President Bush proposed Wednesday that the executive branch assume significant control over the program that has been the backbone of federal assistance for Americans infected with AIDS.
Bush said that the $2 billion Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, which since 1990 has been the government's largest subsidy of medical and other services specifically for HIV-positive people in the United States, "takes too little account of the most urgent needs." He said the administration should have greater power to decide where the money is distributed and how it is spent, focusing more on paying for medicine and doctors' visits than on social services.
Bush made his proposals at a black church here during a speech that interwove themes of AIDS and religion. The president speaks often about a law the administration pushed through Congress last year to combat the epidemic in Africa and the Caribbean, but Wednesday's remarks focused in unusual detail on his philosophy for coping with it domestically. "We will continue to confront the disease abroad, and we will confront it here at home as well," he said. "These efforts are not mutually exclusive."
AIDS activists have complained that Bush has largely sought to freeze spending on the Ryan White act, and the president on Wednesday did not pledge any expansion of the program. Instead, he and Health and Human Services Secretary Tommy G. Thompson, who accompanied him, said the solution is to ask Congress, which must renew the program next year, to give HHS far more discretion to target the way the subsidies are used. The money is currently allotted according to a complex government formula.
Bush and Thompson also said they want to establish stronger methods of finding out whether organizations are making good use of their subsidies and to expand the number of religious groups funded to help people with AIDS.
Bush announced that the administration has decided to divert $20 million from an unrelated health program to give 10 states more money under a chronically overstretched part of the program, the AIDS Drug Assistance Program, which helps poor people pay for medicine.
The president also announced that the administration had added Vietnam to a list of 14 African and Caribbean countries eligible for assistance under the global AIDS initiative enacted last year -- a choice that drew mixed reactions from AIDS activists who would have preferred that the administration select a country that has been hit harder by the disease.
Bush said the administration is releasing a second $500 million installment of the $2.4 billion that is to be spent this year under the global AIDS law. The law allows for $3 billion to be spent this year, but Bush asked for $2 billion, which Congress increased to $2.4 billion.
Bush laced his 31 minutes of remarks with biblical references, as he often does when addressing black audiences. When HIV-positive people begin to take antiretroviral drugs, he said, "there's a Lazarus effect -- and people, all of a sudden, say, 'I have hope.' " Bush, again, argued for religious groups to deliver more social services, saying, "People shouldn't fear the fact if there's a cross on the wall and an AIDS program in that building."
Wednesday's destination, Greater Exodus Baptist Church, a few blocks north of Philadelphia's City Hall, is the only church Bush has visited twice since he took office, the White House said. He visited a block party at the church on July 4, 2001. His return trip reflects the pastor's support for the administration's "faith based" agenda and for Bush, including at the 2000 Republican National Convention in Philadelphia.
The Rev. Herbert H. Lusk II, a former running back for the Philadelphia Eagles who has been pastor of the church for 23 years, founded a charity in 1989 with fellow football players called People for People that is a prototype of the religious community outreach programs Bush favors.
Funded primarily through state and local grants, the charity is drawing increasingly on the federal aid Bush has made available through executive actions, Lusk said. People for People has a $1 million federal grant to help low-income people buy homes and last year received about $300,000 for its charter school. Lusk said that Greater Exodus and a coalition of other black churches that have missions in Africa are preparing to apply for some of the global AIDS funding that is at the heart of Bush's remarks. "It's going to be in the millions, I'll tell you that," Lusk said. "It won't be small potatoes."
After he left the church, Bush attended a private fundraiser in nearby Villanova that raised $1.4 million for the Republican National Committee.
AIDS activists in Washington were skeptical of Bush's plans to seek greater power over how the Ryan White act money is spent. Marsha Martin, executive director of AIDS Action, a large umbrella group of local AIDS service organizations, said the program should allow more flexibility over spending decisions -- by states and communities, not the federal government.
Terji Anderson, executive director of the National Association of People With AIDS, criticized treating social services for people with HIV "as somehow icing on the cake," saying that some people cannot get to doctors without transportation or child care for which the law now pays.