Lawmakers Debate AIDS Infection Reporting Plan

A congressional hearing on legislation that would commit nearly $1.5 billion to the treatment of early-stage AIDS infections next year erupted Thursday into a debate over a proposal to require doctors to report the names of infected patients to health authorities.

On opposite sides of the issue were Rep. William E. Dannemeyer (R-Fullerton), who supports mandatory reporting of patients infected with the AIDS virus, and Rep. Henry A. Waxman (D-Los Angeles), who believes the decision should be left up to the states.

“The cornerstones of public health--confidential reporting (of the infected) and (sexual) contact tracing--should be adopted in every community in America,” Dannemeyer said.

“It should be up to the public health people (in each state) to decide whether (mandatory reporting) is going to contain the disease, or whether that’s going to drive people away (from testing centers) for fear of discrimination,” Waxman countered.

The two lawmakers squared off during a hearing before the health and environment subcommittee of the House Committee on Energy and Commerce. The subcommittee heard testimony on two bills written by Waxman that are likely to be the only major pieces of AIDS legislation considered by Congress this year.

Early treatment of those infected with the human immunodeficiency virus, which causes AIDS, has assumed increasing importance in the last year as researchers have demonstrated that experimental drugs such as AZT can forestall the onset of the disease, perhaps for years.

The Waxman measures would extend Medicaid coverage to pay for early treatment of infected patients who are poor.

Under current policy, Medicaid covers treatment only after a patient has a fully developed case of AIDS. Extension of Medicaid coverage as proposed by Waxman could cost more than $660 million in the first year and more than $5 billion over five years, the Congressional Budget Office estimates.

In addition, the legislation would provide $500 million a year for grants to agencies that offer counseling, drug treatment and other services to those newly infected with HIV but not yet ill, $300 million for emergency aid to cities with more than 2,000 AIDS patients and $60 million to continue model counseling and outpatient programs.

During the hearing, four witnesses invited by Dannemeyer told Waxman that his legislation should include language denying federal funds to states that do not require doctors to report in confidence to public health authorities the names of those who have tested positive for HIV.

Dannemeyer is expected to offer an amendment to that effect. A similar effort in 1988 failed on the House floor.

However, other witnesses invited by Waxman, including David Wexler, chairman of the board of AIDS Project Los Angeles, said mandatory reporting would drive those most in need of AIDS testing underground because they would fear breaches of confidentiality and resulting discrimination.