| Abstract: | Passage of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 followed a form familiar to students of policymaking in the American intergovernmental system: the provision of significant federal financing for policy initiatives located primarily at the state and local levels. The successes and failures of the Act, including its 1996 reauthorization, suggest both the strengths and the limitations of that design. This paper examines the structure of the Act as a vehicle for the federal government to fund AIDS service delivery at the state and local levels and the intergovernmental consequences of allocation policies associated with the Act. It concludes that perennial problems of equity and access cannot be resolved by the delegation of responsibility for significant policy or funding decisions to localities; rather, questions about the role of the federal government in overcoming intralocal and interlocal disparities remain to be addressed. |
