Puncturing an AIDS Initiative
By John F. Harris and Amy Goldstein
At 8:30 a.m. on Monday, Health and Human Services Secretary Donna E. Shalala was huddled with her top scientific advisers, preparing for a news conference later that morning in which she planned to announce that federal funds could be used for needle-exchange programs.
A news release announcing the long-debated decision was ready. So were talking points for the secretary's case: Federal funding could start flowing because there was now conclusive research that needle exchanges slowed the spread of AIDS without encouraging drug use.
"The evidence is airtight," Shalala planned to say, according to a copy of the talking points.
But the decision was not as airtight as Shalala and her staff believed. Shortly before 9 a.m., she was called out of the meeting for a phone call from White House Chief of Staff Erskine B. Bowles. The needle-exchange decision, he told Shalala, was proving too politically risky. President Clinton had changed his mind.
So the secretary quickly changed hers. When Shalala, joined by her visibly uncomfortable advisers, faced reporters at midday, it was to announce that federal funds would not be used to support needle-exchange programs.
The last-minute reversal over paying for clean needles for addicts offers a vivid view into decision-making in Clinton's second term, according to several administration officials in the White House and other agencies.
In one sense, the decision reflects lessons learned after five years. Unlike the early days of his tenure, when Clinton became ensnared in controversies over gun control and gays in the military, he is determined to avoid giving his opponents any openings against him on lightning-rod issues. If Clinton had approved needle funding, White House aides contend, Congress would have overturned the decision, scorching the administration while doing nothing to combat AIDS.
But the needle decision also shows that Clinton, even with a more seasoned staff and organizational structure beneath him, is still prone to last-minute agonizing that leaves Cabinet members unsure what to expect of him.
In the debate over how to fight AIDS, needle-exchange programs have been particularly divisive. The idea is to slow the spread of HIV among intravenous drug users and to their sex partners and children by giving them clean syringes, thus lessening the number of addicts who contract the virus by sharing dirty needles. But the programs have many critics, largely conservative, who contend they essentially condone illegal drug use by handing free needles to addicts.
While avoiding a showdown with Republicans on Capitol Hill, the administration's retreat on funding the programs enraged many AIDS activists and researchers who felt betrayed on the brink of a long-sought victory.
"The politics of this issue . . . overshadowed the fact that lives can be saved," said Winnie Stachelberg, political director of the Human Rights Campaign.
Yesterday, a few dozen patients and activists brought their anger directly to HHS, picketing the agency's headquarters on Independence Avenue SW.
Within the White House, advisers said they were resigned to the criticism on what they considered a no-win issue. "This was a case of pick your poison," said one senior official who worked closely on the needle issue.
Clinton also had to pick between two members of his Cabinet. Shalala, like most of the administration's senior health officials, argued that needle-exchange programs are sensible. Barry R. McCaffrey, the retired general who heads the Office of National Drug Control Policy, warned that funding needles would send a devastating message about the administration's commitment to fighting drugs. Both made their cases vociferously in memos and in person to Clinton.
Vice President Gore, according to officials in the White House and other agencies, had sided with Shalala in favor of the programs, believing that the inevitable political flak the decision would incite was worth absorbing. But Rahm Emanuel, a senior Clinton adviser, warned that the political risks were foolhardy.
Domestic policy adviser Bruce Reed was left to arbitrate the conflict and divine the president's true wishes.
When Clinton left a week ago for a summit in Chile, Clinton had given subordinates the clear sense that he was ready to move forward with some kind of federal funding for needle exchanges though exactly what was still open to question. In a meeting in Bowles's office last Thursday, according to several officials, the chief of staff told Reed and Shalala to proceed on the assumption there would be some federal funding and to continue working on the details. Bowles cautioned that Clinton had not yet made a final decision.
Meanwhile, bureaucratic warfare continued. Officials at the drug control policy office suspected they were being deliberately kept out of the loop. The drug agency had not been invited to a Roosevelt Room meeting Friday to discuss how to announce the decision. James McDonough, a deputy of McCaffrey, found out about the meeting anyway and walked in halfway through, according to several officials.
HHS officials, meanwhile, were livid at McCaffrey. They were convinced his office was leaking information about administration deliberations to subvert Clinton's anticipated decision. In addition, White House and agency officials were certain that he was urging congressional Republicans to speak out early against paying for needles.
One of the offices to get a call was that of Rep. J. Dennis Hastert (R-Ill.), chairman of the House speaker's task force for a drug-free America. "We heard from a number of administration sources that, if you at least want to delay the announcement and perhaps affect the final outcome, get the word out," Hastert's spokesman said yesterday.
Friday, while Hastert was traveling with Clinton in Chile, the congressman's office issued a statement denouncing the prospect of lifting the funding ban. McDonough said the drug control agency is by its charter supposed to work with both parties. While McCaffrey made his views known, he said, the director did not try to undermine Clinton.
"General McCaffrey constantly keeps the Congress informed of where he stands on the drug issue," McDonough said. "He is not reticent in defining his concerns."
HHS officials continued on the belief that they had triumphed over McCaffrey. HHS and the White House told AIDS activists to expect good news at the Monday news conference. All last weekend, officials faxed Reed documents at his home laying out various ideas to explain the decision. At one stage, the idea was to allow federal funds on a demonstration basis in eight cities.
Shalala knew that reporters would ask if politics affected the decision. "Absolutely not," she planned to say, according to the talking points. "From the beginning of this effort, it has been about science, science, science."
She and her aides did not know that Clinton's mind was turning. On the plane ride to Chile, officials said, the strong-willed McCaffrey had further pressed his case. In addition, Clinton told aides he had read a persuasive letter against needle exchanges from former health, education and welfare secretary Joseph A. Califano Jr.
Flying back to Washington late Sunday night, Clinton made his decision. Caught by surprise, HHS canceled the full-scale news conference it had planned and replaced it with a small briefing at which no cameras were allowed.
With the new federal imprimatur that needle exchanges are scientifically sound, Shalala announced, state and local governments and community groups should feel free to move ahead with them. Today, the George Soros Foundation plans to announce that it will give $1 million in matching grants to needle exchanges across the United States. But the ban on federal funds, Shalala said, would remain in place.
Staff writer Maria Elena Fernandez contributed to this report.
© Copyright 1998 The Washington Post Company