One thing is clear about the new Congress and the Obama administration: They agree on the fact that health care reform, broadly, must be among the first policy challenges tackled in 2009. Indeed, the first nomination hearing the new Congress held upon convening in January was for Tom Daschle, Obama’s choice to lead the Department of Health and Human Services, as well as his newly created White House Office of Health Reform. Daschle has emphasized that he believes the Clinton-era reform effort failed primarily because the administration waited too long to roll it out, and he’s vowed not to repeat the mistake.

It’s similarly certain that the national debate over what our new health care system looks like will be a grueling one. So much so that, in early January, Obama’s transition team began floating CNN personality Sanjay Gupta as a candidate for surgeon general—bringing a celebrity voice and skilled television communicator to the team. The question remains, however, whether whatever system emerges from the fight will be one that is prepared to deal with the increasingly complex and steadily worsening AIDS epidemic.

Over the past 12 years, America’s combined successes and failures in responding to the AIDS epidemic have put the country on track for a major treatment access crisis. On one hand, the phenomenal success of antiretroviral drugs has kept people alive. The AIDS death rate in America plummeted 70 percent in just two years when combination therapy hit the market. Today, people living with HIV and AIDS have 28 meds in five drug classes from which they can build treatment regimens. More options are still on the way.

But the drugs are not a cure, and that means there are also more people in need of ongoing, lifelong care and treatment today than ever before. Many of them, particularly those who are black, do not have adequate private health insurance to cover the massive costs of that care. The federal program that supports care and treatment costs for low-income people with HIV/AIDS had more than half a million clients in 2006 and paid for meds for just under a third of people with AIDS getting treatment. Medicaid and Medicare cover about half of people in treatment.

States share the costs of these public care systems with the federal government—and carry a significant portion of the financial burden. That’s bad news in the current economy. As governors and state legislators scramble to deal with exploding budget deficits, AIDS programs are as likely as any other to face serious budget cuts. This, just as more people lose private insurance and turn to the public system. In many states, particularly in the South, AIDS programs are likely to be among the most vulnerable. Yet, the already tattered AIDS safety net—which has been severely neglected over the past eight years—can hardly afford that financial instability.

Obama and Daschle have vowed to avert disaster. Both have pledged to make sure that AIDS funding reflects the demographics of the epidemic—which must mean that more resources get spent in black communities, among gay and bisexual men and in the South. And most significantly, Obama has vowed to overhaul the AIDS safety net by drafting America’s first ever national strategy for addressing the epidemic—and to begin implementing it in his first year in office.