Bush Expected to Take Early Action on AIDS

Recently, about a dozen activists who have been working to achieve what they consider a compassionate federal AIDS policy met for more than an hour with officials from President-elect George Bush’s transition team. They emerged extremely pleased.

“The Bush people were informed, they were engaged in this issue and they understood that it would be a high priority,” said Jeff Levi, executive director of the National Gay and Lesbian Task Force, who participated in the meeting. “That moves us light years ahead of the current Administration.”

Although AIDS was barely mentioned during the presidential campaign, it promises to become one of the most critical health issues facing the new Administration.

Crucial Decisions

With a total caseload expected to approach 365,000 before Bush finishes his first term, and a national health care system already straining under the weight of the burgeoning epidemic, the President-elect will almost certainly be forced to make some crucial health policy decisions early in his tenure.

AIDS activists expect Bush to be more aggressive and sympathetic in formulating an AIDS public policy than his predecessor, President Reagan.

“George Bush is an extremely fair guy,” said Dr. Burton Lee, who served on the presidential AIDS commission and who is a Bush personal friend. “There is not going to be a hiding from this problem, or a putting it under the table because of the people affected by the disease.”

A Bush transition team official said that the Bush staff is “taking great pains to become as educated as we can on AIDS. Obviously, it’s a priority--an issue we should be committed to. We are not yet in policy development. But the AIDS group was one of the first we had in the door for a meeting--that is some evidence of commitment and concern.”

To be sure, much will depend on key appointments still to be made--most important among them that of secretary of health and human services. Nevertheless, there have already been some early signs that the Bush Administration will bring some long-sought-after changes in AIDS policy. Some months ago, at a private dinner, Bush met with Dr. Anthony Fauci, the director of AIDS programs for the National Institutes of Health, and Surgeon General C. Everett Koop, who both briefed him extensively on AIDS. It was an encounter that reportedly so impressed Bush, that many believe it was one reason Bush called Fauci one of his “heroes” during the second presidential election campaign debate.

More importantly, the first real indication that Bush had broken from Reagan on AIDS came last summer after the release of the presidential commission report. The recommendations essentially were disregarded by the Reagan White House--even though the panel had been appointed and charged by the Reagan Administration to develop a national strategy on AIDS. But Bush endorsed the report immediately--specifically its centerpiece proposals, that strong anti-discrimination and confidentiality legislation be enacted to protect the ill and the infected.

‘Right Thing’

“I called him up in Maine a few days later and I said: ‘Mr. Vice President, I’m calling you to tell you what a courageous act you just performed. I wasn’t anticipating that,’ ” said Adm. James D. Watkins, chairman of the commission, also a friend of the President-elect. “I said: ‘You’re going to lose a lot of right-wing votes because of this.’ He said: ‘Jim, I know it. But it was the right thing to do.’

“When he said that, I broke down,” Watkins continued. “It was such an important statement to me, personally, that I had not heard from anyone in the executive branch, that I was overwhelmed by it. I knew then there was hope.”

Congressional sources involved in AIDS legislation agreed.

“Mr. Bush isn’t going to push for national health insurance to pay for AIDS, but he’s also not going to be silent when people talk about discrimination,” one of them said. “That’s a crucial change. He’s either going to be someplace in the middle--or he may be as surprising as Adm. Watkins and Surgeon General Koop turned out to be. They came to this issue probably as conservative people--and came away from it changed.”

Among the new President’s first tests will be whether he pushes Congress to enact the anti-discrimination and confidentiality legislation that many people feel is crucial to curbing the epidemic. The major bill in question would expand to the private sector an anti-discrimination law that protects the handicapped--including those with infectious diseases. The existing law affects only institutions that receive federal funds.

Confidentiality Rules

Additional legislation has been proposed to protect the ill and infected against violations of confidentiality.

“I cannot think of anything more important for the President to do early in his Administration than to work with the Congress to ensure early passage,” Watkins said. “He can say: ‘This is my first contribution to a kinder and gentler society.’ This would be my fondest wish.”

The public health community has been unified in calling for such protections, saying that they are essential to containing the epidemic. Most public health professionals believe that individuals will not voluntarily be tested for AIDS infection if they believe they will suffer social or economic repercussions as a result.

But the Reagan Administration opposed such measures and congressional attempts at legislation failed during the last session. Some conservative members viewed the bills as having a “hidden” gay rights agenda, while others felt uneasy supporting them without some endorsement from the President.

“I’m optimistic that the Bush Administration will help us over some of the legislative barriers we’ve had in the past,” said Rep. Henry A. Waxman (D-Los Angeles), chairman of the House Energy and Commerce subcommittee on health, and author of major AIDS legislation in the House. “There are lots of members of Congress who want to do the right thing but just don’t want to be out on a limb by themselves.”

Needed, Responsible

He added: “With a President supporting the legislation, it will be clear that these policies are both needed and responsible. Strong leadership will make such legislation likely. Presidential support will be enough for moderates in both parties to rally behind these proposals.”

Dr. Lee has proposed that Bush appoint someone to serve in the White House as “a point man” for AIDS.

“It would give some reassurance to the entire AIDS community that there was somebody there communicating with the executive branch,” Lee said. “During the Reagan years, people were faulting the White House for a lack of leadership on this. If there was somebody in there, a liaison, an awful lot of criticism and weight would be taken off the President in his handling of the problem. There would be somebody for the critics to go to.”

Another potential task facing Bush, which will also offer some clues to his approach to AIDS policy, will be how he handles amendments to the fiscal 1990 budget as they affect AIDS activities.

One drug has been approved thus far for AIDS therapy, but there is still no cure and no vaccine, although efforts on these fronts are accelerating. Further, there is the need for increased federally funded AIDS education programs, all of which require more money than has been appropriated thus far.

Budget Request

The Department of Health and Human Services requested $1.9 billion for AIDS activities, but the Office of Management and Budget pared its figure back to $1.6 billion, which the department felt was inadequate.

“The test of George Bush’s commitment on this issue will be whether he will give the public health officials the resources they feel are necessary,” said Levi, the gay and lesbian task force director.

Waxman agreed. “I hope that the Bush Administration will be more realistic in its budget request than we saw from the Reagan Administration,” he said. “If not, Congress will have to come in as we’ve done for the last seven years and put in more money.”

Moreover, Levi said, regardless of the “positive feelings we are getting about (Bush) people working specifically on health issues, how the deficit is handled is going to have an impact ultimately on the resources available for health programs.”

In other areas affected by AIDS, Bush will also be forced to confront the growing burden on the nation’s health care delivery system, already overtaxed in areas most heavily afflicted by AIDS.

In a document given Bush transition people, a coalition of groups active in AIDS work wrote: “Reforms in health care financing and assistance to those systems are critical. We must improve access to care, not only for the growing numbers of men, women and children with . . . disease, but also for all who are catastrophically ill or inadequately served by existing public and private health care delivery systems.”

Levi added: “There has to be a recognition that there are public hospital systems in the country that are collapsing under the weight of AIDS and they are going to have to address that, particularly in New York and California.”

Although specific AIDS policy initiatives are still forthcoming, observers expect Bush to align himself with the public health community and to try to distance himself from the kind of political rhetoric--and arguments over values and morality--that has marked the AIDS debate in recent years.

“AIDS will become a lot less inflammatory during the Bush Administration,” one congressional source predicted. However, he added: “But the problems are going to get a lot harder.”