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Senate Leaders Reach 'Tentative' Agreement on Legislation To Reauthorize PEPFAR, AP/ Reports
  Kaiser [Jun 26, 2008]
Senate negotiators on Wednesday reached a "tentative" agreement on measures (HR 5501, S 2731) to reauthorize the President's Emergency Plan for AIDS Relief, the AP/ reports (Abrams, AP/, 6/25).__
Senate Majority Leader Harry Reid (D-Nev.) last week set a Tuesday deadline for negotiators to come to an agreement on the reauthorization measures but moved the deadline to Wednesday earlier this week after Senate Foreign Relations Committee Chair Joseph Biden (D-Del.) asked for one more day to finalize the deal. The Senate version of the PEPFAR reauthorization bill passed the Foreign Relations Committee in March, and the House version was approved 308-116 in April. Both the Senate and House versions of the bill would reauthorize PEPFAR at $50 billion over five years. However, Sen. Tom Coburn (R-Okla.) and six other Republican senators blocked the legislation in opposition to its cost and "mission creep" into health and development efforts. In addition, they sought language that would guarantee that 55% of PEPFAR funding goes toward treatment, including antiretroviral drugs (Kaiser Daily HIV/AIDS Report, 6/25). __
According to Reid, Democratic leaders reached an "agreement in principle" with Coburn and the six other senators. Under the agreement, "more than half" of PEPFAR funding would go to treatment, according to the AP/ The agreement requires that antiretrovirals used in PEPFAR programs be approved by FDA or another approved regulator agency. In addition, the agreement prevents PEPFAR funding for wealthier developing nations, such as China and Russia.__Reid said that with the agreement, the Senate "should be able" to pass the legislation "quickly and easily."
Reid said he hopes to pass the legislation before President Bush leaves for the Group of Eight industrialized nations summit, which begins July 7 in Japan. However, some leaders involved in the negotiations said the Senate might not take up the legislation until after the July 4 recess (AP/, 6/25). President Bush has said that he supports the reauthorization legislation and that he would like it to pass in Congress so he can use it at the summit to call for increased contributions from other countries (Kaiser Daily HIV/AIDS Report, 6/25).
Reid said he hopes the Senate "can agree to pass this bipartisan legislation by unanimous consent" ahead of the G8 summit. He added he will move to pass the bill early in July if the Senate does not act on it this week (Graham-Silverman, CQ Today, 6/25). Reid added that it "would send an important message to the world that our country's commitment to fight HIV/AIDS has not wavered" if the Senate passes the bill ahead of the G8 summit. Biden welcomed the deal, saying that "it is our moral obligation to lead the effort to fight these diseases" (AP/, 6/25). __
White House spokesperson Dana Perino said Congress and the White House have "made tremendous progress toward getting this bill passed," adding the White House "really want[s] to make sure Congress does this before they leave for their recess in August" (CQ Today, 6/25). __
"I'm encouraged the Bush administration and congressional leaders decided to restore much of this key [treatment] provision that has been so integral to PEPFAR's success," Coburn said (AP/, 6/25). While Coburn said he supports the agreement, he also indicated he would object if Democrats do not allow a full Senate debate and open amendment process,which according to CQ Today means "a unanimous-consent request isunlikely to win Coburn's approval." Some Republicans who had blocked the bill with Coburn also expressed opposition to a unanimous consent vote and are working on their own amendments to the legislation. __
Reid said that he hopes Michael Enzi (R-Wyo.) could persuade objectors to allow the bill to move. "He had three people who were objecting to that," Reid said earlier, adding, "He took care of two of them today and hopes to take care of the other tomorrow" (CQ Today, 6/25).__Sen. Jim DeMint (R-S.C.), who was one of the seven Republicans blocking the legislation, continued to object to the cost of the measure, saying it is "completely irresponsible" for the U.S. "to attempt to buy friendship around the world by spending $50 billion" (Rosen, Columbia State, 6/26).__
David Bryden, a spokesperson for the Global AIDS Alliance, said the group is reviewing the new agreement but is concerned that the amount of funding allocated to treatment will limit available funds for other services, such as care for AIDS orphans. He said the group "will be forced to oppose this bill if it compromises the effectiveness" of PEPFAR (AP/, 6/25). Several hundred advocates on Thursday plan to march on the Senate and give funeral wreaths to Senators who have blocked the legislation, according to Bryden (Abdullah, McClatchy, 6/25).
Related Editorial _The seven Republican senators who are blocking the legislation "should clear the way soon to allow swift action and make it possible for the president to take the U.S. commitment" to the G8 summit, an AshevilleCitizen-Times editorial says. The editorial adds that it is "hard to comprehend how a few senators can stand in the way" of the legislation (Asheville Citizen-Times, 6/26).
Senate reaches an agreement on global AIDS bill
WASHINGTON (AP) - Senate negotiators said Wednesday they had reached a tentative agreement on a key obstacle to one of the most ambitious federal health initiatives ever, a $50 billion act to combat AIDS, malaria and tuberculosis in Africa and other countries hard-hit by those diseases.
The agreement sets the stage for the Senate to vote in the near future on the five-year bill that would more than triple the size of the $15 billion global AIDS bill that Congress, at the urging of President Bush, passed in 2003. The current act expires at the end of September.
Senate Majority Leader Harry Reid said they had an "agreement in principle" with several Republican senators, led by Sen. Tom Coburn of Oklahoma, who had voiced opposition to aspects of the bill. With that agreement, Reid said, "we should be able to do this quickly and easily and it should be done before President Bush goes to the G-8 Summit next week. That would send an important message to the world that our country's commitment to fight HIV/AIDS has not wavered." Reid said his preference was to pass the bill this week, but others involved in the negotiations said it was more likely the Senate would take it up after returning from the July 4 recess.
Coburn, a medical doctor who has treated AIDS patients, held up the bill over his demands that a fixed percentage of funding go to treatment programs. The 2003 bill stipulated that 55 percent of funds go to treatment, but that figure was taken out of the bill that overwhelmingly passed the House last April.
Writers of the new bill argued that caregivers on the ground would be better able to determine how to allocate money on prevention and treatment programs, but Coburn said there was a danger of money being diverted into unrelated development and poverty programs.
Under the tentative agreement, "more than half" of bilateral AIDS funding would be spent on treatment.
"I'm encouraged the Bush administration and congressional leaders decided to restore much of this key provision that has been so integral to PEPFAR's success," Coburn said, referring to the acronym for the President's Emergency Plan for AIDS Relief.
The tentative deal also requires that drugs procured by PEPFAR be approved by the Food and Drug Administration or a stringent regulator authority and prevents funding for more wealthy countries such as Russia and China.
Senate Foreign Relations Committee Chairman Joe Biden, D-Del., who negotiated the deal with ranking Republican Richard Lugar of Indiana and the top Republican on the Health, Education, Labor and Pensions Committee, Michael Enzi of Wyoming, welcomed the deal, saying HIV/AIDS alone claimed 2 million lives last year and "it is our moral obligation to lead the effort to fight these diseases."
David Bryden, spokesman for the Global AIDS Alliance, said they were carefully reviewing the compromise but were concerned that amounts set aside for treatment could limit funding for other programs such as those helping children orphaned by AIDS. "We will be forced to oppose this bill if it compromises the effectiveness of the AIDS program," he said.
The current PEPFAR act, operating mostly in sub-Saharan Africa, has been one of the major successes of the Bush administration's foreign policy, supporting anti-retroviral treatment for about 1.5 million. It is on target to prevent 7 million new infections and provide care for 10 million, including orphans and vulnerable children.
The new and expanded bill has been promoted by the White House, which actively engaged in the negotiations, and supported by presumed presidential nominees Sens. Barack Obama, D-Ill., and John McCain, R-Ariz.
Negotiators cautioned that several conservative Republicans still have issues with the bill, including the $50 billion price tag.
But they said it was important to achieve progress before the July 7-9 G-8 summit in Japan, when Bush will be urging other industrialized nations to contribute more to the global effort to combat AIDS. The bill is S. 2731
Burr, allies need to relent on disease bill obstructionism
asheville citizen-times June 26, 2008

Sen. Richard Burr, R-N.C., signed a letter in March along with six other U.S. senators objecting to any action on a bill that would spend $50 billion combating AIDS, tuberculosis and malaria in Africa, the Caribbean and other countries around the world. The letter was addressed to Senate Minority Leader Mitch McConnell, R-Kentucky.
The bill passed the House on a strong bipartisan vote of 308-116 and is supported by the president. But so far, the seven senators have successfully blocked the bill from coming to a vote in the Senate.
The senator from North Carolina would do his party, the nation and millions of desperate people around the world a great service if he would withdraw his objection and encourage his fellows to do the same. He and his fellow obstructionists should clear the way soon to allow swift action and make it possible for the president to take the U.S. commitment to the G-8 meeting in Japan in early July. That would give the president leverage to seek additional commitments from other developed nations to fight these deadly scourges.
Dole pushing measure
In May, North Carolina's other senator, Elizabeth Dole, also a Republican, joined 13 other Republican senators in urging McConnell and Majority Leader Harry Reid to bring the bill to the Senate floor for debate.
"The programs the Act would reauthorize - the President's Emergency Plan for AIDS Relief, the President's Malaria Initiative and tuberculosis programs - have had an enormously positive effect in combating these diseases in Africa and throughout the developing world," they wrote in a letter to the Senate leaders. This program may well be one of the greatest legacies of a president badly in need of positive legacies.
Burr and the six other senators holding up the bill object that it increases the current spending level from $15 billion over five years to more than $50 billion over five years and allows more flexibility in how the money is spent.
Inconsistent on spending
With the federal government engaged in out-of-control deficit spending, their objection to "mission creep" deserves to be taken seriously. But it would be more credible if they were or had been objecting to "mission creep" in other areas of the budget - defense spending, perhaps, or the war on terror. The U.S. budgeted in the neighborhood of $481 billion and $145 billion respectively for those programs in 2008, an increase of 12 percent and 45 percent respectively over 2007.
The administration budget for 2009 would increase the Pentagon budget to $515 billion for day-to-day operations, a figure that alone is more than the total combined military spending by every other country in the world, National Public Radio reported earlier this year. That figure doesn't include supplemental requests to fund the wars in Iraq and Afghanistan. If you add all projected defense-related spending for fiscal 2009 the $515 billion balloons to $750 billion, almost a third of all U.S. federal spending today, the NPR report said.
"To put it another way," according to NPR reporter Guy Raz, "If the Pentagon were an independent country, it would be the 10th richest in the world." By comparison, $50 billion over five years, or an average of $10 billion a year, to provide medical help for some of the poorest and most desperate people on the planet seems a paltry sum.
From a purely pragmatic point of view, it's a commitment that shows America as a gentler, kinder nation, not the selfish bully she's often been seen as under this president. Earning the regard of people in other nations as opposed to their enmity might go a long way toward insuring our security.
A plane with no mission
It might go even further than the $65 billion that the Air Force wants to build 184 of its F-22 fighters, designed to prevail in dogfights against Soviet aircraft, according to a November report in Time Magazine by national security reporter Mark Thompson.
"That's despite the fact that plane-on-plane aerial combat has followed the Soviet Union into the dustbin of history," Thompson observed. It would be interesting to know if the seven senators have or intend to lodge an objection to the Air Force's request.
Ultimately, the reason to approve the AIDS bill is because it's the moral thing to do. The suffering this bill could help relieve can't be quantified or translated into figures. It's incalculable.
The program is "on schedule to achieve its topline goals of supporting treatment for 2 million AIDS patients with life-saving antiretroviral therapies, preventing the transmission of 7 million new cases of the disease, and supporting care for 10 million people infected or affected by HIF/AIDS, including orphans and vulnerable children," Dole and the other senators asking that it be brought forward for reauthorization said in their letter to Senate leaders.
It's hard to comprehend how a few senators can stand in the way.
Here's hoping Sen. Burr will not shame North Carolina by continuing to be one of them.
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