Library Index :: Death and Dying Reference :: The Cost of Health Care - Increasing Costs, Government Health Care Programs, Who Pays For End-of-life Care?

The Cost of Health Care - The Cost Of Dying In America

The Alliance for Aging Research, in Seven Deadly Myths: Uncovering the Facts about the High Cost of the Last Year of Life (Washington, DC, 1997), reported that there are several misconceptions about the cost of health care for older adults at the end of life:

  • Contrary to popular belief, older people do not generally receive heroic, high-technology medical treatments at the end of life. Only 3 percent of terminally ill Medicare patients receive costly, aggressive care. Furthermore, the older the patient, the less likely he or she is to receive aggressive care when dying.
  • A majority of older adults do not die in hospitals. The percentage of the elderly dying in hospitals decreases with age. In fact, the SUPPORT researchers, who conducted the largest-ever study of the care of critically ill and dying patients, found that estimated inpatient hospital costs for patients 80 and older were approximately $7,000 lower than for patients under the age of 50.

TABLE 9.13
Federal spending for human immunodeficiency virus (HIV)-related activities, by agency and type of activity, selected fiscal years 1985–2002
[Data are compiled from federal government appropriations]

Agency and type of activity 1985 1990 1995 1998 1999 2000 2001 20021
Education and prevention 33 591 770 807 902 998 1,396 1,629
Department of Health and Human Services discretionary spending2 33 460 604 641 719 751 950 1,091
Department of Veterans Affairs – 29 31 32 30 33 35 35
Department of Defense – 28 12 10 10 10 17 17
Agency for International Development – 71 120 121 139 200 380 473
Other – 3 3 3 4 4 14 13
Medical care 83 1,227 3,738 5,858 6,595 7,356 8,324 9,117
Centers for Medicare & Medicaid Services: Medicaid (federal share) 70 670 1,500 2,600 2,900 3,300 3,700 4,200
Medicare 5 110 1,000 1,400 1,500 1,700 1,900 2,050
Department of Health and Human Services discretionary spending2 – 158 680 1,213 1,507 1,711 1,948 2,118
Department of Veterans Affairs 8 185 281 339 364 305 363 348
Department of Defense – 63 60 47 52 54 58 53
Agency for International Development – – – – – – 50 38
Office of Personnel Management – 37 212 253 266 279 292 297
Other – 4 5 6 6 7 13 14
Cash assistance 17 239 1,052 1,296 1,383 1,547 2,096 1,628
Social Security Administration: Disability Insurance 12 184 631 787 828 870 919 961
Supplemental Security Income 5 55 250 305 330 370 340 390
Department of Housing and Urban Development – – 171 204 225 232 257 277
Ricky Ray Hemophilia Relief Fund3 – – – – – 75 580 –
–Quantity zero.
… Category not applicable.
1Preliminary figures.
2Department of Health and Human Services discretionary spending is spending that is not entitlement spending. Medicare and Medicaid are examples of entitlement spending.
3The 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 anti-hemophilic factor between July 1, 1982 and December 31, 1987, and who contracted HIV. Some family members may also be covered by the Fund. $75 million was appropriated in fiscal year 2000 and $580 million in fiscal year 2001.
4The Office of the Assistant Secretary for Health prior to fiscal year 1996.
5Prior to 1995 the Social Security Administration was part of the Department of Health and Human Services.
SOURCE: "Table 126. Federal Spending for Human Immunodeficiency Virus (HIV)-Related Activities, according to Agency and Type of Activity: United States, Selected Fiscal Years 1985–2002," in Health, United States, 2003, Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, Hyattsville, MD, 2003
  • It is commonly assumed that aggressive care for older adults is futile and a waste of money, since they are going to die anyway. Medicare data shows that of patients who incur the most expenses, half die within a short period of time despite the treatment, and the other half survive the particular episode that required aggressive treatment.
  • Advance directives do not guarantee that physicians will honor patients' end-of-life preferences. Advance directives may be of limited usefulness if they are written in vague terms and lack specificity. For example, physicians may be reluctant to withhold a specific life-prolonging measure if a patient's advance directive simply states a preference not to prolong dying. Further, when physicians are unable or reluctant to accurately predict when patients are near the end of life, they may be unwilling to comply with advance directives.
  • Limiting end-of-life care for the elderly does not save significantly on Medicare costs. While data reveals that 27 to 30 percent of Medicare expenditures are for terminal care, the approximately 3 percent of high-cost Medicare patients accounts for less than 1 percent of total annual health care costs.
  • The aging of America has not yet become a major factor in the rising cost of health care. HCFA (CMS) analysts have found that general price inflation and health sector-specific inflation have been responsible for increased health care costs. In fact, the HCFA projects that between 1965 and 2005 the growing elderly group will add less than 1 percent to the annual growth of personal health care costs. They predict that only after 2010, when baby boomers start turning 65, will aging be a major factor in health care spending.
  • The Alliance observes that both the popular media and academic literature tend to associate America's aging with economic disasters. Cross-cultural studies indicate that countries such as Japan, which has experienced a dramatic rise in the aging population, show no parallel increase in health care spending.

TABLE 9.14
Ryan White CARE (Comprehensive AIDS Emergency) Act Title l Grant Awards, 1991–2004

Eligible metropolitan areas 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Atlanta, GA $2,123,775 $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
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
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
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
Boston, MA $2,236,267 $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
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
Chicago, IL $3,229,799 $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
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
Dallas, TX $1,379,434 $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
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
Detroit, MI $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
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
Ft. Lauderdale, FL $1,807,299 $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
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
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
Houston, TX $3,710,210 $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
Hudson $1,562,728 $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
Jersey City, NJ 6,426,456 5,884,194
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
Las Vegas, NV $75,000 $3,402,697 $3,689,337 $4,455,787 $4,231,997 4,658,661 4,473,401
Los Angeles, CA $7,848,314 $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
Miami, FL $3,044,301 $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
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
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
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
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
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
New York, NY $33,457,519 $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
Newark, NJ $4,111,603 $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
Norfolk, VA $75,000 $3,665,087 $4,089,698 $4,736,759 $4,906,134 5,168,622 4,820,201
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
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
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
Philadelphia, PA $2,323,850 $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
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
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
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
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
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
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

TABLE 9.14
Ryan White CARE (Comprehensive AIDS Emergency) Act Title l Grant Awards, 1991–2004

Eligible metropolitan areas 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
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
San Diego, CA $1,460,205 $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
San Francisco, CA $12,713,831 $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
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
San Juan, PR $1,681,081 $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
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
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
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
Vineland-Millville Bridgeton, NJ $340,644 $454,338 $677,001 $594,001 $688,648 $684,897 $807,157 $910,779 810,259 847,898
Washington, DC $3,392,784 $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
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
Total: $86,083,000 $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
SOURCE: Adapted from "Title l Funding History," and "Ryan White CARE Act: Fiscal Year 2003 Title l Awards," in "HHS Awards $600 Million for AIDS Care in Major Urban Areas," in HHS News, and "Ryan White CARE Act: Fiscal Year 2004 Title l Awards," in "HHS Awards $595 Million for AIDS Care in Major Urban Areas," in News Release, Health Resource and Services Administration, HIV/AIDS Bureau, Rockville, MD, 2004

TABLE 9.15
Ryan White CARE (Comprehensive AIDS Emergency) Act Title ll Grant Awards, 1991–2004

State Fiscal years 1991–95 Fiscal year 1996 Fiscal year 1997 Fiscal year 1998 Fiscal year 1999 Fiscal year 2000 Fiscal year 2001 Fiscal year 2002 Fiscal year 2003 Total
AL $4,829,350 $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
AK $500,000 $288,443 $362,917 $444,562 $593,491 $644,658 $863,456 $898,686 $926,023 974,705
AZ $5,707,125 $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
AR $2,819,849 $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
CA $101,736,257 $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
CO $6,273,190 $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
CT $7,398,150 $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
DE $1,655,026 $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
DC $8,609,687 $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
FL $62,624,900 $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
GA $17,635,309 $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
HI $2,113,003 $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
ID $568,982 $285,657 $362,917 $444,562 $581,700 $637,862 $946,929 $977,028 $940,179 964,689
IL $19,658,478 $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
IN $5,035,921 $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
IA $1,157,658 $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
KS $2,000,328 $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
KY $2,458,912 $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
LA $10,104,144 $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
ME $810,055 $536,845 $719,201 $806,854 $970,811 $1,053,098 $1,165,524 $1,222,848 $1,291,963 1,333,909
MD $14,021,974 $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
MA $12,364,148 $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
MI $9,295,185 $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
MN $3,220,768 $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
MS $3,479,363 $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
MO $9,053,788 $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
MT $456,197 $129,912 $201,037 $375,524 $477,324 $493,995 $766,328 $784,249 $798,932 810,671
NE $923,095 $506,277 $733,358 $931,421 $1,206,634 $1,363,635 $1,556,845 $1,752,274 $1,735,366 1,757,215
NV $3,194,245 $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
NH $642,850 $332,092 $529,197 $651,190 $861,790 $927,722 $1,137,986 $1,170,914 $1,225,589 1,257,028
NJ $29,042,291 $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
NM $1,682,335 $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
NY $103,550,023 $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
NC $8,016,460 $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
ND $419,872 $107,243 $124,390 $145,189 $175,060 $183,474 $287,207 $288,717 $292,543 292,543
OH $9,109,982 $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
OK $3,581,484 $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
OR $4,318,167 $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
PA $17,227,187 $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
RI $1,585,172 $1,083,242 $1,548,831 $1,843,025 $2,354,312 $2,574,101 $2,814,801 $2,981,815 $3,104,681 31,098,002
SC $7,019,356 $4,516,376 $6,622,883 $8,161,966 $10,934,388 $13,250,895 $16,641,780 $18,086,947 $18,549,396 3,189,276
SD $500,000 $112,536 $138,843 $161,507 $205,084 $233,352 $338,771 $372,293 $391,032 19,323,103
TN $5,770,766 $3,757,915 $5,736,623 $7,230,546 $9,818,153 $11,468,392 $14,706,935 $16,464,366 $21,178,234 705,706
TX $44,589,664 $16,132,517 $25,697,515 $35,149,403 $50,244,224 $56,932,045 $66,476,848 $70,384,189 $68,629,133 21,178,234
UT $1,677,559 $810,043 $1,251,524 $1,542,931 $2,083,114 $2,426,761 $2,788,914 $3,111,672 $3,235,191 70,065,527
VT $503,727 $279,529 $342,140 $404,394 $488,047 $510,156 $787,721 $838,895 $883,059 3,235,191
VA $8,798,087 $5,365,718 $8,116,678 $10,452,242 $13,099,292 $14,845,195 $18,847,843 $20,770,666 $20,375,565 883,059
WA $8,192,474 $3,154,250 $4,898,005 $6,404,980 $8,333,780 $9,019,810 $9,311,929 $10,243,929 $10,986,852 20,817,878
WV $774,743 $446,290 $740,356 $937,140 $1,422,541 $1,462,626 $1,705,633 $1,856,487 $1,943,767 11,121,586
WI $3,429,155 $1,840,433 $2,579,528 $3,054,537 $3,812,983 $4,242,502 $4,918,809 $5,290,698 $5,183,308 2,021,847

TABLE 9.15
Ryan White CARE (Comprehensive AIDS Emergency) Act Title ll Grant Awards, 1991–2004

State Fiscal years 1991–95 Fiscal year 1996 Fiscal year 1997 Fiscal year 1998 Fiscal year 1999 Fiscal year 2000 Fiscal year 2001 Fiscal year 2002 Fiscal year 2003 Total
WY $444,037 $113,650 $137,940 $169,038 $196,506 $205,536 $329,954 $340,041 $350,383 5,214,471
GU $16,937 $4,970 $11,608 $11,052 $19,652 $38,809 $116,169 $118,503 $132,268 360,347
PR $31,723,832 $9,376,181 $12,920,475 $16,793,353 $23,401,013 $25,647,632 $26,646,201 $28,814,408 $30,748,881 52,314
VI $170,167 $197,360 $191,525 $222,610 $624,935 $667,110 $833,928 $772,935 $976,601 50,000
AS $50,000 $50,000 $52,314 135,839
MI $50,000 $51,323 $52,314 52,314
North Mar $50,000 $51,323 $54,627 54,627
RP $50,000 $50,000 $50,000 50,000
FSM $50,000 $50,000 $50,000 976,601
Totals: $612,491,414 $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
SOURCE: Adapted from "Ryan White Care Act Title ll Grant Awards," and "Ryan White CARE Act Title ll 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," in News Release, Health Resource and Services Administration, HIV/AIDS Bureau, Rockville, MD, 2004

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