV/AIDS
Thinking about everything you know about
HIV/AIDS, does this information mainly come from
things youve seen and heard from
Asked of those who say media Would you say
most of the information you have about HIV/AIDS
comes from (percents shown based on total)
Some other source
Friends and family
Television
The media, such as radio, television, newspapers
and Internet
School
The Internet
Newspapers
Radio
Your doctor or other health professional
Media, unspecified
Source Kaiser Family Foundation Survey of
Americans on HIV/AIDS (conducted Jan. 26-March 8,
2009)