Caught in the middle of a fight between urban and rural states, the Baltimore region could lose more than half of its $20 million allotment of federal funds to care for people with HIV infection if Congress fails to reach an accord this year, local officials said yesterday.
The prospect of losing the money spurred city officials and AIDS activists to call on lawmakers to avoid leaving thousands of local residents without medical care and lifesaving drugs.
"We're facing a crisis that resources won't be available and we'll end up with lines of people waiting for the medications," said Dr. William Blattner, chief epidemiologist at the University of Maryland's Institute of Human Virology and head of a city commission on HIV/AIDS.
Appearing at a news conference, officials also urged the state to dip into its estimated $2.3 billion surplus to cover any shortfall in AIDS funding. In the audience were numerous people who depend on federal assistance for their treatment.
"We'll have a lot of sick people unable to work with no place to go," said Lorenzo Turner, 52, who received an HIV infection diagnosis 10 years ago and uses a wheelchair because he has lost feeling in his legs. He said he exhausted his savings paying for medical care before qualifying for federal assistance, which covers his medications and doctor visits.
In September, the House passed a bill reauthorizing the Ryan White CARE Act, the mechanism by which the federal government pays for AIDS services nationwide. The House bill would keep money flowing to Baltimore and its surrounding six counties, but the measure is stalled in the Senate.
Rep. Elijah E. Cummings, a Baltimore Democrat, said Congress "ought to be able to come together and figure this out," adding that any delay would leave AIDS patients stranded like hurricane victims on the Gulf Coast.
Also urging quick action were City Council President Shiela Dixon, city Health Commissioner Joshua Sharfstein and Lenwood Green, chairman of the Greater Baltimore HIV Health Services Planning Council. That council determines how the region's allotment of Ryan White money is divided up.
How much money is in jeopardy is a matter of speculation, though a consultant retained by the planning council said it could be as high as $19 million. The firm, InterGroup Services Inc., made its report to the council last week.
Most at yesterday's event, however, put the figure at $5 million to $14 million.
The Ryan White act, named after an Indiana boy who fought discrimination before dying of AIDS, provides indigent patients with free medications, doctor visits and other services.
This year, the Baltimore region is receiving about $20 million in Ryan White funds that reach about 10,000 patients, Sharfstein said. The program is the region's largest funding source, by far, for AIDS services.
The future of AIDS funding hangs in limbo as the Senate, on recess for the mid-term elections, considers whether to reauthorize Ryan White.
A group of Senate Democrats has vigorously opposed the bill in its present form because it would shift some money from states with largely urban populations that were hit early by the AIDS epidemic. Receiving more would be Southern and largely rural states that are relatively new to the epidemic.
Among the opponents are Sen. Hillary Rodham Clinton, a New York Democrat, and senators from Illinois, Florida and California. Those four states would face substantial losses.
Though Maryland would not be hurt in the tilt toward rural states, it faces a different problem. Legislation reauthorizing the act in 2000 put states on a six-year timetable to begin reporting the names of all people testing positive for HIV, the virus that causes AIDS.
The penalty for failing to make the change would be the loss of some of a state's funds.
Maryland is one of a small group of states that have yet to switch. It has clung to a method of reporting that protects the patient's identity, recording instead a 12-digit code that combines the person's Social Security number and birthday.
Advocates of name-based reporting say it enables health authorities to track infections and prevent further cases. Opponents say such gains come at the expense of privacy.
The House bill would protect Maryland and other states if they committed themselves to making the change within a reasonable period. If the Senate doesn't follow suit, Maryland's funding will decline as soon as March.
Sen. Barbara Mikulski, a Maryland Democrat, said yesterday that she supports legislation that would allow Maryland to switch to name-based reporting without losing federal money in the transition.
"Federal Ryan White Care Act dollars are critical to ensure the high-quality services, medicine and treatments continue to be available to Marylanders," she said in a statement.
A spokesman for Sen. Paul Sarbanes, also a Maryland Democrat, said he supports legislation that would ensure steady funding for areas with the greatest need, including metropolitan Baltimore.
In the spring the Maryland General Assembly approved a provision that would put name-based reporting in motion if the federal government required it. But changing over to the new system could take four or five years, experts say. Meanwhile, the state would lose money unless Congress provided for a grace period.
"People could die in a major way -- not to scare anyone -- if we don't rectify this in a hurry and make some changes," Dixon said.