The House gave its stamp of approval Thursday to the controversial ban on AIDS-infected immigrants, and the White House indicated it is likely to agree despite President Clinton's oft-stated intention to remove the prohibition.
"The President has to work with Congress," White House Press Secretary Dee Dee Myers said. "He can't act unilaterally on issues like this."
The House voted, 356 to 58, to direct members of a House-Senate conference committee to accept a Senate amendment keeping the ban.
The amendment, part of a Senate bill reauthorizing programs of the National Institutes of Health, forbids AIDS-infected immigrants to enter the United States but changes current rules to enable tourists or other visitors to come into this country for up to 30 days without requiring them to be tested.
The ban, which has been in effect since 1987, has been the focus of an intense international debate and has been widely condemned by the global public health community as medically unjustified and discriminatory.
Lawmakers supporting the ban had argued that allowing infected foreigners into this country would place healthy Americans at risk and could overwhelm the health care system.
"We have never before permitted the immigration of those who are infected in the middle of an epidemic--we should not start now," said Rep. Thomas J. Bliley Jr. of Virginia, ranking Republican on the House Energy and Commerce subcommittee on health.
Removing the ban would "add to an already overburdened and overwhelmed health care system," Bliley said.
Rep. Henry A. Waxman (D-Los Angeles), sponsor of the NIH bill in the House, opposes the AIDS ban but nevertheless voted to support the House motion. He said he did so because he intends to try to alter the ban in House-Senate negotiations and believed he would have "more maneuverability" if there were no "sharp division in the House" over the issue.
"My own view is that the Senate provision is not good policy," Waxman said. "I wouldn't want us to adopt the Senate language. I would support a different way of approaching the issue."
Rep. Nancy Pelosi (D-San Francisco), whose district has one of the highest AIDS caseloads in the nation, was one of a handful of House members who opposed the motion.
"I do not believe Congress should be making scientific and medical decisions about who should come into this country." she said.
The full NIH bill, approved, 283 to 131, by the House, provides $22 billion over five years for spending on biomedical research and earmarks funds for research into breast, ovarian and other reproductive cancers, and prostate cancer. It also establishes safeguards to prevent abuses in the use of fetal tissue in medical research.
The White House indicated Clinton would sign the NIH legislation, even if it preserves the ban on immigrants infected with the human immunodeficiency virus, which causes AIDS.
"To hold up funding for the National Institutes of Health when it contains much-needed funding for breast and ovarian cancer and osteoporosis and other research is a serious, serious thing," Myers said. "We'll have to wait and see how the bill ultimately comes to him, but I think Congress' intent on this is becoming clear."
Clinton had promised during the campaign and after his election that he would remove the immigration ban on foreigners infected with HIV. But the White House appeared to back off after the Senate action in February.
Supporters of the ban have used the cost argument in the past, while opponents have pointed out that immigration regulations require immigrants seeking permanent resident status to prove they are economically self-sufficient. Those who cannot demonstrate such financial independence can be barred entry.
The Agency for Health Care Policy and Research, part of the department of Health and Human Services, has estimated the average cost of treating an AIDS patient, from diagnosis to death, at $102,000.
Estimates are not available as to the numbers of AIDS-infected immigrants who would enter the country if permitted, or how much it would cost to treat them.
"Immigrants with HIV are not going to break the bank," said Aimee Berenson, legislative counsel to the AIDS Action Council. "Immigrants should be admitted--or excluded--on the same basis as anyone else. HIV status should not be a factor."