Federal TB bill hits late snag in dispute over funding

Time to make some noise, ALA urges

For a few glorious days last month, a bill that would have transfused millions of badly needed federal dollars into state and local TB control programs seemed assured of a smooth and speedy passage through the Senate. Introduced by Sens. Ted Kennedy (D-MA) and Ted Stevens (R-AL), the Comprehensive TB Elimination Act (S. 1115) had deftly cleared committee and was poised for passage by unanimous consent, a procedure often used to pry loose bills with strong bipartisan support that get stuck in last-minute legislative logjams.

But before the bill could be introduced onto the floor, Sen. Jon Kyl (R-AZ) placed a hold on it, saying it simply would cost taxpayers too much money. (And no, the dollar amount named in the bill wasn’t negotiable, he told lobbyists later that week.) The bill would have added $235 million to the federal TB budget, which has been essentially flat for eight years in a row, and stood this year at an anemic $126.5 million.

As the clock ticked off the handful of days remaining until midterm elections, the American Lung Association scrambled to alert local chapters, and was urging other Republican sponsors of the bill in the Senate (including Stevens) to persuade Kyl to relinquish his hold on the bill.

After the November elections, a lame-duck Senate conceivably could still approve the bill through the regular channels. But even if that happened, it’s unlikely it would leave enough time for the bill to win passage in the House. That would mean starting the whole torturous process over again from scratch in a new Congress next year.

That came as bad news to TB control programs and other public health advocates. "This is a terribly, terribly short-sighted move," says Lee B. Reichman, MD, MPH, executive director of the TB Model center at the New Jersey Medical School in Newark. "This would have provided money that’s urgently needed to protect Americans not just from TB but also from the scourge of multidrug-resistant TB."

TB experts in Kyl’s home state say they certainly could have used the extra money. "I think all states are suffering from the economic downturn, and we’re no exception," says Cheryl McRill, MD, state TB controller. Though TB rates have fallen, case totals in Arizona have held steady, in part because of the state’s booming population, which has grown by half over the past decade.

The biggest challenge, McRill adds, is making sure there’s continuity of treatment for deportees. That means keeping in touch with all the links in the correctional services chain, from local jails to prisons to immigration detention facilities, so they tell TB controllers when prisoners still in treatment are about to be deported. Recently, in a collaboration between Arizona TB controllers and TB experts across the border in Sonora, Mexico, free housing was established, providing a place where patients can stay while they finish treatment.

But across the country, budgets continue to tighten for public health programs such as those. According to a recent report from the Kaiser Commission on Medicaid and the Uninsured, state revenues fell an average of 10% last quarter, marking the fourth consecutive quarter of declines. Forty-one states are in the process of cutting back patients from Medicaid rolls, and state TB controllers across the country report they are working with budgets that have been pared to the bone. (See TB Monitor, October 2002, p. 109).

Along with the money the bill would have provided to federal domestic TB control, it would have increased the budget for TB vaccine research at the National Institutes of Health to $240 million.

Sherrod Brown (D-OH) and Connie Morella (R-NJ) originally introduced the bill in the House on World TB Day in 2001. At the same time, Brown also introduced the Stop TB Now Act, the international version of the Comprehensive TB Elimination Act. That bill, which aims to boost funding for international TB control from $60 million to $200 million, has been tucked into a larger bill that addresses HIV/AIDS funding abroad. The international bill still is active and stands a good chance of passing, congressional observers say.