Opponents of Gov. Arnold Schwarzenegger’s last-minute line item budget vetoes of HIV/AIDS funding have blasted his decision as an illegal use of power that will in the short term destroy a health service network that took 20 years to build and in the long term will cost lives, increase the total cost of health care in the state, and will eliminate the federal funds used to help pay for them.

Health service agencies are considering a legal challenge. And the head of a state legislative caucus has added legislators will file an amicus brief the moment a suit is filed.

After the legislature belatedly passed a state budget last month that included hefty cuts across the board, the governor signed. But he selectively crossed out an additional $487 million in line item vetoes. Nearly 11 percent of that -- $52.2 million -- was from the Office of AIDS Prevention and Treatment, the single biggest chunk of Schwarzenegger’s cuts.

All of $24.6 million in state funding has been cut from HIV reduction and prevention programs. The governor vetoed $8.2 million for counseling and testing initiatives and $7.4 million from early intervention programs. Schwarzenegger cut a further $8 million from therapeutic monitoring and $6.3 million from home and community-based care programs. He cut another $1.1 million from AIDS housing and another million in state funding for HIV/AIDS surveillance, which includes epidemiologic studies the HIV/AIDS cases registry.

Federal funding for these programs remains unaffected, but
Assemblymember John Pérez (D-Los Angeles), chair of the Assembly Democratic Caucus, said the state Constitution restricts the governor’s line-item authority to vetoes on new spending. He added Schwarzenegger illegally applied them to budget spending he had already approved in February.

"He does not get a second bite at the apple now," Pérez said.

Pérez told EDGE he has received calls from numerous agencies that include HIV health providers and battered women’s programs.

"If the Legislature had standing, we’d be filing now," he said. "This is absolutely unprecedented, illegal, unconstitutional, and immoral. Once a suit happens, then legislators can file briefs."

As the state budget stands now, California will wipe out all state funding for the current 2009-10 year for HIV education and prevention, counseling and testing, early intervention, therapeutic monitoring, home and community based care and AIDS housing. That, Pérez and providers warn, would wipe out the state’s eligibility for federal funds dependent on the state providing at least half the funding in those areas.

"With HIV testing programs sidelined and the state’s ability to prevent new infections stymied, new infections in California will increase--each new infection can mean up to $600,000 dollars in lifetime health care costs," Michael Weinstein, president of the AIDS Healthcare Foundation, said. "With the ability to monitor the effectiveness of lifesaving AIDS drugs hampered, the state’s already cash-strapped AIDS Drug Assistance Program will only end up spending more for drugs."

Although the AIDS Drug Assistance Program is not immediately imperiled, the funds which come in from pharmaceutical rebates are being used to make up a budget gap; there will be no money next year to replace it.

"It has taken well over two decades to build up an adequate network of care and services. With one blue pencil the governor has managed to decimate that network. It will take a long, long time to ever see it again -- if we ever do."
"The federal government provided California with $128 million this year and the state matched that with $64 million (50 percent)," Pérez’s office told EDGE. "Many of the programs that were decimated by the Governor’s cuts have some minimal amount of funding from the federal government. Those paltry sums will likely be eliminated next year if the state continues to not fund services. That impact will also extend to ADAP. We were teetering close this year to being below the 50 percent match, but next year we will likely lose every dollar we have. Without adequate resources to provide prevention, education and testing, those in the HIV/AIDS community stress that we will see an increase in the number of those affected by HIV infection."

Philip Curtis, director of government affairs for AIDS Project Los Angeles, echoed these concerns to EDGE.

"These cuts are going to cost the state money in the long run," he said. "If you reduce prevention efforts, you’re going to see more infections, and soon or later those people are going to end up in emergency rooms and state or federal clinics seeking treatment."

Rochelle Roland of the state Office of AIDS is reviewing the budget cutbacks and is expected to file a report with counties and agencies this week. It is expected outpatient medical care will be prioritized and the biggest cuts will be to prevention programs.

The result of wiping out prevention programs from needle exchanges to educational efforts, Curtis said, means "the consequence is likely to be an increase of HIV infections, a greater number of people getting ill and in the long term greater cost in health care."

"Beyond the state and federal funding, there really isn’t any other place to go," he said. "There may be foundation grants here and there, but there is no other source like those. There is no replacing this money."

When those people do fall sick, Curtis warned, ADAP may not be there to catch them.

"These drugs are what keep people alive and healthy," Curtis said. We don’t expect state revenues to increase much over the next year and we don’t expect any greater contributions from the general fund to the ADAP program. So in the next cycle, ADAP could be on the chopping block."

Services expected to be cut back or completely eliminated include crystal methadone and free condom programs, tests that check viral loads and drug resistance and nurse case managers. Roughly 1,500 new cases of HIV in California are identified annually through testing and counseling programs that will be curtailed.

In addition to the judicial challenge, protest rallies are being scheduled. A rally has tentatively been set for Thursday in Los Angeles. A demonstration is planned to take place at noon on Wednesday in front of the State Building in the San Francisco Civil Center.

"The Governor’s heartless act is not only deadly, but guaranteed to cost California taxpayers millions more in the future," Weinstein said. "With HIV testing programs sidelined and the state’s ability to prevent new infections stymied, new infections in California will increase--each new infection can mean up to $600,000 dollars in lifetime health care costs. With the ability to monitor the effectiveness of lifesaving AIDS drugs hampered, the state’s already cash-strapped AIDS Drug Assistance Program will only end up spending more for drugs."