To Pay for Separation of Immigrant Children, the Trump Administration Seeks to Raid Ryan White HIV Care Programs
Drew Gibson is a freelance writer and a policy associate at AIDS United in Washington, D.C. You can follow him on Twitter at @SuppressThis or visit his blog "Virally Suppressed," which covers a multitude of issues related to public health and social justice.
July 11, 2018
At this point in the Trump administration's reign of kleptocratic terror, one would think that we had reached a place where the maliciousness of its actions would cease to shock. Surely after 18 months of Machiavellian maneuvering, its ability to render us mute with disbelieving anger at its callous disregard for humanity must have been tempered. Yet, this week the Trump administration has proven once again that it has not yet exhausted our capacity for revulsion, having devised a scheme to simultaneously rip health care away from people living with HIV and to continue terrorizing immigrant children by shifting funding from the Ryan White HIV/AIDS Program to the Office of Refugee Resettlement (ORR), where it would be used to hold undocumented immigrant children in cages.
According to an article published by Slate, the Trump administration has been drawing up plans to accommodate an expected dramatic increase in the number of young immigrant children being held in detention by the ORR. This increase, which the administration estimates could entail the detention of an additional 13,600 immigrant minors by the end of 2018, many of whom would be forcibly separated from their parents, contradicts The White House's recent statements that it would end its draconian separation policies. In addition to the tremendous cost in human suffering of such an increase, the Trump administration estimates that it would result in a $1.9 billion budget shortfall by the start of 2019.
To offset the costs of such a massive increase in immigrant child detainees, the Trump administration appears to be seriously considering taking money from Ryan White and repurposing it in the ORR. While the Slate article did not state the Trump administration's justification for pilfering funds appropriated for one federal program for use in another, it is possible that it would be based on the Health and Human Services (HHS) secretary's transfer authority.
Trump Has Authority to Move Money, but Hasn't Notified Congress
Discretionary transfer authority provided by the annual appropriations process allows the HHS secretary to transfer up to 1% of the funds in any HHS budget account to another HHS budget account, meaning that the Trump administration could theoretically transfer up to $231.9 million from Ryan White into the ORR, as they are both housed within HHS. However, in the past, the HHS secretary's transfer authority has been primarily used to transfer funding between programs having similar functions, as was the case in 2016 when then-HHS secretary Sylvia Burwell transferred $34 million within the National Institutes of Health from initiatives researching cancer, Alzheimer's disease, and diabetes to work on finding a vaccine for the Zika virus. Shifting money from the Ryan White program, where it would be used to provide primary medical care and support services for people living with HIV, to the ORR, where it would be used to traumatize immigrant children, is a different sort of proposition.
Under the HHS secretary's transfer authority, the Trump administration must notify congressional appropriators 15 days in advance of any funding transfer. As congressional appropriators have yet to be notified of any pending transfer of funds from Ryan White to the ORR, it looks as if the HHS has not yet initiated a transfer. Another tactic the Trump administration might reemploy is to set its sights on unspent Ryan White funding from prior fiscal years that can be reappropriated.
People Living With HIV and Immigrants Have a Shared Fight Ahead
In the coming days and weeks, we will no doubt learn more about the Trump administration's plans to transfer funding from Ryan White to the ORR, but regardless of what details come to light, we already know everything necessary to vigorously and vehemently oppose this scheme. It is bad enough that the Trump administration has endeavored to take away funding appropriated specifically to provide care to people living with HIV. Had it sought to shift that money to another department to address another pressing health care need, we still would have opposed it. But to take that funding away to tear young children away from their families, imprisoning them in chain-link cages for the crime of existing, is so barbaric and heartless that it warrants an opposition from the HIV advocacy community that is vicious and unyielding.
Until now, the Trump administration's attacks on immigrants living in the U.S. have concerned HIV advocates, but they have not consumed us. They were seen as peripheral: issues that occasionally intersected with concerns of the HIV advocacy community but were not necessarily central to them. However, as of today, that relationship is forever changed. The fates of these young migrant children and their families and people living with and affected by HIV are inextricably linked. Immigrants' fight must now be our fight, and we cannot rest until every penny of Ryan White funding is guaranteed to be used for its intended purpose and every immigrant child is reunited with his or her family and no longer detained.