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The Status of Funding for Zika: The President’s Request and Congressional Proposals

Zika virus, a mosquito-transmitted infection that until recently had caused little concern, has become an urgent global challenge with widespread transmission occurring in the Americas, a region that had previously not seen any cases before 2015. Predictions that local transmission would spread to the continental United States by summer were met with the first cases of local transmission identified in Miami in July.1 Of particular concern is the discovery that Zika virus in pregnant women can cause microcephaly as well as other serious birth defects, prompting the World Health Organization (WHO) to declare a “public health emergency of international concern” on February 1st of this year.2

On the heels of the Ebola outbreak of 2014 – during which the U.S. government played a pivotal global role in the response including a request from the President and quick Congressional approval of more than $5 billion in emergency funds to combat Ebola3,4 – the President sought to launch a similar response to Zika. On February 22, the President sent a request to Congress for almost $1.9 billion in emergency Zika funding for Fiscal Year (FY) 2016, which would support domestic (including U.S. territories) and international response efforts including: mosquito control (vector management), expanded surveillance of transmission and infections, research and development activities (vaccines, diagnostics, and vector control methods), health workforce training, public education campaigns, and maternal and child health programs.5 As of September 2016, however, no new funding for Zika has been appropriated, although Congress has considered several bills. In the meantime, the Administration announced it had identified almost $700 million in existing sources (largely from unobligated emergency Ebola funding appropriated in FY 2015) to be used to address immediate Zika activity needs and has stated that Congress needs to approve the full $1.9 billion request in order to continue the response effort and reimburse the Ebola accounts.6,7,8

As Congress returns from recess this September and is expected to once again consider funding for Zika, this brief compares funding in the President’s emergency Zika request to the Congressional bills that have been proposed thus far. Specifically, it looks at the President’s February 22nd request compared to House and Senate bills that passed each chamber in May and a Conference Agreement that was approved by the House in June but blocked in the Senate and opposed by the Administration (see Table 1).

Table 1: Timeline of Administration & Congressional Actions
Proposal Date of Most Recent Action
President’s Request February 22, 2016 (Sent to Congress)
House (H.R. 5243) May 18, 2016 (Passed by the House)
Senate (S. Amdt. 3900 to H.R. 2577) May 19, 2016 (Passed by the Senate)
Conference Agreement (H.Rept. 114-640 to H.R. 2577) June 23, 2016 (Passed by the House)
SOURCE: Kaiser Family Foundation analysis of data from the Office of Management and Budget (OMB), Agency Congressional Budget Justifications, Congressional appropriations bills and accompanying reports, and Congressional Research Service (CRS) reports.
  • Total Funding Amount: The President’s Request of $1.89 billion is significantly above the amount proposed in all three Congressional bills (see Figure 1 and Table 2). The Request is nearly three times greater than the House bill ($622.1 million) and almost $1 billion greater than the Senate bill and Conference Agreement (each of which is approximately $1.1 billion).
Figure 1: Total Zika Funding, President’s Request Compared to Congressional Proposals

Figure 1: Total Zika Funding, President’s Request Compared to Congressional Proposals

Table 2: Zika Funding (in millions)
Agency / Department / Account Request House Senate Conference
Agreement
State & Foreign Operations (SFOPs)
Department of State $41.1
(2%)
$9.1
(1%)
$37.1
(3%)
$19.6
(2%)
     Diplomatic & Consular Programs $14.6
(1%)
$9.1
(1%)
$14.6
(1%)
$14.6
(1%)
     International Organizations & Programs (IO&P) $13.5
(1%)
$13.5
(1%)
     Nonproliferation, Anti-terrorism, Demining, and Related Programs (NADR) $8.0
(<1%)
$4.0
(<1%)
     Repatriation Loans $1.0
(<1%)
$1.0
(<1%)
$1.0
(<1%)
     Emergencies in the Diplomatic and Consular Service (EDCS) $4.0
(<1%)
$4.0
(<1%)
$4.0
(<1%)
U.S. Agency for International Development (USAID) $335.0
(18%)
$110.0
(18%)
$221.0
(20%)
$155.0
(14%)
     Global Health Programs (GHP) account $325.0
(17%)
$100.0
(16%)
$211.0
(19%)
$145.0
(13%)
     Operating Expenses $10.0
(1%)
$10.0
(2%)
$10.0
(1%)
$10.0
(1%)
Total State & Foreign Operations (SFOPs): $376.1
(20%)
$119.1
(19%)
$258.1
(23%)
$174.6
(16%)
Health & Human Services (HHS)
Centers for Disease Control & Prevention (CDC) $828.0
(44%)
$170.0
(27%)
$449.0
(41%)
$476.0
(43%)
Centers for Medicare and Medicaid Services $246.0
(13%)
Food & Drug Administration (FDA) $10.0
(1%)
Health Resources & Services Administration (HRSA) $51.0
(5%)
National Institutes of Health (NIH) $130.0
(7%)
$230.0
(37%)
$200.0
(18%)
$230.0
(21%)
Public Health & Social Services Emergency Fund (PHSSEF) $295.0
(16%)
$103.0
(17%)
$150.0
(14%)
$227.0
(20%)
Total Health & Human Services (HHS): $1,509.0
(80%)
$503.0
(81%)
$850.0
(77%)
$933.0
(84%)
Total Zika Funding: $1,885.1 $622.1 $1,108.1 $1,107.6
SOURCE: Kaiser Family Foundation analysis of data from the Office of Management and Budget (OMB), Agency Congressional Budget Justifications, Congressional appropriations bills and accompanying reports, and Congressional Research Service (CRS) reports.
  • New or Offset Funding: Moreover, the proposals differ by whether the funding would be “new” appropriations (funding provided in addition to previous appropriations) or entirely offset through rescissions to prior appropriations (see Figure 2).9 For instance, all of the $1.89 billion in the President’s Request would be new appropriations, while the House bill of $622.1 million would be entirely offset through rescissions to previous congressionally approved appropriations ($352.1 million from unobligated emergency Ebola funding and $270 million from a non-recurring expenses fund at the Department of Health and Human Services). The majority of funding in the Senate bill would be new with the exception of a $10 million rescission to unobligated emergency Ebola funding. Finally, the Conference Agreement proposed a mix of new and offset funding. Of the $1.11 billion in the Agreement, $347.6 million (31%) would be new funding, while $760 million (69%) would be offset through rescissions to emergency Ebola funding ($117 million), the non-recurring expenses fund ($100 million) at the Department of Health and Human Services (HHS), and the Affordable Care Act (ACA) ($543 million).
Figure 2: Zika Funding – New or Offset

Figure 2: Zika Funding – New or Offset

  • Funding by Agency: In all of the proposals, HHS would receive the majority of resources accounting for approximately 80% of funding in each, while the State Department and U.S. Agency for International Development (USAID) would receive the remaining funding (see Table 2). Funding between agencies, however, varies by proposal providing an indication of how each would prioritize the U.S. response (see Figure 3). For instance, the Centers for Disease Control and Prevention (CDC) would receive the largest share of funding among all agencies (more than 40%) in the President’s Request, Senate, and Conference Agreement, while the National Institutes of Health (NIH) accounts for the largest share of total funding (37%) in the House bill; the CDC would receive the second largest share (27%) in the House bill. USAID accounts for the second largest share in the President’s Request (18%) and Senate bill (20%), but is the third largest share in the House bill (18%) and fourth largest share in the Conference Agreement (14%) behind NIH (21%) and the Public Health & Social Services Emergency Fund (PHSSEF) (20%).
Figure 3: Zika Funding, by Agency

Figure 3: Zika Funding, by Agency

  • Activities Supported: The President’s request includes detailed information on the wide range of activities that would be funded both domestically and abroad through multiple agencies. These include: mosquito control (vector management) activities through CDC (both domestic and international) and USAID (international); research and development on vaccines, treatment, and diagnostics at NIH, CDC, FDA, and USAID; and support for maternal and child health activities through CDC (domestic only), the Centers for Medicare and Medicaid Services (CMS), and USAID (international). The three proposals from Congress provide much less detail and there are several differences with the President’s request. The biggest difference is in the amount requested, as discussed above.  In addition, there are some substantive differences, such as $246 million requested by the President to support maternal and child health activities by CMS in Puerto Rico and other U.S. territories, which is not included in any of the Congressional proposals, and varying policy provisions (e.g., concerning whether prior spending for Zika can be reimbursed) as described below.
  • Spending Period: Another difference between the proposals is the period of time for which funds would be available (see Figure 4 and Table 3). For instance, the majority of funding ($1.84 billion) in the President’s Request would be available “until expended” meaning there is no time limit on when the funds need to be spent, and the remaining $46.1 million, which would be provided to the State Department and USAID, would be available through FY 2017. All funding in the House proposal would be available only in FY 2016, the shortest period among all the proposals, while all funding in the Conference Agreement would be available through FY 2017. The majority of the Senate proposal ($892 million) would be available through FY 2017, with the remainder ($216 million; $211 million at USAID and $5 million at the State Department) available until expended.
Figure 4: Zika Funding, by Expenditure Date

Figure 4: Zika Funding, by Expenditure Date

Table 3: Zika Funding – Spending Period
Agency / Department / Account Request House Senate Conference Agreement
State & Foreign Operations (SFOPs)
Department of State Sep. 2016 Sep. 2017
     Diplomatic & Consular Programs Sep. 2017 Sep. 2017
     International Organizations & Programs (IO&P) Sep. 2017 Sep. 2017
     Nonproliferation, Anti-terrorism, Demining, and Related Programs (NADR) Sep. 2017 Sep. 2017
     Repatriation Loans Until Expended Until Expended
    Emergencies in the Diplomatic and Consular Service (EDCS) Until Expended Until Expended
U.S. Agency for International Development (USAID) Sep. 2016 Sep. 2017
     Global Health Programs (GHP) account Until Expended Until Expended
     Operating Expenses Sep. 2017 Sep. 2017
Health & Human Services (HHS)
Centers for Disease Control & Prevention (CDC) Until Expended Sep. 2016 Sep. 2017 Sep. 2017
Centers for Medicare and Medicaid Services Until Expended
Food & Drug Administration (FDA) Until Expended
Health Resources & Services Administration (HRSA) Sep. 2017
National Institutes of Health (NIH) Until Expended Sep. 2016 Sep. 2017 Sep. 2017
Public Health & Social Services Emergency Fund (PHSSEF) Until Expended Sep. 2016 Sep. 2017 Sep. 2017
SOURCE: Kaiser Family Foundation analysis of data from the Office of Management and Budget (OMB), Agency Congressional Budget Justifications, Congressional appropriations bills and accompanying reports, and Congressional Research Service (CRS) reports.

Policy Provisions: Each of the proposals include policy provisions specifying and placing restrictions on how the funding would be utilized. For instance, the President’s Request, the Senate, and the Conference Agreement include some authorities to reimburse prior obligations associated with the Zika response; the House proposal does not include reimbursement authority. The Conference Agreement also places a restriction on some of the funding directed to HHS that, it has been argued, would prevent funds going to organizations that provide family planning and reproductive health services, as well as re-directs funds from other health efforts, including from the ACA, and were cited as reasons why Democrats in the Senate blocked the bill.10

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.