AIDS Funding for Federal Government Programs: FY1981-FY2009

Congressional research reportApr 23, 2008

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Prepared for Members and Committees of Congress

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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.

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Introduction ..................................................................................................................................... 1

HHS Discretionary Funding: NIH, CDC, and HRSA ..................................................................... 2

NIH............................................................................................................................................ 2

CDC .......................................................................................................................................... 3

HRSA ........................................................................................................................................ 3

HHS Entitlement Funding: Medicaid and Medicare at CMS.......................................................... 4

Medicaid.................................................................................................................................... 4

Medicare.................................................................................................................................... 5

Funding for Other AIDS Programs.................................................................................................. 6

HIV/AIDS Minority Initiative................................................................................................... 6

International HIV/AIDS Programs............................................................................................ 6

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 .......................... 2

Figure 3. Estimated Federal Government Spending on HIV/AIDS Treatment, FY2008 ................ 5

Figure 4. HHS Spending on HIV/AIDS Programs........................................................................ 14

Figure 5. HHS HIV/AIDS Spending, by Program/Function, as a Percentage of Total ................. 14

Table 1. HIV/AIDS Minority Initiative ........................................................................................... 6

Table 2. HHS Discretionary Funding for HIV/AIDS ...................................................................... 7

Table 3. HHS Discretionary Funding for HIV/AIDS, by Agency................................................... 9

Table 4. Total Federal Government Spending on HIV/AIDS, by Function................................... 10

Table 5. Federal Government Spending on HIV/AIDS: FY1982-FY2009 ................................... 12

Table 6. Federal Government Spending on International HIV/AIDS Programs, by

Function...................................................................................................................................... 15

Author Contact Information .......................................................................................................... 16

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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

Support

10%

Treatment

63%

Source: HHS Budget Office, March 20, 2008.

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

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/.

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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.

. Estimated Total Federal Spending on HIV/AIDS, by Agency, FY2008

Figure 2

Veterans

Other

HHS

Discretionary

28%

State Dept.

20%

USAID

Social

Security

HHS

Entitlement

38%

HHS Budget Office, March 20, 2008.

Note: USAID, U.S. Agency for International Development. See Table 4.

Source:

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.

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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

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estimates FY2008 funding for AIDS research at $2.913 billion. The Administration’s request for

FY2009 is $2.913 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 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

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 is $2.171 billion.4 (For further information on

the Ryan White program, see CRS Report RL33279, The Ryan White HIV/AIDS Program, by

(name redacted).)

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.

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.

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.

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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 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

Estimate based on average federal Medicaid assistance percentage (FMAP) for the nation as a whole.

Personal communication, HHS Budget Office, April 17, 2008.

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.

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Figure 3. Estimated Federal Government Spending on HIV/AIDS Treatment, FY2008

State Dept.

20%

Ryan

White

15%

Other

Medicaid

28%

Medicare

31%

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.

Source:

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 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,

An HIV-positive individual must have a recognized AIDS-defining illness in order to meet the disability

classification.

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.

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.

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.

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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.

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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.

. HIV/AIDS Minority Initiative

Table 1

($ in millions)

Program

HRSA

CDC

SAMHSA

Minority Communities Fund

Office of Minority Health

Office of Women’s Health

FY2005

FY2006

FY2007

FY2008

FY2009

$129

112

$129

112

$131

111

$135

112

139

112

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.

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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.

Personal communication, HHS Budget Office, April 17, 2008.

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.

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The Global Fund to Fight AIDS, Tuberculous and Malaria, was first proposed at the July 2000 G8 Summit in Okinawa.14 Its purpose is to attract, manage and disburse funding through a publicprivate 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

. HHS Discretionary Funding for HIV/AIDS

Table 2

($ in thousands)

$ Increase over

% Increase over

Funding

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

FY1993

2,079,591

116,639

FY1994

2,568,682

489,091

24%

FY1995

2,700,498

131,816

FY1996

2,897,923

197,425

FY1997

3,267,220

369,297

13%

FY1998

3,536,519

269,299

FY1999

4,094,489

557,970

16%

FY2000

4,546,326

451,837

11%

Year

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.

For additional information, see CRS Report RL33771, Trends in U.S. Global AIDS Spending: FY2000-FY2008, by

(name redacted), CRS Report RL33485,

U.S. International HIV/AIDS, Tuberculosis, and Malaria Spending:

FY2004-FY2008, by (name redacted), CRS Report RL31712,

The Global Fund to Fight AIDS, Tuberculosis, and

Malaria: Background, by (name redacted), CRS Report RL34192,

PEPFAR: From Emergency to Sustainability,

by (name redacted), CRS Report RL32001,

HIV/AIDS in the Caribbean and Central America, by (name re

dacted), CRS Report RL33584, AIDS in Africa, by (name redacted).

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$ Increase over

% Increase over

Year

Funding

prior year

FY2001

5,225,645

679,319

15%

FY2002

5,788,553

562,908

11%

FY2003

6,093,846

305,293

FY2004

6,242,501

148,655

FY2005

6,279,141

36,640

0.6%

FY2006

6,235,251

-43,890

-0.7%

FY2007

6,357,719

122,468

FY2008

6,586,086

228,367

FY2009 Request

6,592,399

6313

0.1%

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.

Source:

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. HHS Discretionary Funding for HIV/AIDS, by Agency

Table 3

($ in thousands)

Agency

FY2000

FY2001

FY2002

FY2003

FY2004a

FY2005a

FY2006

FY2007

FY2008

FY2009

FDA

HRSA

IHS

CDC

NIH

SAMHSA

AHRQ

Global AIDS Trust

Fund

Total

$76,317

1,599,231

3,770

687,164

2,004,428

110,347

1,787

63,282

—

$75,818

1,815,000

3,810

859,045

2,247,015

156,677

3,381

64,899

—

$75,818

1,917,200

3,886

931,141

2,499,458

169,034

2,913

64,103

125,000

$72,830

2,024,962

3,940

936,426

2,716,218

170,614

1,825

67,681

99,350

$73,847

2,066,861

4,013

862,854

2,849,952

171,205

2,017

62,637

149,115

$87,661

2,075,296

4,074

855,535

2,920,551

173,024

1,088

62,712

99,200

$88,758

2,064,705

4,261

838,225

2,901,859

171,872

2,750

63,821

99,000

$90,563

2,141,195

4,437

879,241

2,905,788

171,545

2,800

63,150

99,000

$94,425

2,170,192

4,587

872,427

2,913,345

172,226

2,800

61,325

294,759

$95,369

2,171,312

3,629

871,314

2,913,345

172,907

2,800

61,723

300,000

$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

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.

Source:

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Table 4.Total Federal Government Spending on HIV/AIDS, by Function

($ in millions)

Agency/

Department

FDA

HRSA

IHS

CDC

NIH

SAMHSA

AHRQ

PH emergency fund

Global AIDS trust fund

HHS discretionary

CMS/Medicaid

CMS/Medicare

Subtotal, HHS

Social Security — DI

Social Security — SSI

Veterans Affairs

Defense Department.

Agency for Int. Dev.

Justice/Bureau of Prisons

State Department

Labor Department

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FY2007 Actual

Income

Research Prevent Treatmt support

$91

—

2,906

—

$3,001

—

$3,001

—

2,138

—

879

—

131

—

$1,024 $2,333

—

3,900

—

4,200

$1,024 $10,433

—

465

466

124

1,147

2,101

—

$1,450

420

—

FY2008 Enacted

Income

Total Research Prevent Treatmt support

FY2009 President’s Budget

Income

Total Research Prevent Treatmt support

$91

2,141

879

2,906

172

$6,358

3,900

4,200

$14,458

$1,450

420

505

590

3,248

—

$94

2,170

872

2,913

172

295

$6,586

4,100

4,500

$15,186

$1,484

479

540

106

371

4,662

—

$94

—

2,913

—

$3,012

—

$3,012

—

2,167

—

872

—

132

—

147

$1,114 $2,460

—

4,100

—

4,500

$1,114 $11,060

—

500

371

—

1,645

3,017

—

$1,484

479

—

$95

—

2,913

—

$3,013

—

$3,013

—

2,168

—

871

—

133

—

150

$1,114 $2,465

—

4,400

—

4,800

$1,114 $11,665

—

$35

$607

342

—

1,626

3,153

—

Total

—

$95

—

2,171

—

871

—

2,913

—

173

—

300

— $6,592

—

4,400

—

4,800

— $15,792

$1,519 $1,519

490

—

645

—

342

—

4,779

—

Agency/

Department

FY2007 Actual

Income

Research Prevent Treatmt support

FY2008 Enacted

Income

Total Research Prevent Treatmt support

FY2009 President’s Budget

Income

Total Research Prevent Treatmt support

Total

Education Dept.

—

HUD

—

286

—

300

—

300

OPM-FEHB

—

107

—

107

—

114

—

114

—

123

—

123

$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

Subtotal, Non-HHS

Total, federal government $3,032 $2,684 $13,307 $2,156 $21,179 $3,047 $3,185 $14,768 $2,263 $23,263

Source: Table prepared by the Congressional Research Service (CRS) based on analysis from HHS Budget Office, March 20, 2008.

$3,039 $3,130 $15,624 $2,309 $24,102

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.

Ȭŗŗȱ

. Federal Government Spending on HIV/AIDS: FY1982-FY2009

Table 5

($ in millions)

HHS

CMS

Year Discretionary

Medicaid

Medicare

DI SSI

Defense

DOJAID Prisons

State

Labor

HUD

OPMFEHB

Education

Total

1982

—

1983

$29

—

$44

1984

$60

—

$103

1985

$109

—

$205

1986

$234

130

—

$508

1987

$502

200

—

$922

1988

$962

330

—

$1,615

1989

$1,304

490

150

136

—

$2,322

1990

$1,592

670

110

184

220

124

—

$3,070

1991

$1,891

870

180

266

258

127

—

$3,833

1992

$1,967

800

400

372

150

279

125

103

—

$4,345

1993

$2,079

1,000

600

481

200

299

155

117

100

175

—

$5,213

1994

$2,569

1,300

800

568

250

312

127

115

156

193

—

$6,398

1995

$2,700

1,500

1,000

631

250

317

110

120

171

212

—

$7,019

1996

$2,898

1,800

1,100

684

250

331

115

—

171

226

—

$7,680

1997

$3,267

2,200

1,300

738

275

350

117

—

196

241

—

$8,777

1998

$3,537

2,600

1,400

787

305

378

121

—

204

253

—

$9,689

1999

$4,094

2,900

1,500

828

330

401

139

—

225

266

$10,779

2000a

$4,546

3,300

1,700

870

370

345

200

—

232

279

$12,025

2001a

$5,226

3,700

1,900

919

340

405

108

430

—

257

292

$14,184

2002

$5,789

4,200

2,050

961

390

391

510

—

277

297

—

$14,988

ȬŗŘȱ

HHS

CMS

Year Discretionary

Medicaid

Medicare

DI SSI

Defense

DOJAID Prisons

State

Labor

HUD

OPMFEHB

Education

Total

2003

$6,094

4,800

2,400

1,019

395

396

774

141

290

321

—

$16,739

2004

$6,243

5,400

2,600

1,050

415

402

105

963

638

295

343

—

$18,481

2005

$6,279

5,700

2,900

1,250

450

445

110

633

1,376

282

370

—

$19,817

$6,235

3,600b

3,900b

1,365

440

468

102

621

1,977

—

286

100

—

$19,116

$6,358

3,900b

4,200b

1,450

420

505

590

3,248

—

286

107

—

$21,179

2008

$6,586

4,100b

4,500b

1,484

479

540

106

371

4,662

—

300

114

—

$23,263

2009

$6,592

4,400b

4,800b

1,519

490

645

342

4,779

—

300

123

—

$24,102

2006

2007

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.

Source:

Ȭŗřȱ

ȱȱȱȱ ȱǱȱŗşŞŗȬŘŖŖşȱ

Figure 4. HHS Spending on HIV/AIDS Programs

16000

14000

12000

10000

8000

6000

4000

2000

199219931994199519961997199819992000200120022003200420052006200720082009

Discretionary: Research

Discretionary: Prevention

Medicaid

Medicare

Discretionary: Treatment

HHS Budget Office, March 20, 2008.

Note: FY2009 is based on the Administration’s budget request.

Source:

Figure 5. HHS HIV/AIDS Spending, by Program/Function, as a Percentage of Total

100%

80%

60%

40%

20%

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

HHS Budget Office, March 20, 2008.

Note: FY2009 is based on the Administration’s budget request.

Source:

ȱȱȱ

ŗŚȱ

. Federal Government Spending on International HIV/AIDS Programs, by Function

Table 6

($ in millions)

Agency/

Department

Centers for Disease

Control

National Institutes of

Health

Global AIDS trust fund

FY2007 Actual

Research

FY2008 Enacted

Prevent Treatment

FY2009 President’s Budget

Total Research Prevent Treatment

Total Research

Prevent

Treatment

Total

—

121

—

121

—

119

—

119

—

119

—

119

362

—

362

364

—

147

—

147

364

295

366

—

150

—

150

366

300

$362

$170

$50

$582

$364

$266

$147

$777

$366

$269

$150

$785

Defense Department

Agency for

International

Development

State Department

Labor Department

—

466

1,147

—

124

2,101

—

590

3,248

—

371

1,645

—

3,017

—

371

4,662

—

342

1,626

—

3,153

—

342

4,779

—

Subtotal, Non-HHS

—

1,613

2,225

3,838

—

2,024

3,017

5,041

—

1,968

3,153

5,121

$362

$1,784

$2,275

$4,420

$364

$2,290

$3,164

$5,818

$366

$2,237

$3,303

$5,906

Subtotal, HHS

Total

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.

Source:

Ȭŗśȱ

ȱȱȱȱ ȱǱȱŗşŞŗȬŘŖŖşȱ

ȱȱ ȱ

(name redacted)

Specialist in Biomedical Policy

/redacted/@crs.loc.gov, 7-....

ȱȱȱ

ŗŜȱ

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