For other versions of this document, see http://wikileaks.org/wiki/CRS-RL30731
------------------------------------------------------------------------------
Order Code RL30731
AIDS Funding for Federal Government Programs:
FY1981-FY2009
Updated April 23, 2008
Judith A. Johnson
Specialist in Biomedical Policy
Domestic Social Policy Division
AIDS Funding for Federal Government Programs:
FY1981-FY2009
Summary
Federal government spending on HIV (the human immunodeficiency virus) and
AIDS (acquired immune deficiency syndrome) is estimated at $23.3 billion in
FY2008. Of the total, 63% is for treatment programs; research programs receive
13%; prevention programs receive 14%, and income support programs receive 10%.
The Administration's government-wide request level for all HIV/AIDS programs in
FY2009 is $24.1 billion.
AIDS programs within the Department of Health and Human Services (HHS)
account for 66% of the total amount spent on HIV/AIDS by the federal government
in FY2008, a total of $15.2 billion for both discretionary and entitlement programs.
Within the HHS discretionary budget, funding for HIV/AIDS research, prevention,
and treatment programs has increased from $200,000 in FY1981 to an estimated
$6.586 billion in FY2008; the Administration's request for FY2009 is $6.592 billion.
This report provides an overview of HHS spending on HIV/AIDS as well as
budget numbers for other federal government programs targeting HIV/AIDS. This
report is updated once per year to reflect the new budget figures.
Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
HHS Discretionary Funding: NIH, CDC, and HRSA . . . . . . . . . . . . . . . . . . . . . . 3
NIH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
CDC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
HRSA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
HHS Entitlement Funding: Medicaid and Medicare at CMS . . . . . . . . . . . . . . . . 5
Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Funding for Other AIDS Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
HIV/AIDS Minority Initiative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
International HIV/AIDS Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
List of Figures
Figure 1. Estimated Total Federal Spending on HIV/AIDS, by Function,
FY2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Figure 2. Estimated Total Federal Spending on HIV/AIDS, by Agency,
FY2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Figure 3. Estimated Federal Government Spending on HIV/AIDS
Treatment, FY2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Figure 4. HHS Spending on HIV/AIDS Programs . . . . . . . . . . . . . . . . . . . . . . . 14
Figure 5. HHS HIV/AIDS Spending, by Program/Function, as a Percentage of
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
List of Tables
Table 1. HIV/AIDS Minority Initiative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Table 2. HHS Discretionary Funding for HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . 9
Table 3. HHS Discretionary Funding for HIV/AIDS, by Agency . . . . . . . . . . . 10
Table 4. Total Federal Government Spending on HIV/AIDS, by Function . . . . 11
Table 5. Federal Government Spending on HIV/AIDS: FY1982-FY2009 . . . . 12
Table 6. Federal Government Spending on International HIV/AIDS Programs,
by Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
AIDS Funding for Federal Government
Programs: FY1981-FY2009
Introduction
Untreated HIV infection leads to a gradual deterioration of the immune system
and leaves affected individuals susceptible to the opportunistic infections and cancers
that typify AIDS. Since 1981, a cumulative total of 1,014,797 AIDS cases in the
United States and dependent areas have been reported to the Centers for Disease
Control and Prevention (CDC).1 Of this total, 448,871 persons were reported to be
living with AIDS as of the end of December 2006. In addition to the total number
of people living with AIDS, another 233,079 persons were known to be infected with
HIV (does not include data from five states and the District of Columbia; these areas
have not been reporting name-based HIV infection case numbers to CDC since at
least 2003).
Figure 1. Estimated Total Federal Spending on HIV/AIDS,
by Function, FY2008
Research
13%
Prevention
14%
Income Treatment
Support 63%
10%
Source: HHS Budget Office, March 20, 2008.
1
Data in this paragraph are from Table 3, p. 13 and Table 12, pp. 24-25 of the CDC,
HIV/AIDS Surveillance Report, 2006, vol. 18, at [http://www.cdc.gov/hiv/topics/
surveillance/resources/reports/].
CRS-2
Federal government AIDS spending is estimated at $23.3 billion in FY2008 (see
Table 5). The Bush Administration request for FY2009 is $24.1 billion. Of the total
amount spent by the federal government on HIV/AIDS in FY2008, the majority
(63%) of funding is for treatment programs; funding for research receives 13% of the
total (see Figure 1 and Table 4). The remaining amounts are for prevention
programs (14%) and income support for persons with AIDS (10%).
AIDS programs within HHS (Health and Human Services) account for 66% of
the total amount spent on AIDS by the federal government (see Figure 2). HHS
entitlement funding supports the treatment of HIV/AIDS patients through Medicaid
and Medicare, which are administered by the Centers for Medicare and Medicaid
Services (CMS). HHS discretionary funding supports AIDS research and prevention
programs, as well as treatment programs. Table 2 provides a history of HHS
discretionary funding for HIV/AIDS from the beginning of the epidemic in FY1981
to the present.
Funding for HIV/AIDS programs within HHS has increased markedly over the
past 15 years as measured in constant 2000 dollars, shown in Figure 4 near the end
of this report. Even though HHS has revised its estimates of spending by Medicaid
for FY2007 through FY2009, Figure 4 still shows that most of the overall rise can
be attributed to increased spending on Medicaid, Medicare, and treatment programs
in the discretionary budget, largely through the Ryan White program administered by
the Health Resources and Services Administration (HRSA). The increase in
HIV/AIDS research and prevention programs has been much less pronounced, and
their portion of the total amount spent by HHS on HIV/AIDS has declined over the
past 15 years (see Figure 5). For example, in FY1992 HIV/AIDS research and
prevention programs at HHS accounted for 51% of the total amount spent by HHS
on HIV/AIDS; by FY2008, such programs were about 27% of the total amount spent
by HHS on HIV/AIDS, reflecting the growing amounts spent on treatment services
under Medicaid and Medicare.
CRS-3
Figure 2. Estimated Total Federal Spending on HIV/AIDS,
by Agency, FY2008
Veterans Other
2% 2%
HHS
State Dept. Discretionary
20% 28%
USAID
2%
Social
Security
8%
HHS
Entitlement
38%
Source: HHS Budget Office, March 20, 2008.
Note: USAID, U.S. Agency for International Development. See Table 4.
About 90% of FY2008 HHS discretionary funding for HIV/AIDS is allocated
to three HHS agencies: the National Institutes of Health (NIH), which supports
HIV/AIDS research; CDC, which supports HIV/AIDS prevention programs; and,
HRSA, which administers the Ryan White program, an HIV/AIDS treatment
program (see Table 3 and Table 4). The budgets and activities of these three
agencies are briefly described below, followed by a discussion of entitlement
program spending on HIV/AIDS.
HHS Discretionary Funding: NIH, CDC, and HRSA
NIH
NIH is the principal agency of the federal government charged with the conduct
and support of biomedical and behavioral research. NIH conducts research at its own
27 institutes and centers and supports more than 200,000 scientists and research
personnel working at over 3,100 U.S. institutions. NIH funding for FY2008 was
provided in P.L. 110-161 (H.R. 2764), and NIH estimates FY2008 funding for AIDS
research at $2.913 billion. The Administration's request for FY2009 is $2.913
CRS-4
billion.2 Funding for AIDS research is distributed among the NIH institutes in
accordance with the scientific priorities identified in the annual comprehensive plan
for AIDS research developed by the institutes along with the Office of AIDS
Research (OAR).
OAR was established in statute by the National Institutes of Health
Revitalization Act of 1993 (P.L. 103-43) and given substantially enhanced authority
and responsibility beyond the office NIH had established under the same name.
Congress appropriated funds to OAR in FY1995. However, since FY1996, Congress
has not provided a direct appropriation for the OAR (aside from amounts identified
for the operations of the office itself). For FY2008, the House and Senate do not
specify a funding amount for AIDS research at NIH. Instead, funding for AIDS
research is included within the appropriation for each Institute/Center/Division of
NIH, with decisions as to specific projects to fund and levels of funding left to the
Director of NIH and the Director of OAR.
CDC
CDC works with community, state, national, and international public health
agencies to prevent HIV infection and reduce AIDS-associated morbidity and
mortality through its information and education programs. CDC also supports
research, surveillance, and epidemiology studies on HIV/AIDS. CDC distributes
much of its HIV funds to state and local agencies through cooperative agreements,
grants, and contracts. CDC funding for FY2008 was provided in P.L. 110-161 (H.R.
2764). According to the HHS Budget Office, CDC will be spending $872 million on
HIV/AIDS activities in FY2008; the Administration's request for FY2009 is $871
million.3
HRSA
The HIV/AIDS Bureau within HRSA administers the Ryan White program, a
four-part federal grant program designed to provide emergency relief and essential
health care services to patients infected with HIV. The program funds hundreds of
grantees that serve 531,000 people each year. The Ryan White HIV/AIDS Treatment
Modernization Act of 2006 (P.L. 109-415, H.R. 6143) reauthorized the Ryan White
program through September 30, 2009.
HRSA funding for FY2007 was provided in P.L. 110-161 (H.R. 2764).
According to the HHS Budget Office, HRSA will be spending $2.170 billion on
Ryan White program activities in FY2008. The Administration's request for FY2009
2
For additional information on OAR budget and research activities for FY2009, see
"Department of Health and Human Services, Fiscal Year 2009, Justification of Estimates
for Appropriations Committees, National Institutes of Health, Volume I, Overview," pp. 1-
17, at [http://officeofbudget.od.nih.gov/ui/2008/OAR.pdf].
3
For further information on the CDC HIV/AIDS budget and program activities, see
"Department of Health and Human Services, Fiscal Year 2009, Justification of Estimates
for Appropriations Committees, Centers for Disease Control and Prevention," pp. 61-78, at
[http://www.cdc.gov/fmo/PDFs/FY09_CDC_CJ_Final.pdf].
CRS-5
is $2.171 billion.4 (For further information on the Ryan White program, see CRS
Report RL33279, The Ryan White HIV/AIDS Program, by Judith A. Johnson.)
HHS Entitlement Funding:
Medicaid and Medicare at CMS
Medicaid
Medicaid is a federal-state matching entitlement program that provides medical
assistance for eligible low-income persons and families and certain aged, disabled,
and medically needy individuals. In order to obtain Medicaid coverage, persons must
belong to one of the categories of persons who can qualify for coverage (such as
families with children and disabled persons) and have low income or deplete their
income on the cost of their care. Medicaid has played an important role in needed
health care for persons with HIV and AIDS because of its coverage of prescription
drugs.
Within broad federal guidelines, each state designs and administers its own
Medicaid program, resulting in wide variations among the states in coverage, benefits
offered, and payment for services. The portion of a state's Medicaid budget provided
by the federal government varies from 50% in relatively affluent states to 80% in
poorer states. Medicaid is one of the largest source of federal funding for AIDS
treatment and health care services (see Figure 3).
For FY2008, the federal share of Medicaid spending on AIDS treatment is
estimated at $4.1 billion, and for FY2009, the federal share estimate is $4.4 billion.
Total FY2008 federal and state Medicaid spending for AIDS treatment will be an
estimated $7.2 billion ($4.1 billion federal and $3.1 billion state).5 CMS analysts
have significantly lowered their estimate of the federal share of Medicaid spending
on AIDS treatment due to two factors: (1) the impact of Medicare Part D prescription
drug coverage and (2) lowered per capita health care costs based on internal CMS
data and external data.6 However, a study by analysts outside of CMS found that
although "implementation of Medicare drug benefit resulted in a major shift of
prescription drug spending from Medicaid to Medicare ... spending for antiretroviral
medications decreased by a much smaller percentage than did spending for many
4
For more information on the HRSA Ryan White budget and program activities, see
"Department of Health and Human Services, Fiscal Year 2009, Justification of Estimates
for Appropriations Committees, Health Resources and Services Administration," pp. 163-
193, at [ftp://ftp.hrsa.gov/about/budgetjustification09.pdf].
5
Estimate based on average federal Medicaid assistance percentage (FMAP) for the nation
as a whole.
6
Personal communication, HHS Budget Office, April 17, 2008.
CRS-6
other classes. People with HIV and AIDS continue to depend heavily on Medicaid
to pay for their health care, as most do not qualify for Medicare."7
Figure 3. Estimated Federal Government Spending on HIV/AIDS
Treatment, FY2008
VA Other
3%
3%
Medicaid
State Dept. 28%
20%
Ryan
White
15% Medicare
31%
Source: HHS Budget Office, March 20, 2008.
Notes: Other includes the following: Substance Abuse and Mental Health; Public Health Emergency
Fund; Department of Defense; Bureau of Prisons; Federal Employee Health Benefits Program; Global
AIDS Trust Fund. See Table 3.
Medicare
Medicare is a federal health care insurance program for the elderly and certain
disabled persons. In general, in order to qualify for coverage under Medicare, a
person must be age 65 or older, disabled, or suffering from kidney failure (end-stage
renal disease or ESRD). According to one estimate, about 80% of beneficiaries with
HIV/AIDS that qualified for Medicare did so because of a disability,8 the remainder
7
Brian K. Bruen and Laura M. Miller, "Changes in Medicaid Prescription Volume and Use
in the Wake of Medicare Part D Implementation," Health Affairs, January/February 2008,
v. 27, pp. 196-202.
8
An HIV-positive individual must have a recognized AIDS-defining illness in order to meet
the disability classification.
CRS-7
were eligible because they were 65 or older or had ESRD.9 The elderly qualify the
month they turn 65, and those with ESRD qualify within three months of being
diagnosed with irreversible kidney disease requiring dialysis or a kidney transplant.
However, disabled people, including those with AIDS, must wait for a total of 29
months after a determination that they are disabled before they become eligible for
Medicare coverage.10
Early in the epidemic, few individuals with AIDS survived the long waiting
period. With improved drug therapies, the life expectancy of individuals with HIV
has increased, and it is expected that the number able to qualify for Medicare
coverage will continue to rise.11 The Medicare Prescription Drug, Improvement and
Modernization Act of 2003 (P.L. 108-173) provided for the implementation of a
prescription drug program, often called Medicare Part D, which became effective
January 1, 2006. CMS analysts have adjusted their estimate of Medicare spending
on AIDS treatment based on two factors: (1) the impact of Medicare Part D
prescription drug coverage and (2) lowered per capita health care costs based on
internal CMS data and external data.12 For FY2008, funding for the care of persons
with HIV/AIDS under Medicare is estimated to be $4.5 billion, and the estimate for
FY2009 is $4.8 billion.
Funding for Other AIDS Programs
HIV/AIDS Minority Initiative
In 1998 the White House announced a series of initiatives targeting appropriated
funds for HIV/AIDS prevention and treatment programs in minority communities.
The Congressional Black Caucus worked with the Clinton Administration to
formulate the approach. For FY2008, a total of $403 million is provided to continue
these activities. For FY2009, the Administration has requested $387 million. See
Table 1 below for further details.
9
Nancy Fasciano et al., Profile of Medicare Beneficiaries with AIDS: Application of an
AIDS Case Finding Algorithm, Executive Summary, October 14, 1999. Submitted by
Mathematica Policy Research, Inc.
10
Disabled people begin collecting Social Security disability cash benefits five months after
a determination that they are disabled and then must wait an additional 24 months for a total
of 29 months before becoming eligible for Medicare.
11
Combination drug therapies do not work for everyone with HIV. However, for individuals
who are successfully treated, the drug therapies will keep them healthy longer, thereby
preventing some from qualifying for disability.
12
Personal communication, HHS Budget Office, April 17, 2008.
CRS-8
Table 1. HIV/AIDS Minority Initiative
($ in millions)
Program FY2005 FY2006 FY2007 FY2008 FY2009
HRSA $129 $129 $131 $135 139
CDC 94 96 96 96 76
SAMHSA 112 112 111 112 112
Minority Communities Fund 52 52 52 51 52
Office of Minority Health 8 10 9 7 7
Office of Women's Health 1 1 1 2 1
Total, Minority HIV/AIDS Initiative 397 399 400 403 387
Source: Table prepared by the Congressional Research (CRS) based on analysis from the HHS
Budget Office, February 15, 2008.
Notes: Totals may not add due to rounding. FY2009 is based on the Administration's budget request.
International HIV/AIDS Programs
In January 2003, President Bush announced in the State of the Union speech a five-
year $15 billion program, the President's Emergency Plan for AIDS Relief
(PEPFAR).13 The five-year program targets countries with a very high prevalence
of HIV infection; its goals are to prevent 7 million new infections, provide treatment
to 2 million HIV-infected people, and provide care for 10 million HIV-infected
individuals and AIDS orphans.
The Global Fund to Fight AIDS, Tuberculous and Malaria, was first proposed
at the July 2000 G-8 Summit in Okinawa.14 Its purpose is to attract, manage and
disburse funding through a public-private partnership dedicated to the reduction of
infections, illness and death caused by these three diseases in countries in need. It
was established in January 2002 as a charitable foundation in Geneva, Switzerland;
the first round of grants was approved in April 2002. U.S. support of the fund occurs
through USAID and HHS.
As indicated in Table 6, federal government spending on international
HIV/AIDS programs in FY2008 is $5.8 billion; the Administration's request for
FY2009 is $5.9 billion.15
13
The U.S. Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003 (H.R.
1298, P.L. 108-25), signed into law on May 27, 2003.
14
Fact Sheet, Office of the Spokesman, U.S. Department of State, December 13, 2002, at
[http://www.state.gov/r/pa/prs/ps/2002/15583.htm].
15
For additional information, see CRS Report RL33771, Trends in U.S. Global AIDS
Spending: FY2000-FY2008, by Tiaji Salaam-Blyther; CRS Report RL33485, U.S.
International HIV/AIDS, Tuberculosis, and Malaria Spending: FY2004-FY2008, by Tiaji
Salaam-Blyther; CRS Report RL31712, The Global Fund to Fight AIDS, Tuberculosis, and
(continued...)
CRS-9
Table 2. HHS Discretionary Funding for HIV/AIDS
($ in thousands)
$ Increase over % Increase over
Year Funding prior year prior year
FY1981 $200 -- --
FY1982 5,555 $5,355 2,678%
FY1983 28,736 23,181 417%
FY1984 61,460 32,724 114%
FY1985 108,618 47,158 77%
FY1986 233,793 125,175 115%
FY1987 502,455 268,662 115%
FY1988 962,018 459,563 94%
FY1989 1,304,012 341,994 36%
FY1990 1,592,756 288,744 22%
FY1991 1,891,232 298,476 19%
FY1992 1,963,414 72,182 4%
FY1993 2,079,591 116,639 6%
FY1994 2,568,682 489,091 24%
FY1995 2,700,498 131,816 5%
FY1996 2,897,923 197,425 7%
FY1997 3,267,220 369,297 13%
FY1998 3,536,519 269,299 8%
FY1999 4,094,489 557,970 16%
FY2000 4,546,326 451,837 11%
FY2001 5,225,645 679,319 15%
FY2002 5,788,553 562,908 11%
FY2003 6,093,846 305,293 5%
FY2004 6,242,501 148,655 2%
FY2005 6,279,141 36,640 0.6%
FY2006 6,235,251 -43,890 -0.7%
FY2007 6,357,719 122,468 2%
FY2008 6,586,086 228,367 4%
FY2009 Request 6,592,399 6313 0.1%
Source: Table prepared by the Congressional Research Service (CRS) based on analysis from HHS
Budget Office, March 20, 2008.
Note: FY2009 is based on the Administration's budget request.
15
(...continued)
Malaria: Background, by Tiaji Salaam-Blyther; CRS Report RL34192, PEPFAR: From
Emergency to Sustainability, by Tiaji Salaam-Blyther; CRS Report RL32001, HIV/AIDS in
the Caribbean and Central America, by Mark P. Sullivan; and CRS Report RL33584, AIDS
in Africa, by Nicolas Cook.
CRS-10
Table 3. HHS Discretionary Funding for HIV/AIDS, by Agency
($ in thousands)
Agency FY2000 FY2001 FY2002 FY2003 FY2004a FY2005a FY2006 FY2007 FY2008 FY2009
FDA $76,317 $75,818 $75,818 $72,830 $73,847 $87,661 $88,758 $90,563 $94,425 $95,369
HRSA 1,599,231 1,815,000 1,917,200 2,024,962 2,066,861 2,075,296 2,064,705 2,141,195 2,170,192 2,171,312
IHS 3,770 3,810 3,886 3,940 4,013 4,074 4,261 4,437 4,587 3,629
CDC 687,164 859,045 931,141 936,426 862,854 855,535 838,225 879,241 872,427 871,314
NIH 2,004,428 2,247,015 2,499,458 2,716,218 2,849,952 2,920,551 2,901,859 2,905,788 2,913,345 2,913,345
SAMHSA 110,347 156,677 169,034 170,614 171,205 173,024 171,872 171,545 172,226 172,907
AHRQ 1,787 3,381 2,913 1,825 2,017 1,088 2,750 2,800 2,800 2,800
OS 63,282 64,899 64,103 67,681 62,637 62,712 63,821 63,150 61,325 61,723
Global AIDS Trust Fund -- -- 125,000 99,350 149,115 99,200 99,000 99,000 294,759 300,000
Total $4,546,326 $5,225,645 $5,788,553 $6,093,846 $6,242,501 $6,279,141 $6,235,251 $6,357,719 $6,586,086 $6,592,399
Source: Table prepared by the Congressional Research Service (CRS) based on analysis from HHS Budget Office, March 20, 2008.
Notes: FY2009 is based on the Administration's budget request. FDA: Food and Drug Administration; HRSA: Health Resources and Services Administration; IHS: Indian Health
Service; CDC: Centers for Disease Control and Prevention; NIH: National Institutes of Health; SAMHSA: Substance Abuse and Mental Health Services Administration; AHRQ:
Agency for Healthcare Research and Quality; OS: Office of the Secretary (includes the Office of HIV/AIDS Policy, Office for Civil Rights, Office of Minority Health, Office of
Women's Health and the Public Health and Social Services Emergency Fund/Minority Communities Fund); Global Aids Trust Fund: While budgeted in NIH, HHS contributions
to the Global Fund to Fight HIV/AIDS, Malaria, and Tuberculosis are not reflected in the NIH HIV/AIDS spending figures, but are accounted for separately.
a. CDC reported funding for HIV/AIDS expenditures have been comparably adjusted downward to reflect the new budget structure at CDC that excludes administrative and management
costs. The FY2004 adjustment was about $68 million, and the FY2005 adjustment was about $74 million.
CRS-11
Table 4. Total Federal Government Spending on HIV/AIDS, by Function
($ in millions)
FY2007 Actual FY2008 Enacted FY2009 President's Budget
Income Income Income
Agency/Department Research Prevent Treatmt support Total Research Prevent Treatmt support Total Research Prevent Treatmt support Total
FDA $91 -- -- -- $91 $94 -- -- -- $94 $95 -- -- -- $95
HRSA -- 3 2,138 -- 2,141 -- 3 2,167 -- 2,170 -- 3 2,168 -- 2,171
IHS 1 3 -- -- 4 1 3 -- -- 5 1 2 -- -- 4
CDC -- 879 -- -- 879 -- 872 -- -- 872 -- 871 -- -- 871
NIH 2,906 -- -- -- 2,906 2,913 -- -- -- 2,913 2,913 -- -- -- 2,913
SAMHSA -- 40 131 -- 172 -- 40 132 -- 172 -- 40 133 -- 173
AHRQ 3 -- -- -- 3 3 -- -- -- 3 3 -- -- -- 3
OS -- 11 -- -- 11 -- 10 -- -- 10 -- 10 -- -- 10
PH emergency fund -- 37 15 -- 52 -- 36 14 -- 51 -- 37 15 -- 52
Global AIDS trust fund 50 50 99 147 147 295 -- 150 150 -- 300
HHS discretionary $3,001 $1,024 $2,333 -- $6,358 $3,012 $1,114 $2,460 -- $6,586 $3,013 $1,114 $2,465 -- $6,592
CMS/Medicaid -- -- 3,900 -- 3,900 -- -- 4,100 -- 4,100 -- -- 4,400 -- 4,400
CMS/Medicare -- -- 4,200 -- 4,200 -- -- 4,500 -- 4,500 -- -- 4,800 -- 4,800
Subtotal, HHS $3,001 $1,024 $10,433 -- $14,458 $3,012 $1,114 $11,060 -- $15,186 $3,013 $1,114 $11,665 -- $15,792
Social Security -- DI -- -- -- $1,450 $1,450 -- -- -- $1,484 $1,484 -- -- -- $1,519 $1,519
Social Security -- SSI -- -- -- 420 420 -- -- -- 479 479 -- -- -- 490 490
Veterans Affairs 5 35 465 -- 505 5 35 500 -- 540 $3 $35 $607 -- 645
Defense Department. 26 10 58 -- 94 30 18 58 -- 106 23 10 58 -- 91
Agency for Int. Dev. -- 466 124 -- 590 -- 371 -- -- 371 -- 342 -- -- 342
Justice/Bureau of Prisons -- 2 19 -- 21 -- 2 19 -- 21 -- 2 19 -- 21
State Department -- 1,147 2,101 -- 3,248 -- 1,645 3,017 -- 4,662 -- 1,626 3,153 -- 4,779
Labor Department -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Education Dept. -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
HUD -- -- -- 286 286 -- -- -- 300 300 -- -- -- 300 300
OPM-FEHB -- -- 107 -- 107 -- -- 114 -- 114 -- -- 123 -- 123
Subtotal, Non-HHS $31 $1,660 $2,874 $2,156 $6,721 $35 $2,071 $3,708 $2,263 $8,077 $26 $2,015 $3,959 $2,309 $8,310
Total, federal
government $3,032 $2,684 $13,307 $2,156 $21,179 $3,047 $3,185 $14,768 $2,263 $23,263 $3,039 $3,130 $15,624 $2,309 $24,102
Source: Table prepared by the Congressional Research Service (CRS) based on analysis from HHS Budget Office, March 20, 2008.
Notes: HHS: Department of Health and Human Services; CMS: Centers for Medicare and Medicaid Services; DI: Disability Insurance; HUD: Department of Housing and Urban
Development; SSI: Supplemental Security Income; OPM-FEHB: Office of Personnel Management-Federal Employees Health Benefits.
CRS-12
Table 5. Federal Government Spending on HIV/AIDS: FY1982-FY2009
($ in millions)
HHS
CMS SS
DOJ- OPM-
Year Discretionary Medicaid Medicare DI SSI VA Defense AID Prisons State Labor HUD FEHB Education Total
1982 $6 -- -- -- -- 2 -- -- -- -- -- -- -- -- $8
1983 $29 10 -- -- -- 5 -- -- -- -- -- -- -- -- $44
1984 $60 30 -- 5 1 7 -- -- -- -- -- -- -- -- $103
1985 $109 70 5 10 3 8 -- -- -- -- -- -- -- -- $205
1986 $234 130 5 30 5 20 79 -- -- -- -- -- 5 -- $508
1987 $502 200 15 55 15 51 74 -- 1 -- 1 -- 8 -- $922
1988 $962 330 30 95 20 78 53 30 1 -- 1 1 13 1 $1,615
1989 $1,304 490 55 150 35 136 86 40 2 1 1 -- 22 -- $2,322
1990 $1,592 670 110 184 55 220 124 71 5 1 1 -- 37 -- $3,070
1991 $1,891 870 180 266 95 258 127 78 5 1 1 -- 61 -- $3,833
1992 $1,967 800 400 372 150 279 125 94 5 1 1 48 103 -- $4,345
1993 $2,079 1,000 600 481 200 299 155 117 5 1 1 100 175 -- $5,213
1994 $2,569 1,300 800 568 250 312 127 115 6 1 1 156 193 -- $6,398
1995 $2,700 1,500 1,000 631 250 317 110 120 6 1 1 171 212 -- $7,019
1996 $2,898 1,800 1,100 684 250 331 98 115 6 -- 1 171 226 -- $7,680
1997 $3,267 2,200 1,300 738 275 350 84 117 7 -- 2 196 241 -- $8,777
1998 $3,537 2,600 1,400 787 305 378 95 121 7 -- 2 204 253 -- $9,689
CRS-13
HHS
CMS SS
DOJ- OPM-
Year Discretionary Medicaid Medicare DI SSI VA Defense AID Prisons State Labor HUD FEHB Education Total
1999 $4,094 2,900 1,500 828 330 401 86 139 7 -- 2 225 266 1 $10,779
a
2000 $4,546 3,300 1,700 870 370 345 97 200 8 -- 2 232 279 1 $12,025
2001a $5,226 3,700 1,900 919 340 405 108 430 15 -- 11 257 292 1 $14,184
2002 $5,789 4,200 2,050 961 390 391 96 510 16 -- 11 277 297 -- $14,988
2003 $6,094 4,800 2,400 1,019 395 396 82 774 17 141 11 290 321 -- $16,739
2004 $6,243 5,400 2,600 1,050 415 402 105 963 17 638 11 295 343 -- $18,481
2005 $6,279 5,700 2,900 1,250 450 445 110 633 20 1,376 2 282 370 -- $19,817
b b
2006 $6,235 3,600 3,900 1,365 440 468 102 621 21 1,977 -- 286 100 -- $19,116
2007 $6,358 3,900b 4,200b 1,450 420 505 94 590 21 3,248 -- 286 107 -- $21,179
b b
2008 $6,586 4,100 4,500 1,484 479 540 106 371 21 4,662 -- 300 114 -- $23,263
2009 $6,592 4,400b 4,800b 1,519 490 645 91 342 21 4,779 -- 300 123 -- $24,102
Source: Table prepared by the Congressional Research Service (CRS) based on analysis from HHS Budget Office, March 20, 2008.
Notes: FY2009 is based on the Administration's budget request. May not add due to rounding. HHS: Department of Health and Human Services; Discretionary AIDS budget; CMS:
Centers for Medicare and Medicaid Services; SS: Social Security; DI: Disability Insurance; SSI: Supplemental Security Income; VA: Veterans Affairs; AID: U.S. Agency for
International Development; DOJ-Prisons: Department of Justice, Bureau of Prisons; HUD: Department of Housing and Urban Development; OPM-FEHB: Office of Personnel
Management-Federal Employees Health Benefits.
a. FY2000 total includes $75 million for the HRSA Ricky Ray Hemophilia program, and FY2001 total includes $580 million for the HRSA Ricky Ray Hemophilia program.
b. Medicaid and Medicare amounts have been revised due to the impact Medicare Part D prescription drug coverage and lowered per capita health care costs.
CRS-14
Figure 4. HHS Spending on HIV/AIDS Programs
16000
14000
12000
10000
8000
6000
4000
2000
0
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Discretionary: Research Discretionary: Prevention Discretionary: Treatment Medicaid Medicare
Source: HHS Budget Office, March 20, 2008.
Note: FY2009 is based on the Administration's budget request.
Figure 5. HHS HIV/AIDS Spending, by Program/Function, as a
Percentage of Total
100%
80%
60%
40%
20%
0%
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Discretionary: Research Discretionary: Prevention Discretionary: Treatment Medicaid Medicare
Source: HHS Budget Office, March 20, 2008.
Note: FY2009 is based on the Administration's budget request.
CRS-15
Table 6. Federal Government Spending on International HIV/AIDS Programs, by Function
($ in millions)
FY2007 Actual FY2008 Enacted FY2009 President's Budget
Agency/Department Research Prevent Treatment Total Research Prevent Treatment Total Research Prevent Treatment Total
Centers for Disease Control -- 121 -- 121 -- 119 -- 119 -- 119 -- 119
National Institutes of Health 362 -- -- 362 364 -- -- 364 366 -- -- 366
Global AIDS trust fund -- 50 50 99 -- 147 147 295 -- 150 150 300
Subtotal, HHS $362 $170 $50 $582 $364 $266 $147 $777 $366 $269 $150 $785
Defense Department -- -- -- -- -- 8 -- 8 -- -- -- --
Agency for International
Development -- 466 124 590 -- 371 -- 371 -- 342 -- 342
State Department -- 1,147 2,101 3,248 -- 1,645 3,017 4,662 -- 1,626 3,153 4,779
Labor Department -- -- -- -- -- -- -- -- -- -- -- --
Subtotal, Non-HHS -- 1,613 2,225 3,838 -- 2,024 3,017 5,041 -- 1,968 3,153 5,121
Total $362 $1,784 $2,275 $4,420 $364 $2,290 $3,164 $5,818 $366 $2,237 $3,303 $5,906
Source: Table prepared by the Congressional Research Service (CRS) based on analysis from HHS Budget Office, March 20, 2008.
Notes: May not add due to rounding. HHS: Department of Health and Human Services.
------------------------------------------------------------------------------
For other versions of this document, see http://wikileaks.org/wiki/CRS-RL30731