The Cost of Health Care - The Cost Of Dying

The Canadian Health Services Research Foundation (CHSRF), in "Myth: The Cost of Dying Is an Increasing Strain on the Healthcare System" (CHSRF, 2003), reported that treating the dying is not growing and overwhelming health care systems. The report describes research conducted in North America and Europe, showing that thirty years of research debunk the myth that health care costs in the last year of life are extraordinarily high and are increasing. Research spanning countries and continents, the report notes, shows that treating the dying accounts for only about 10% to 12% of many countries' total health care budgets.

In "Medicare Expenditures during the Last Year of Life: Findings from the 1992–1996 Medicare Current Beneficiary Survey—Cost of Care" (Donald R. Hoover et al, Health Services Research, vol. 37, no. 6, December, 2002), the authors show that approximately 22% of total annual U.S. health care expenditures is spent during the last year of life. This figure is higher than noted in the previous paragraph. These expenses consume about 26% of the Medicare budget and about FIGURE 9.3 Growth in the number and percent of Medicare beneficiaries with disabilities or end stage renal disease, selected years 1970–2030 "Number of Medicare Beneficiaries," in Program Information on Medicare, Medicaid, SCHIP, and Other Programs of the Centers for Medicare and Medicaid Services, Centers for Medicare and Medicaid Services, June 2002, http://www.cms.hhs.gov/TheChartSeries/ (accessed February 28, 2006)18% of non-Medicare budgets. The researchers note, however, that end-of-life Medicare expenses grew at the same rate as did other Medicare expenses in the early 1990s and are not growing more quickly than other Medicare expenses.

Why aren't health care costs in the last year of life rising? The CHSRF report comments that most people die without using costly high-tech equipment, and many die after only two weeks or less in a hospital. In the United States nearly half (46%) of Medicare recipients were not hospitalized before they died. Hospitalization dramatically drives up the cost of dying in America, and many terminally ill patients are choosing alternatives to hospitalization, such as hospice and home health care.

TABLE 9.14 Federal spending for human immunodeficiency virus (HIV)-related activities, by agency and type of activity, selected fiscal years 1985–2003

TABLE 9.14
Federal spending for human immunodeficiency virus (HIV)-related activities, by agency and type of activity, selected fiscal years 1985–2003
[Data are compiled from federal government appropriations]
Agency and type of activity	1985	1990	1995	1999	2000	2001	2002	2003a
Agency	Amount in millions
All federal spending		$209	$3,070	$7,019	$10,779	$12,025	$14,184	$14,988	$16,677
Department of Health and Human Services, total		201	2,372	5,200	8,494	9,621	11,406	12,039	13,292
Department of Health and Human Services, discretionary spending, totalb		109	1,592	2,700	4,094	4,546	5,226	5,789	6,142
National Institutes of Health		66	908	1,334	1,793	2,004	2,247	2,499	2,717
Substance Abuse and Mental Health Services Administration		—	50	24	92	110	157	169	171
Centers for Disease Control and Prevention		33	443	590	657	687	859	931	936
Food and Drug Administration		9	57	73	70	76	76	76	80
Health Resources and Services Administration (HRSA)	—	113	661	1,416	1,599	1,815	1,917	2,025
Agency for Healthcare Research and Quality	—	8	9	2	2	3	3	2
Office of the Secretaryc	—	10	6	12	13	15	14	18
Indian Health Service	—	3	4	4	4	4	4	4
Emergency Fund	…	…	…	50	50	50	50	50
Global AIDS Trust Fund	…	…	…	…	…	…	125	99
The International Mother and Child HIV Prevention Initiatived	…	…	…	…	…	…	…	40
Centers for Medicare & Medicaid Services	75	780	2,500	4,400	5,000	5,600	6,250	7,150
Social Security Administratione	17	…	…	…	…	…	…	…
Ricky Ray Hemophilia Relief Fund (HRSA)f	…	…	…	…	75	580	…	…
Social Security Administratione	…	239	881	1,158	1,240	1,259	1,351	1,395
Department of Veterans Affairs	8	220	317	401	345	405	391	396
Department of Defense	—	124	110	86	97	108	96	78
Agency for International Development	—	71	120	139	200	430	510	873
Department of Housing and Urban Development	—	—	171	225	232	257	277	292
Office of Personnel Management	—	37	212	266	279	292	297	321
Other departments	—	7	8	10	11	27	27	30
Activity	Amount in millions
Research	75	1,013	1,460	1,900	2,125	2,368	2,614	2,821
Department of Health and Human Services discretionary spendingb	75	974	1,417	1,869	2,085	2,328	2,580	2,800
Department of Veterans Affairs	—	6	5	7	7	7	8	8
Department of Defense	—	33	38	24	33	33	26	13
Education and prevention	33	591	770	902	998	1,396	1,629	1,940
Department of Health and Human Services discretionary spendingb	33	460	604	719	751	950	1,091	1,130
Department of Veterans Affairs	—	29	31	30	33	35	35
Department of Defense	—	28	12	10	10	17	17	11
Agency for International Development	—	71	120	139	200	380	473	749
Other	—	3	3	4	4	14	13	15
Medical care	83	1,227	3,738	6,595	7,356	8,324	9,117	10,229
Centers for Medicare & Medicaid Services:
Medicaid (federal share)	70	670	1,500	2,900	3,300	3,700	4,200	4,800
Medicare	5	110	1,000	1,500	1,700	1,900	2,050	2,350
Department of Health and Human Services discretionary spendingb	—	158	680	1,507	1,711	1,948	2,118	2,212
Department of Veterans Affairs.	8	185	281	364	305	363	348	353
Department of Defense	—	63	60	52	54	58	53	54
Agency for International Development	—	—	—	—	—	50	38	124
Office of Personnel Management	—	37	212	266	279	292	297	321
Other	—	4	5	6	7	13	14	15

TABLE 9.14 Federal spending for human immunodeficiency virus (HIV)-related activities, by agency and type of activity, selected fiscal years 1985–2003 [CONTINUED] "Table 128. Federal Spending for Human Immunodeficiency Virus (HIV)-Related Activities, according to Agency and Type of Activity, United States, Selected Fiscal Years 1985–2003," in Health, United States, 2004, Centers for Disease Control and Prevention, National Center for Health Statistics, September 2004, ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/Health_US/hus04tables/ (accessed February 27, 2006)

TABLE 9.14
Federal spending for human immunodeficiency virus (HIV)-related activities, by agency and type of activity, selected fiscal years 1985–2003 [CONTINUED]
Agency and type of activity	1985	1990	1995	1999	2000	2001	2002	2003a
Notes: "—"=Quantity zero. "…"=Category not applicable.
aPreliminary figures.
bDiscretionary spending is contrasted with entitlement spending. Medicare and Medicaid are examples of entitlement spending.
cThe Office of the Assistant Secretary for Health prior to fiscal year 1996 (FY1996).
dThe International Mother and Child HIV Prevention Initiative was introduced in 2002 with funding starting in fiscal year 2003 (FY2003).
ePrior to 1995 the Social Security Administration was part of the Department of Health and Human Services.
fThe Ricky Ray Hemophilia Relief Fund was established by the U.S. Congress in 1998 to make compassionate payments to certain individuals who were treated with antihemophilic factor between July 1, 1982 and December 31, 1987, and who contracted HIV. Some family members may also be covered by the fund.
SOURCE: "Table 128. Federal Spending for Human Immunodeficiency Virus (HIV)-Related Activities, according to Agency and Type of Activity, United States, Selected Fiscal Years 1985–2003," in Health, United States, 2004, Centers for Disease Control and Prevention, National Center for Health Statistics, September 2004, ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/Health_US/hus04tables/(accessed February 27, 2006)
Cash assistance	17	239	1,052	1,383	1,547	2,096	1,628	1,687
Social Security Administration:
Disability insurance	12	184	631	828	870	919	961	985
Supplemental security income	5	55	250	330	370	340	390	410
Department of Housing and Urban Development	—	—	171	225	232	257	277	292
Ricky Ray Hemophilia Relief Fundf	…	…	…	…	75	580	…	…

TABLE 9.15 Ryan White CARE (Comprehensive AIDS Resources Emergency) Act Title I Grant Awards, 1992–2005

TABLE 9.15
Ryan White CARE (Comprehensive AIDS Resources Emergency) Act Title I Grant Awards, 1992–2005
Eligible metropolitan areas	1992	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005
Atlanta, GA	$3,130,126	$5,490,571	$7,488,801	$9,091,331	$9,208,162	$12,632,117	$12,021,454	$13,147,268	$15,507,832	$15,992,692	$17,554,590	$18,751,178	$18,339,732	$19,126,568
Austin, TX	$2,124,274	$2,398,671	$3,337,861	$2,856,752	$3,175,509	$3,575,995	$3,922,582	$3,946,480	3,995,912	3,800,520	3,851,321
Baltimore, MD	$1,898,561	$3,250,343	$3,923,438	$4,715,150	$8,364,074	$10,033,688	$12,184,481	$13,478,549	$15,351,112	$16,698,367	$17,986,832	21,458,791	19,710,879	19,179,964
Bergen-Passaic, NJ			$2,019,121	$2,847,639	$3,369,095	$4,292,593	$4,354,291	$4,320,176	$4,626,995	$5,234,104	$5,313,602	5,203,065	4,814,704	4,376,432
Boston, MA	$2,823,768	$4,154,744	$6,955,035	$7,079,242	$8,360,436	$9,033,443	$9,463,130	$10,647,381	$12,469,255	$15,363,160	$15,198,508	15,398,403	14,848,697	13,651,229
Caguas, PR				$902,928	$1,064,876	$1,431,210	$1,405,197	$1,610,314	$1,713,686	$1,750,404	$1,768,847	1,623,395	1,816,647	1,816,497
Chicago, IL	$4,327,603	$7,390,763	$9,625,451	$12,099,865	$13,164,930	$15,741,071	$15,995,512	$18,227,884	$19,003,954	$22,963,079	$23,005,863	23,225,285	25,426,760	24,992,277
Cleveland, OH					$1,384,956	$1,877,513	$2,459,443	$2,933,058	$3,107,796	$3,384,855	$3,535,615	3,593,703	3,486,936	3,464,211
Dallas, TX	$3,119,688	$4,542,034	$6,935,644	$8,176,385	$7,820,653	$8,129,583	$9,082,217	$10,164,078	$11,077,000	$12,098,406	$12,001,240	13,205,009	12,820,583	13,038,882
Denver, CO			$3,375,884	$3,092,041	$3,549,707	$4,668,572	$4,278,161	$4,150,341	$4,581,734	$4,840,128	$4,741,353	5,035,812	4,529,097	4,305,958
Detroit, Ml		$2,091,739	$2,849,559	$2,406,902	$4,405,380	$6,087,121	$5,628,350	$6,585,744	$7,234,813	$7,612,631	$8,363,876	8,766,530	8,590,281	8,605,663
Dutchess County, NY		$609,583	$581,761	$776,847	$854,481	$1,220,662	$1,208,858	$1,362,331	$1,271,442	1,337,041	1,231,242	1,222,865
Ft. Lauderdale, FL	$3,065,827	$4,591,215	$6,814,599	$5,091,994	$6,584,204	$8,312,185	$10,128,631	$10,810,324	$11,437,539	$13,816,037	$14,872,845	14,695,524	14,749,550	14,611,634
Ft. Worth, TX					$2,255,398	$1,902,232	$2,618,024	$2,935,543	$2,968,606	$3,298,024	$3,376,074	3,503,726	3,373,450	3,502,064
Hartford, CT					$3,048,467	$2,661,473	$3,613,029	$4,019,409	$4,417,574	$4,868,180	$4,648,410	4,679,151	4,552,237	4,498,360
Houston, TX	$5,826,845	$7,820,319	$10,133,592	$10,233,981	$10,312,524	$10,768,697	$12,722,479	$15,489,996	$17,665,434	$19,283,756	$19,720,190	20,526,823	19,128,572	19,911,575
Hudson	$2,181,853	$3,618,220	$4,140,141	$3,770,366	$3,767,874	$4,600,103	$5,320,300	$5,015,785	$5,541,714	$6,167,889	$6,278,761
Jacksonville, FL				$2,418,868	$2,725,251	$3,762,713	$3,443,168	$3,683,146	$4,175,873	$4,799,813	$5,019,332	5,166,800	4,863,093	5,025,194
Jersey City, NJ												6,426,456	5,884,194	5,644,838
Kansas City, MO			$2,655,564	$2,726,195	$2,514,291	$2,884,537	$2,622,409	$2,952,910	$3,064,120	$3,386,127	$3,328,170	3,138,000	3,240,813	2,786,392
Las Vegas, NV							$75,000	$3,402,697	$3,689,337	$4,455,787	$4,231,997	4,658,661	4,473,401	4,531,754
Los Angeles, CA	$9,788,087	$19,190,269	$25,568,865	$31,216,202	$26,555,597	$30,227,298	$30,637,106	$33,540,737	$34,683,327	$35,020,216	$37,962,755	39,994,550	36,644,121	36,834,089
Miami, FL	$5,923,065	$9,716,264	$15,258,563	$19,195,347	$15,156,078	$18,863,208	$18,472,153	$21,248,387	$23,450,383	$25,385,904	$27,097,189	27,024,359	25,540,011	24,551,236
Middlesex-Somerset-Hunterdon, NJ					$2,198,883	$1,919,076	$2,597,923	$2,555,029	$2,750,975	$2,888,808	$2,925,300	2,991,173	2,723,697	2,689,723
Minneapolis-St. Paul, MN	$1,370,726 $1,990,700 $2,570,712 $2,548,603 $2,826,949 $3,216,026 $3,220,400 3,255,148  3,093,915  3,011,747
Nassau-Suffolk, NY		$2,012,809	$2,886,968	$3,895,849	$3,683,885	$4,697,795	$4,939,871	$5,632,012	$6,118,736	$6,532,144	$6,242,641	6,470,593	5,951,789	5,805,121
New Haven, CT			$2,136,872	$2,711,634	$4,002,182	$5,336,678	$5,348,730	$6,100,471	$6,261,941	$6,944,353	$6,644,351	7,545,500	7,069,348	7,050,669
New Orleans, LA		$1,796,972	$3,243,332	$3,503,009	$2,087,199	$4,727,682	$4,921,857	$5,695,360	$5,935,834	$6,942,652	$7,066,837	7,326,105	6,787,028	7,323,546
New York, NY	$35,894,688	$44,469,219	$100,054,267	$93,587,184	$92,241,697	$92,459,373	$95,325,334	$96,961,856	$107,560,148	$119,256,891	$117,739,488	103,875,412	122,103,117	117,906,710
Newark, NJ	$5,363,563	$3,542,848	$7,009,180	$11,791,405	$9,725,848	$11,612,530	$12,630,257	$14,390,269	$14,554,092	$16,254,538	$17,467,481	17,706,875	15,312,104	15,412,565
Norfolk, VA							$75,000	$3,665,087	$4,089,698	$4,736,759	$4,906,134	5,168,622	4,820,201	4,726,063
Oakland, CA	$2,123,466	$2,602,816	$3,929,287	$4,148,299	$4,741,595	$5,905,961	$5,926,194	$6,218,532	$6,704,657	$6,776,406	$6,987,208	7,024,473	6,611,607	6,092,561
Orange County, CA		$1,839,726	$2,702,937	$3,319,282	$3,629,317	$4,401,330	$3,810,759	$4,300,690	$4,670,880	$4,956,671	$5,564,004	5,683,092	5,233,329	5,041,476
Orlando, FL			$2,715,587	$3,194,835	$3,599,489	$4,319,349	$4,609,839	$4,907,180	$6,007,600	$6,497,014	$7,225,978	7,329,133	7,821,786	7,963,150
Philadelphia, PA	$3,671,248	$4,729,230	$7,374,936	$9,836,096	$10,345,478	$13,465,328	$14,081,773	$16,011,451	$18,134,011	$22,114,655	$23,522,981	24,744,302	24,448,485	24,051,724
Phoenix, AZ			$2,217,471	$2,447,784	$2,901,602	$3,380,053	$3,412,037	$3,865,319	$5,001,568	$6,575,645	$6,422,556	6,867,905	6,814,427	6,467,107
Ponce, PR		$1,280,364	$1,176,793	$1,908,071	$1,685,036	$2,183,463	$2,200,114	$2,487,768	$2,460,695	$2,607,961	$2,858,721	2,611,677	2,718,331	2,431,319
Portland, OR				$2,402,734	$2,688,924	$3,472,480	$3,057,466	$3,115,251	$3,216,312	$3,513,044	$3,649,120	3,687,601	3,567,475	3,445,252
Riverside-San Bernardino, CA			$2,402,010	$2,656,331	$4,687,432	$5,986,979	$5,634,427	$6,463,388	$6,913,948	$6,940,381	$7,428,435	7,199,843	6,823,183	6,362,841
Sacramento, CA					$2,463,814	$2,038,827	$2,389,370	$2,578,873	$2,744,171	$2,899,765	$2,840,714	2,660,029	2,968,051	2,782,514
St. Louis, MO			$2,248,247	$2,581,330	$2,587,364	$3,506,350	$3,561,850	$3,664,771	$4,239,080	$4,432,316	$4,767,604	5,068,856	4,371,154	4,494,789

TABLE 9.15 Ryan White CARE (Comprehensive AIDS Resources Emergency) Act Title I Grant Awards, 1992–2005 [CONTINUED] Adapted from "Title I Funding History," and "Ryan White CARE Act: Fiscal Year 2003 Title I Awards," in "HHS Awards $600 Million for AIDS Care in Major Urban Areas," HHS News, and "Ryan White CARE Act: Fiscal Year 2004 Title I Awards, in "HHS Awards $595 Million for AIDS Care in Major Urban Areas," in News Release, and "Ryan White CARE Act: Fiscal Year 2005 Title I Awards," in "HHS Awards Almost $1.7 Billion for HIV/AIDS Care," in HHS News, March 2, 2005, Health Resources and Services Administration, HIV/AIDS Bureau, http://www.hhs.gov/news/press/2005pres/20050302.html (accessed November 7, 2005)

TABLE 9.15
Ryan White CARE (Comprehensive AIDS Resources Emergency) Act Title I Grant Awards, 1992–2005 [CONTINUED]
Eligible metropolitan areas	1992	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005
SOURCE: Adapted from "Title I Funding History," and "Ryan White CARE Act: Fiscal Year 2003 Title I Awards," in "HHS Awards $600 Million for AIDS Care in Major Urban Areas," HHS News, and "Ryan White CARE Act: Fiscal Year 2004 Title I Awards, in "HHS Awards $595 Million for AIDS Care in Major Urban Areas," in News Release, and "Ryan White CARE Act: Fiscal Year 2005 Title I Awards," in "HHS Awards Almost $1.7 Billion for HIV/AIDS Care," in HHS News, March 2, 2005, Health Resources and Services Administration, HIV/AIDS Bureau, http://www.hhs.gov/news/press/2005pres/20050302.html (accessed November 7, 2005)
San Antonio, TX				$1,731,222	$2,396,426	$3,014,191	$2,952,239	$3,014,654	$3,163,374	$3,862,398	$3,876,586	3,806,139	3,833,443	3,893,845
San Diego, CA	$2,778,724	$3,761,979	$5,233,574	$5,628,252	$6,592,104	$8,198,109	$8,452,437	$8,872,685	$9,071,625	$10,577,352	$10,436,496	10,765,303	10,287,797	9,741,708
San Francisco, CA	$19,043,763	$27,217,076	$39,275,384	$32,119,914	$35,397,274	$37,194,634	$36,394,914	$36,218,513	$35,246,477	$35,771,651	$33,561,470	33,941,235	29,849,780	28,297,777
San Jose, CA					$2,275,044	$1,992,602	$2,445,480	$2,486,136	$2,612,060	$2,866,655	$2,754,005	2,798,524	2,656,550	2,497,465
San Juan, PR	$3,579,982	$4,679,777	$8,456,057	$10,269,416	$8,199,506	$10,550,845	$11,658,912	$11,912,865	$13,558,330	$15,094,482	$16,235,174	14,772,898	14,732,565	14,695,304
Santa Rosa, CA				$1,207,605	$1,142,456	$1,330,630	$1,225,807	$1,127,018	$1,152,406	$1,206,194	$1,131,226	1,106,742	1,107,428	1,049,715
Seattle, WA		$2,824,570	$3,233,903	$4,048,484	$4,289,545	$5,481,431	$5,060,533	$5,303,343	$5,488,688	$5,852,286	$5,978,779	6,286,678	5,842,615	5,631,611
Tampa, St. Petersburg, FL		$2,265,553	$3,304,312	$4,231,119	$4,610,201	$6,548,952	$6,536,189	$7,236,728	$8,016,131	$8,595,830	$8,530,778	8,856,949	8,719,669	9,196,277
Vineland-Millville Bridgeton, NJ				$340,644	$454,338	$677,001	$594,001	$688,648	$684,897	$807,157	$910,779	810,259	847,898	875,354
Washington, DC	$5,127,184	$7,447,578	$9,408,935	$10,787,072	$12,849,067	$15,838,868	$16,710,726	$18,322,558	$19,903,750	$24,507,346	$25,980,259	27,871,807	26,951,014	29,431,967
West Palm Beach, FL			$3,582,542	$3,770,641	$3,390,914	$5,122,618	$5,965,481	$6,711,944	$7,169,030	$7,795,848	$9,156,524	9,871,953	9,408,695	9,526,597
Total	$119,668,041	$182,326,998	$320,336,851	$349,916,505	$372,829,731	$429,377,900	$445,326,000	$485,816,900	$526,811,000	$582,727,700	$597,256,000	$599,513,000	$595,342,001	$587,425,500

TABLE 9.16 Ryan White CARE (Comprehensive AIDS Resources Emergency) Act Title II Grant Awards, 1996–2005

TABLE 9.16
Ryan White CARE (Comprehensive AIDS Resources Emergency) Act Title II Grant Awards, 1996–2005
State	Fiscal year 1996	Fiscal year 1997	Fiscal year 1998	Fiscal year 1999	Fiscal year 2000	Fiscal year 2001	Fiscal year 2002	Fiscal year 2003	Fiscal year 2004	Fiscal year 2005
AL	$2,756,823	$4,167,971	$5,110,076	$7,294,833	$8,223,550	$10,100,107	$11,005,960	$10,867,008	$11,317,534	$11,881,914
AK	$288,443	$362,917	$444,562	$593,491	$644,658	$863,456	$898,686	$926,023	974,705	1,006,313
AZ	$2,260,259	$3,496,214	$4,553,503	$6,281,940	$7,876,550	$9,267,392	$10,130,689	$11,255,601	11,648,614	12,732,077
AR	$1,369,814	$2,050,008	$2,505,494	$3,313,331	$3,729,267	$3,970,060	$4,397,016	$4,933,831	4,933,831	5,161,119
CA	$36,282,354	$57,920,029	$73,677,524	$95,937,546	$106,594,028	$108,968,671	$115,580,982	$118,274,998	121,425,527	121,734,064
CO	$2,509,154	$3,734,969	$4,614,053	$5,755,742	$6,501,977	$7,384,159	$7,988,712	$7,447,255	7,759,634	7,759,634
CT	$3,651,778	$6,120,430	$8,267,209	$11,422,933	$12,473,062	$13,071,734	$13,873,014	$14,915,598	15,175,723	15,746,598
DE	$1,259,006	$1,942,410	$2,429,055	$3,065,717	$3,444,082	$3,952,853	$4,549,172	$5,129,211	5,340,795	5,432,326
DC	$3,332,588	$5,490,772	$7,719,573	$11,009,761	$12,208,813	$13,851,117	$15,492,398	$16,875,124	18,323,488	18,951,519
FL	$25,220,349	$41,314,996	$53,845,136	$73,482,287	$84,151,932	$90,768,728	$99,913,339	$108,800,440	111,668,948	116,883,905
GA	$7,394,151	$12,340,139	$16,211,799	$21,473,723	$24,609,445	$29,063,413	$31,581,983	$32,523,811	33,354,271	36,312,311
HI	$1,180,678	$1,701,733	$1,933,618	$2,425,061	$2,714,578	$2,973,119	$2,879,231	$3,134,711	3,298,130	3,298,130
ID	$285,657	$362,917	$444,562	$581,700	$637,862	$946,929	$977,028	$940,179	964,689	965,496
IL	$7,260,236	$12,033,969	$15,478,545	$21,516,441	$23,741,440	$26,962,344	$29,041,633	$32,061,756	34,870,568	36,007,864
IN	$2,762,555	$4,301,051	$5,362,040	$7,161,199	$7,813,244	$8,888,172	$9,607,370	$10,080,837	11,402,950	11,631,445
IA	$613,264	$917,406	$1,104,116	$1,450,320	$1,597,254	$1,684,688	$1,886,371	$2,046,335	2,067,375	2,111,150
KS	$1,050,840	$1,565,364	$1,888,481	$2,407,272	$2,680,639	$2,856,155	$2,993,080	$3,061,160	3,061,160	3,130,712
KY	$1,344,978	$2,078,323	$2,882,026	$4,075,831	$4,679,465	$5,757,688	$6,377,776	$6,566,479	6,688,723	6,962,984
LA	$4,080,447	$6,969,329	$9,199,630	$13,072,061	$14,659,595	$16,282,740	$19,462,270	$19,165,624	21,324,721	23,096,176
ME	$536,845	$719,201	$806,854	$970,811	$1,053,098	$1,165,524	$1,222,848	$1,291,963	1,333,909	1,333,909
MD	$6,521,685	$10,948,524	$14,847,982	$20,672,553	$23,625,388	$25,567,961	$28,539,346	$33,236,307	34,509,971	36,055,252
MA	$4,836,051	$7,528,256	$9,780,533	$12,626,775	$15,135,145	$17,849,167	$19,027,859	$20,165,312	20,190,874	20,190,874
Ml	$3,897,084	$5,814,246	$7,690,514	$10,452,742	$11,836,551	$12,389,033	$13,817,447	$14,902,329	15,455,849	15,983,050
MN	$1,249,617	$1,878,085	$2,365,346	$2,995,477	$3,429,038	$3,583,168	$3,930,918	$4,041,505	4,059,707	4,183,467
MS	$1,868,450	$2,760,714	$3,623,766	$4,995,545	$5,940,732	$7,005,955	$7,994,828	$8,927,096	9,454,950	10,514,013
MO	$3,131,126	$4,586,448	$5,952,010	$7,811,393	$8,842,764	$9,100,570	$10,041,335	$10,231,106	10,250,137	10,500,632
MT	$129,912	$201,037	$375,524	$477,324	$493,995	$766,328	$784,249	$798,932	810,671	810,671
NE	$506,277	$733,358	$931,421	$1,206,634	$1,363,635	$1,556,845	$1,752,274	$1,735,366	1,757,215	1,757,215
NV	$2,049,946	$3,001,392	$3,898,380	$4,647,952	$4,962,828	$5,341,517	$5,768,265	$6,248,392	6,456,309	6,654,115
NH	$332,092	$529,197	$651,190	$861,790	$927,722	$1,137,986	$1,170,914	$1,225,589	1,257,028	1,281,115
NJ	$13,135,111	$21,380,789	$28,345,926	$37,702,846	$40,762,441	$43,471,413	$45,652,579	$47,117,129	47,641,537	47,641,537
NM	$882,641	$1,183,568	$1,687,316	$2,476,155	$2,684,197	$2,842,890	$3,042,298	$3,338,463	3,338,463	3,489,677
NY	$38,324,520	$64,354,160	$87,884,362	$127,095,837	$138,462,204	$147,829,027	$153,793,751	$166,416,534	169,263,213	171,786,592
NC	$4,810,589	$7,053,271	$8,657,402	$11,672,934	$13,337,097	$16,397,641	$17,948,397	$18,905,269	21,144,376	21,945,256
ND	$107,243	$124,390	$145,189	$175,060	$183,474	$287,207	$288,717	$292,543	292,543	306,199
OH	$4,668,106	$7,316,497	$8,953,866	$11,834,654	$12,862,596	$13,812,449	$14,653,307	$15,732,171	16,762,266	16,794,093
OK	$1,656,387	$2,282,191	$2,890,518	$3,902,893	$4,285,048	$5,081,993	$5,890,896	$5,923,857	5,923,857	5,928,122
OR	$1,684,631	$2,749,308	$3,438,455	$4,333,257	$4,722,939	$4,836,281	$5,266,094	$5,719,559	5,902,627	5,943,054
PA	$7,991,467	$12,944,947	$1,693,781	$23,632,455	$26,896,745	$29,471,755	$32,266,464	$37,124,991	38,316,474	39,891,047
RI	$1,083,242	$1,548,831	$1,843,025	$2,354,312	$2,574,101	$2,814,801	$2,981,815	$3,104,681	3,189,276	3,189,276
SC	$4,516,376	$6,622,883	$8,161,966	$10,934,388	$13,250,895	$16,641,780	$18,086,947	$18,549,396	19,323,103	20,521,015
SD	$112,536	$138,843	$161,507	$205,084	$233,352	$338,771	$372,293	$391,032	705,706	727,255
TN	$3,757,915	$5,736,623	$7,230,546	$9,818,153	$11,468,392	$14,706,935	$16,464,366	$21,178,234	21,178,234	21,178,234
TX	$16,132,517	$25,697,515	$35,149,403	$50,244,224	$56,932,045	$66,476,848	$70,384,189	$68,629,133	70,065,527	73,889,574
UT	$810,043	$1,251,524	$1,542,931	$2,083,114	$2,426,761	$2,788,914	$3,111,672	$3,235,191	3,235,191	3,235,191
VT	$279,529	$342,140	$404,394	$488,047	$510,156	$787,721	$838,895	$883,059	883,059	883,059
VA	$5,365,718	$8,116,678	$10,452,242	$13,099,292	$14,845,195	$18,847,843	$20,770,666	$20,375,565	20,817,878	21,086,328
WA	$3,154,250	$4,898,005	$6,404,980	$8,333,780	$9,019,810	$9,311,929	$10,243,929	$10,986,852	11,121,586	11,198,763
WV	$446,290	$740,356	$937,140	$1,422,541	$1,462,626	$1,705,633	$1,856,487	$1,943,767	2,021,847	2,095,875
WI	$1,840,433	$2,579,528	$3,054,537	$3,812,983	$4,242,502	$4,918,809	$5,290,698	$5,183,308	5,214,471	5,227,607

TABLE 9.16 Ryan White CARE (Comprehensive AIDS Resources Emergency) Act Title II Grant Awards, 1996–2005 [CONTINUED] Adapted from "Ryan White CARE Act Title II Grant Awards," and "Ryan White CARE Act Title II Fiscal Year 2004 Grant Awards," in "HHS Awards More than $1 Billion to States to Help Provide Care, Services and Prescription Drugs for People with HIV/AIDS," News Release, "Ryan White CARE Act: FY 2005 Title II Awards," in "HHS Awards Almost $ 1.7 Billion for HIV/AIDS Care," HHS News, March 2, 2005, Health Resources and Services Administration, HIV/AIDS Bureau, http://www.hhs.gov/news/press/2005pres/20050302.html (accessed November 7, 2005)

TABLE 9.16
Ryan White CARE (Comprehensive AIDS Resources Emergency) Act Title II Grant Awards, 1996–2005 [CONTINUED]
State	Fiscal year 1996	Fiscal year 1997	Fiscal year 1998	Fiscal year 1999	Fiscal year 2000	Fiscal year 2001	Fiscal year 2002	Fiscal year 2003	Fiscal year 2004	Fiscal year 2005
Notes: GU is Guam, PR is Puerto Rico, VI is Virgin Islands, AS is American Samoa, MI is Marshall Islands, North Mar is Northern Marianas, RP is Republic of Palau, FSM is Federated States of Micronesia.
SOURCE: Adapted from "Ryan White CARE Act Title II Grant Awards," and "Ryan White CARE Act Title II Fiscal Year 2004 Grant Awards," in "HHS Awards More than $1 Billion to States to Help Provide Care, Services and Prescription Drugs for People with HIV/AIDS," News Release, "Ryan White CARE Act: FY 2005 Title II Awards," in "HHS Awards Almost $ 1.7 Billion for HIV/AIDS Care," HHS News, March 2, 2005, Health Resources and Services Administration, HIV/AIDS Bureau, http://www.hhs.gov/news/press/2005pres/20050302.html (accessed November 7, 2005)
WY	$113,650	$137,940	$169,038	$196,506	$205,536	$329,954	$340,041	$350,383	360,347	369,918
GU	$4,970	$11,608	$11,052	$19,652	$38,809	$116,169	$118,503	$132,268	135,839	142,852
PR	$9,376,181	$12,920,475	$16,793,353	$23,401,013	$25,647,632	$26,646,201	$28,814,408	$30,748,881	31,098,002	31,098,002
VI	$197,360	$191,525	$222,610	$624,935	$667,110	$833,928	$772,935	$976,601	976,601	976,602
AS						$50,000	$50,000	$52,314	52,314	52,360
MI						$50,000	$51,323	$52,314	52,314	52,360
North Mar						$50,000	$51,323	$54,627	54,627	54,720
RP						$50,000	$50,000	$50,000	50,000	50,000
FSM						$50,000	$50,000	$50,000	50,000	50,000
Totals	$250,414,164	$397,895,000	$504,830,061	$709,904,300	$794,314,000	$874,624,471	$942,189,986	$999,308,000	$1,030,309,284	$1,059,874,618