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