WASHINGTON (AP) – The House agreed Sept. 28 to send more AIDS care money to rural areas and the South, overcoming angry opposition from big-state lawmakers who stand to lose millions.

“It’s shameful and disgraceful,” shouted Rep. Eliot Engel, D-N.Y., before lawmakers voted 325-98 to amend the $2.1 billion Ryan White CARE Act.

“The HIV/AIDS epidemic is moving,” said Rep. Joe Barton, R-Texas. “This is a very fair compromise. It begins to treat all states on an equal footing.”

The bill faces uncertain prospects in the Senate. Several senators are blocking it, and an attempt by supporters to force a Senate vote on Sept. 28 failed.

Supporters said the election-year updates were needed because of how AIDS has changed since the 1990 passage of the Ryan White law, the largest federal program specifically for people with HIV/AIDS. Once a big-city epidemic infecting mostly gay white men, the disease is now prevalent in the South and among minorities.

By some measures, federal funding has not kept up, and states like California, New York and New Jersey get more money per patient than Alabama, Kentucky or North Carolina.

The Ryan White amendments, the first since 2000, make a number of changes aiming to spread money more equally around the country.

While current law only counts patients with full-blown AIDS, the revision also would count patients with the HIV virus who have not developed AIDS. That change would favor parts of the country where the disease is a newer phenomenon, which tend to be Southern and rural areas.

As a result, New York state stands to lose $100 million over the five years of the bill. New Jersey would lose $70 million.

Alabama, by contrast, would get an increase from $11 million a year to about $18 million a year.

Resistance from senators from New York, New Jersey and California threatened to stall the bill in the Senate, where opposition from a single senator can block legislation.

Sen. Mike Enzi, R-Wyo., took to the Senate floor on Sept. 28 to call for an immediate vote, his second attempt. Sen. Mark Dayton, D-Minn., objected on behalf of the holdouts, blocking the gambit.

Enzi, frustrated and shaking his head, said that if the bill didn’t pass before Congress recessed he would ask Majority Leader Bill Frist to call a procedural vote to overcome the stalling tactics, which would take 60 votes.

“I’m desperate. I usually don’t have to do that sort of thing, but I’m willing to do it on this bill,” said Enzi, chair of the Senate Health, Education, Labor and Pensions Committee. “I’m really disappointed that we reached a sticking point like this, and people are going to die.”

Several lawmakers complained that the differences could be resolved if more money were added to the bill. Under the revisions, Ryan White funding would grow by only $70 million.

“That means if we’re going to give to some people who are very deserving, we’re going to take from others who are very deserving,” said Rep. Henry Waxman, D-Calif.

California and some other states are worried about a change in the bill that mandates counting HIV patients by name instead of codes. Some states used code-based systems out of concern for patient privacy. California could lose some $50 million in the last year of the bill, when the name-based system would take effect, if it can’t make the transition.