Paul Ryan

Before it left on spring recess, the U.S. House passed a budget for Fiscal Year 2012 that the president called “wrong for America” and that AIDS activists have said would do “irreparable harm.”

The proposal hasn’t gone over well with many Americans, either. During the two-week recess, the budget bill’s chief author, Rep. Paul Ryan (R-Wisc.), was greeted with crowds of unhappy constituents and many boos.

The primary complaint is that the so-called “Ryan budget” calls for dramatic cuts in Medicaid, which provides health insurance coverage for people with low incomes. And it calls for dramatic cuts in Medicare, which provides health insurance coverage for Americans 65 and older and for people with disabilities, including AIDS.

In a letter to members of the House last month, a large coalition of groups serving people with HIV urged a “no” vote on the plan.

“Chairman Ryan’s proposal to dismantle the Medicaid and Medicare programs, roll back reforms enacted through the Affordable Care Act, and drastically reduce support for vital federal programs will do irreparable harm to people living with HIV disease as well as those at risk for HIV infection,” said the letter. “We will lose our battle against HIV disease and the loss will come with a high price tag in terms of the human toll and costs to the health care system.”

The letter notes that Medicaid is the “single largest source” of funding for HIV-related treatment and care, covering about 40 percent of people with HIV in the United States.

The coalition said Ryan’s proposal to completely defund provisions of President Obama’s recently enacted Affordable Care Act would leave “hundreds of thousands of people with HIV without access to health care coverage and services.”

Overall, Ryan’s plan would cut federal spending by $6 trillion over the next 10 years. For Fiscal Year 2012, Ryan’s plan calls for a 15 percent drop in spending on non-security-related funding—from $565 billion this year to $482 billion next year. That includes a $56 billion cut in discretionary health spending over the next five years. The coalition of AIDS groups say that cut would lead to the loss of programs to prevent new HIV infections.

“It is counterproductive to disable the prevention, care and research programs that have controlled the HIV epidemic and transformed HIV disease from a fatal to a complex but manageable condition in the United States,” said the coalition’s letter.

The letter was sent to members of the House on April 13 and signed by 54 groups, including AIDS United, the Gay Men’s Health Crisis, the AIDS Institute, the National Minority AIDS Council, the San Francisco AIDS Foundation, Treatment Action Group, the AIDS Task Force of Greater Cleveland, and the AIDS Foundation of Chicago.

Some the organizations which signed the letter—such as AIDS United and The AIDS Institute—had expressed relief at the Fiscal Year 2011 budget because there were no cuts in places where people with HIV need additional help. But all AIDS organizations seem to be alarmed at the House plans for FY 12.

Project Inform, a 26-year-old national AIDS policy advocacy group, says on its website that Ryan’s budget would “devastate” the country’s response to HIV.

The National Minority AIDS Council Deputy Executive Director, Daniel Montoya, issued a statement, saying, “Medicare and Medicaid are essential programs that safeguard the health of all Americans, including those living with HIV/AIDS.”

“Placing the burden of his $6 trillion cuts on the backs of our nation’s vulnerable,” said Montoya of Ryan, “is inhumane and un-American.”

The unpopularity of the Medicare/Medicaid provisions prompted Senate Majority Leader Harry Reid (D-Nev.) to say he might put it on the floor for a vote soon, presumably to put Senate Republicans in the uncomfortable position of defending a bill that so many are clamoring against.

There are other budget proposals—the President’s original FY 12 budget plan (which AIDS and LGBT groups generally like) and several in the works by various groups of legislators. One plan, from the Congressional Progressive Caucus, would maintain Medicare and Medicaid but require significant tax increases for people with high incomes and tax capital gains and dividends as ordinary income. The Caucus includes all four openly gay members: Rep. Tammy Baldwin (D-Wisc.), who serves as a vice chairman, as well as Reps. Barney Frank (D-Mass.), Jared Polis (D-Colo.), and David Cicilline (D-RIs.).

The House rejected that proposal during last month’s vote.

But no budget proposal has yet emerged that appears to be capable of gaining passage through both chambers of Congress. So, it’s likely to be another knockdown-drag out fight, like that just finished for FY 11.

And to complicate the negotiations for FY 12, there is the looming gloom of the nation’s debt ceiling. The government anticipates spending to bump up against that ceiling—currently set at $14.6 trillion—in July. Republicans have vowed to oppose an increase in that ceiling unless significant concessions are made to cut spending.

In an effort to encourage cooperation between the House and Senate and both parties, President Obama named a commission of six to find common ground on the budget and on a request to raise the debt ceiling. Vice President Joe Biden is leading the panel

The group holds its first meeting May 5.