Black America stands to be negatively impacted by President Trump’s budget
President Donald Trump’s proposed budget, titled, “America First: A Budget Blueprint to Make America Great Again”, doesn’t say much about HIV/AIDS funding, but what it does say could have a disproportionate impact on Black people living with the disease. Advocates worry that the budget ignores the importance of “wraparound” care—non-medical services that increase the availability or effectiveness of HIV treatment by linking people to care, retaining them in care or supporting people so that they can stay in care or on treatment—when addressing the needs of this population.
Jaron Benjamin, the vice president of community mobilization at Housing Works, says that while the president’s “skinny budget” contains some pretty bad indicators, more troubling is the way that this administration does business. “Whether it’s the budget, whether its negotiating over a bill . . . they’re going to do things a different way, and it’s going to be volatile and unpredictable,” says Benjamin, adding: “What we can count on is that this ad-ministration is not worried about the plights of people who are low-income or people of color. So it makes for a pretty scary situation.”
Sending Up Red Flags
Carl Baloney, director of government affairs at AIDS United, said that the president’s budget proposal gene-rally undermines the health of people living with HIV/AIDS (PLWHA).
The proposal “[e]liminates the discretionary programs within the Office of Community Services, including the Low Income Home Energy Assistance Program (LIHEAP) and the Community Services Block Grant (CSBG), a savings of $4.2 billion from the 2017 annualized CR level.” The budget blueprint also states, “Compared to other income support programs that serve similar populations, LIHEAP is a lower-impact program and is unable to demonstrate strong performance outcomes.” In addition, the president’s budget proposal says that CSBG funds programs that duplicate other federal programs, “such as emergency food assistance and employment services, and is also a limited-impact program.”
Benjamin says that with the stroke of Trump’s pen, all of those block grants could vanish. “Trump’s willingness to get rid of block grants that serve low-income people and people who are disproportionately people of color should also send a red flag up about any talk of trans-forming Medicaid into a block grant program,” he says.
Baloney says that any proposal to block-grant the Medicaid program could lead to long wait lists, reduced services and rationing of care.
Even though the president’s budget says that Ryan White HIV/AIDS Program providers are among the “highest priorities” for funding under the Department of Health and Human Services, any plans to block-grant Medicaid may stretch programs funded through the Ryan White CARE Act—which has been supported by Democrats and Republicans—beyond their limits. “If people are not getting care through Medicaid, the Ryan White program will be overrun,” says Baloney, adding that the program has been highly effective and the administration must continue to invest in it.
Trump’s 2018 budget blue-print also cuts nearly 30 percent from the Department of State and USAID, which some advocates say could lead to backdoor cuts to the President’s Emergency Plan for AIDS Relief (PEPFAR) in the future. “Even people who weren’t fans of President George W. Bush feel like PEPFAR was the best thing that President Bush did,” said Benjamin. “There are tens of millions of people who are on AIDS drugs right now who otherwise wouldn’t have been, and that’s because of PEPFAR.”
An Impossible Decision
Baloney called housing one of the greatest unmet needs for PLWHA. “Once people living with HIV secure adequate housing, it’s easier for them to keep appointments and stay on their medication,” Baloney said. “We see really drastic upticks in viral suppression when people are adequately housed.”
According to CHCDF (the Campaign for Housing and Community Development Funding), a campaign of more than 70 national organizations concerned about funding for affordable housing and community development programs, a 2016 update to the Housing Opportunities for Persons With AIDS (HOPWA) Program, implemented because PLWHA are living longer than when HOPWA was created in 1992, means that an additional $15 million is needed in 2018 so that people continue to receive support. HOPWA is the only federal program dedicated to the housing needs of PLWHA.
In March 2017, Sens. Richard Durbin (D-Ill.) and Kirsten Gillibrand (D-N.Y.) circulated a “Dear colleague” letter requesting $350 million in funding—a $15 million increase over fiscal year 2016 funding levels—for the HOPWA Program in the fiscal year 2018 Transportation and Housing and Urban Development appropriations bill.
“No American should have to choose between essential medical care and treatment or housing for themselves and their families,” the senators wrote in the letter. “HOPWA plays a vital role in ensuring that impossible decision will never need to be made.”
The senators noted that housing assistance has demonstrated the ability not only to reduce the chance of transmission of the disease by improving access and adherence to medical treatment, but also to decrease the reliance on expensive crisis services like emergency rooms and nursing home care.
The letter continued: “Moreover, one prevented infection saves more than $400,000 in lifetime medical costs. Therefore, our investment in these critical services is more than worth it.”
Baloney believes that Black people should demand increased funding and increased investments for critical programs that serve PLWHA. “The federal budget, the budget that the Congress approves, is a statement of values and a statement of priorities,” he says. “When the budget doesn’t adequately address the basic needs of a certain set of people or clearly ignores disenfranchised populations, that’s an indication of that administration’s values,” and the perceived value of those populations.
Baloney adds, “whether these programs are funded or not, it’s a reflection of how the administration values our population.”
Benjamin agrees, noting that Trump’s earlier failure to convince Republican lawmakers to vote on a “repeal and replace” bill that would have killed the Affordable Care Act (also known as Obamacare) means that the president’s agenda is not a runaway train. “If we are in the faces of our elected officials, if we’re constantly vigilant, if we’re constantly seeking out every educational opportunity, then we can effect real change and take control of a process that dictates how our lives play out,” Benjamin says.
Freddie Allen is the senior Washington correspondent for Black Press of America. You can follow him on Twitter.