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The U.S. Congress and Global Health: A Primer

Report
  1. Congressional Research Service (CRS), “Dear Colleague” Letters: Current Practices, RL34636, Nov. 25, 2008.

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  2. Five non-voting Delegates and one non-voting Resident Commissioner also serve in Congress but are not included in this total. They represent the District of Columbia, Guam, the U.S. Virgin Islands, American Samoa, the Northern Mariana Islands, and Puerto Rico in Congress.

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  3. CRS, Committee Types and Roles, Report 98-241, Nov. 10, 2014; U.S. Senate, “Committees,” webpage, http://www.senate.gov/committees/committees_home.htm; U.S. House of Representatives, “Committees,” webpage, http://www.house.gov/committees/; Library of Congress, “Committees of the U.S. Congress,” webpage, https://www.congress.gov/committees, accessed Feb. 6, 2019.

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  4. CRS, Committee Types and Roles, Report 98-241, Nov. 10, 2014.

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  5. Kaiser Family Foundation (KFF), The U.S. Government Engagement in Global Health: A Primer.

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  6. U.S. Senate, “Committees,” webpage, http://www.senate.gov/committees/committees_home.htm; U.S. House of Representations Committee on House Administration, “CMO/CSO Registration Form,” webpage, http://cha.house.gov/member-services/congressional-memberstaff-organizations/cmocso-registration-form#cmo.

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  7. CRS, Bills and Resolutions: Examples of How Each Kind Is Used, Report 98-706.

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  8. U.S. Congress, H.Res.550, 111th Congress, 2009.

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  9. U.S. Congress: S.Res.270, 113th Congress, 2014; S.Con.Res.46 - A concurrent resolution to correct the enrollment of H.R. 1298, 108th Congress, 2003; CRS, Enrollment of Legislation: Relevant Congressional Procedures, RL34480, Oct. 14, 2015.

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  10. U.S. Congress: S.Res.225, 109th Congress, 2005; H.Con.Res.46, 108th Congress, 2003; S.J.Res.111, 98th Congress, 1983; H.J.Res.124, 113th Congress, 2014.

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  11. KFF, The U.S. Government Engagement in Global Health: A Primer; U.S. Congress: Global AIDS and Tuberculosis Relief Act of 2000 (P.L. 106-264); United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003 (P.L. 108-25), Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 (P.L. 110-293), PEPFAR Stewardship and Oversight Act of 2013 (P.L. 113-56), and PEPFAR Extension Act of 2018 (P.L. 115-305).

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  12. Department of Defense Appropriations Act of 1986 (note: effectively authorized the creation of the Military HIV Research Program (MHRP)); Department of Defense Appropriations Act of 2001 (note: effectively authorized the creation of the Defense HIV/AIDS Prevention Program (DHAPP)); KFF, Health in Haiti and the U.S. Government Involvement, fact sheet, Feb. 2010; CRS, FY2010 Supplemental for Wars, Disaster Assistance, Haiti Relief, and Other Programs, Aug. 6, 2010.

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  13. These two provisions, which were incorporated into the Lantos-Hyde Act, appeared in the Elimination of Neglected Diseases Act of 2005 (S. 950, not enacted). CRS, The President’s Malaria Initiative and Other U.S. Global Efforts to Combat Malaria, R40494, April 6, 2009.

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  14. U.S. Congress, United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003 (P.L. 108-25); CRS, PEPFAR Reauthorization: Key Policy Debates and Changes to U.S. International HIV/AIDS, Tuberculosis, and Malaria Programs and Funding, RL34569, Jan. 29, 2009.

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  15. U.S. Congress, Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 (P.L. 110-293); KFF analysis of data from KFF, U.S. Global Health Budget Tracker, downloaded Nov. 11, 2015.

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  16. CRS, Introduction to the Federal Budget Process, Report 98-721.

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  17. KFF, The U.S. Government and Global Health, fact sheet.

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  18. CRS, State, Foreign Operations Appropriations: A Guide to Component Accounts, R40482, Jan. 13, 2015.

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  19. KFF: Budget Tracker: Status of U.S. Funding for Key Global Health Accounts,” tool; The U.S. Government and Global Health, fact sheet.

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  20. U.S. Senate, “Glossary: Supplemental Appropriation,” webpage, http://www.senate.gov/reference/glossary_term/supplemental_appropriation.htm.

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  21. U.S. Congress: Supplemental Appropriations Act, 2009 (P.L. 111-32); Supplemental Appropriations Act, 2010 (P.L. 111-212);

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  22. U.S. Congress, Consolidated Appropriations Act, 2010 (P.L. 111-17).

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  23. KFF, The U.S. Government and International Family Planning & Reproductive Health: Statutory Requirements and Policies, fact sheet.

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  24. These may also be referred to as House, Senate, or Conference Reports. U.S. Government Publishing Office, “Congressional Reports,” webpage, http://www.gpo.gov/fdsys/browse/collection.action?collectionCode=CRPT&bread=true.

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  25. CRS, The President’s Malaria Initiative and Other U.S. Global Efforts to Combat Malaria, R40494, April 6, 2009.

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  26. CRS, The President’s Malaria Initiative and Other U.S. Global Efforts to Combat Malaria, R40494, April 6, 2009. For more information on U.S. global malaria efforts, including PMI, see KFF, The U.S. Government and Global Malaria, fact sheet.

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  27. The most recent iterations of these reports are: Department of State/Office of the Global AIDS Coordinator, The President’s Emergency Plan for AIDS Relief’s (PEPFAR) Annual Treatment Report, Report to Congress, 2015; Department of State/Office of the Global AIDS Coordinator, PEPFAR 2015 Annual Report to Congress, 2015; USAID, Annual Progress Report to Congress: Global Health Programs, FY 2014, 2015; USAID, USAID Health-Related Research and Development Progress Report: An Update on the 2011-2015 Health Research Strategy, Report to Congress, 2014.

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  28. The requirements for congressional notification vary based on the type of request, the funding involved, its governing legislation, the committee of jurisdiction, and the requesting agency/department. When congressional notification (CN) is required, a member who has concerns or additional questions about a congressional notification’s reprogramming or transfer request may place a hold on approval of the CN through the committee, which effectively instructs the requesting agency to take no further action with regard to the specified funds until further information is provided to the committee and the hold is lifted. Although such holds do not have the force of law, the use of holds is part of an informal “understanding between congressional committees and agencies under their jurisdiction.” See CRS, The Executive Budget Process: An Overview, R42633, July 27, 2012, and CRS, The Congressional Appropriations Process: An Introduction, R42388, Nov. 14, 2014, for more information about the congressional notification process as well as the reallocation of budget authority through transfers (“a shift of budget resources from one appropriations account to another”) and reprogramming (“a shift of budgetary resources from one project or purpose to another within an appropriations account”).

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  29. CRS: Counting Regulations: An Overview of Rulemaking, Types of Federal Regulations, and Pages in the Federal Register, R43056, July 14, 2015; Congressional Review of Agency Rulemaking: An Update and Assessment of The Congressional Review Act after a Decade, RL30116, updated May 8, 2008; Disapproval of Regulations by Congress: Procedure Under the Congressional Review Act, RL31160, Oct. 10, 2001.

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  30. CRS, Congressional Oversight: An Overview, R41079, Feb. 22, 2010.

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  31. U.S. Government Publishing Office, “Congressional Reports,” webpage, http://www.gpo.gov/fdsys/browse/collection.action?collectionCode=CRPT&bread=true.

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  32. U.S. House of Representatives, Strengthening Disease Surveillance, House Report 109-436, April 25, 2006.

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  33. CRS, Treaties and Other International Agreements: The Role of the United States Senate, A study prepared for the Committee on Foreign Relations, United States Senate, January 2001.

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  34. KFF, U.S. Participation in International Health Treaties, Commitments, Partnerships, and Other Agreements, report, Sept. 2010.

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  35. CRS, International Food Aid: U.S. and Other Donor Contributions, RS21279, Nov. 12, 2013.

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  36. CRS, Presidential Appointee Positions Requiring Senate Confirmation and Committees Handling Nominations, RL30959, Nov. 25, 2013.

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  37. See also CRS, Senate Consideration of Presidential Nominations: Committee and Floor Procedure, RL31980; CRS, Appointment and Confirmation of Executive Branch Leadership: An Overview, R44083, June 22, 2015.

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  38. Letter to President Barack Obama from 98 Members of Congress Regarding the FY2011 U.S. Contribution to the Global Fund, Oct. 27, 2009, http://www.results.org/images/uploads/files/fy11_global_fund_letter_to_president_obama_10-27-09_with_co-signers_(final).pdf.

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  39. CRS, PEPFAR Reauthorization: Key Policy Debates and Changes to U.S. International HIV/AIDS, Tuberculosis, and Malaria Programs and Funding, RL34569, Jan. 29, 2009. See also KFF, Reauthorization of PEPFAR, The United States Global Leadership Against HIV/AIDS, Tuberculosis and Malaria Act: A Side-by-Side Comparison to Prior Law, fact sheet, July 2, 2008.

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  40. White House, “President Obama Announces More Key Administration Posts,” press release, Jan. 9, 2014.

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  41. SFRC, Nominations hearing, March 6, 2014, video, http://www.foreign.senate.gov/hearings/nominations/030614.

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  42. U.S. Congress, “Actions: PN1312 – 113th Congress (2013-2014),” nomination record PN1312 – Deborah L. Birx – Department of State, https://www.congress.gov/nomination/113th-congress/1312.

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  43. State Department, “Dr. Deborah Birx Sworn-In as New U.S. Global AIDS Coordinator,” press release, April 4, 2014.

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  44. Sarah Ferris, “Timeline of Ebola outbreak,” The Hill, Oct. 2, 2014, http://thehill.com/policy/healthcare/219528-ebola-outbreak. The first cases of Ebola Virus Disease occurred in December 2013 in Guinea, a small country in Africa, but these, along with the growing number of cases spreading through the area, were not identified as Ebola until March 2014. Shortly thereafter, a neighboring country, Liberia, reported its first two cases, and there were early reports of possible Ebola cases in Sierra Leone. http://www.newsweek.com/timeline-worst-ebola-outbreak-ever-276284.

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  45. U.S. Senate, S.Res. 541; U.S. Congress, Continuing Appropriations Resolution, 2015 (P.L. 113-164).

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  46. White House, “Emergency Funding Request to Enhance the U.S. Government’s Response to Ebola at Home and Abroad,” fact sheet, Nov. 5, 2014, https://www.whitehouse.gov/the-press-office/2014/11/05/fact-sheet-emergency-funding-request-enhance-us-government-s-response-eb.

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  47. Statement of Senator Barbara Mikulski during Senate Appropriations Committee hearing, “U.S. Government Response: Fighting Ebola and Protecting America,” Nov. 12, 2014.

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  48. U.S. Congress, Consolidated and Further Continuing Appropriations Act, 2015 (P.L. 113-235); KFF, The U.S. Global Health Budget: Analysis of Appropriations for Fiscal Year 2015, Dec. 22, 2014. For more information, see KFF, The U.S. Response to Ebola: Status of the FY 2015 Emergency Ebola Appropriation, Nov. 23, 2015.

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  49. Most of this funding expires in FY 2019.

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  50. HFAC, “Combatting the Ebola Threat,” subcommittee hearing, Aug. 7, 2014; Senate HELP and Appropriations Committees, “Ebola in West Africa: A Global Challenge and Public Health Threat,” joint committee hearing, Sept. 16, 2014; HFAC, “Global Efforts to Fight Ebola,” subcommittee hearing, Sept. 17, 2014; House E&C Committee, “Examining the U.S. Public Health Response to the Ebola Outbreak,” subcommittee hearing, Oct. 16, 2014.

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  51. Approval of these reprogramming/transfer requests allowed DoD to transfer these funds from the Overseas Contingency Operations account and other accounts to the Overseas Humanitarian, Disaster, and Civic Assistance (OHDACA) account and to reprogram other funds in support of related efforts in Ebola-affected countries. In this case, several members in both chambers placed “holds” on their approval of requested funds, in effect instructing DoD to not take further action with the specified funds until their additional questions were answered and other requirements were fulfilled. House Armed Services Committee (HASC), “HASC Update: DOD Response to the Ebola Outbreak in West Africa,” fact sheet, Oct. 9, 2014; Kristina Wong, “House approves $750M in Ebola funding held up in Senate panel,” The Hill, Oct. 9, 2014; Office of Senator James Inhofe, “Inhofe Approves Reprogramming Request for Ebola Response Effort,” press release, Oct. 10, 2014; Kristina Wong, “Inhofe gives approval for $750M in Ebola funds,” The Hill, Oct. 10, 2014; CRS, “Increased Department of Defense Role in U.S. Ebola Response,” IN10152, Oct. 10, 2014; CRS, FY2015 Budget Requests to Counter Ebola and the Islamic State (IS), R43807, Dec. 9, 2014; White House, “U.S. Response to the Ebola Outbreak in West Africa,” fact sheet, Sept. 16, 2014.

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  52. For example, Senator Patrick Leahy, “The Ebola Crisis,” floor speech, Congressional Record, 113th Congress, 2nd Session, Vol. 160, No. 130: Daily Edition S5550-1, Sept. 11, 2014; Rep. Mike Kelly, “Keeping America Safe From Ebola,” floor speech, Congressional Record, 113th Congress, 2nd Session, Vol. 160, No. 143: Daily Edition H8149-50, Nov. 20, 2014; Reps. Henry Waxman, Frank Pallone, and Diana DeGette, “Letter to Reps. Fred Upton, Joe Pitts, and Tim Murphy about Key Questions on Ebola Outbreak,” correspondence, Oct. 1, 2014; Reps. Betty McCollum and Dave Reichert, “Global Health Caucus invites you to a briefing on the ‘Global Health response to Ebola’,” Dear Colleague letter, Nov. 13, 2014.

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  53. HFAC Subcommittee on Africa, Global Health, Global Human Rights, and International Organizations, “Combatting the Ebola Threat,” subcommittee hearing, Aug. 7, 2014; Senate HELP and Appropriations Committees, “Ebola in West Africa: A Global Challenge and Public Health Threat,” joint full committee hearing, Sept. 16, 2014; HFAC Subcommittee on Africa, Global Health, Global Human Rights, and International Organizations, “Global Efforts to Fight Ebola,” subcommittee hearing, Sept. 17, 2014; House E&C Committee’s Subcommittee on Oversight and Investigations, “Examining the U.S. Public Health Response to the Ebola Outbreak,” subcommittee hearing, Oct. 16, 2014; Senate Appropriations Committee, “U.S. Government Response: Fighting Ebola and Protecting America,” full committee hearing, Nov. 12, 2014; HFAC, “Combating Ebola in West Africa: The International Response,” full committee hearing, Nov. 13. 2014; HFAC Subcommittee on Africa, Global Health, Global Human Rights, and International Organizations, “Fighting Ebola: A Ground-Level View,” subcommittee hearing, Nov. 18, 2014; SFRC Subcommittee on African Affairs, “The Ebola Epidemic: The Keys to Success for the International Response,” Dec. 10, 2014.

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Appendices
  1. KFF compilation of information on relevant congressional committee and subcommittee websites.

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  2. KFF compilation of information on relevant congressional committee and subcommittee websites.

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  3. KFF compilation of information on relevant congressional committee and subcommittee websites.

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  4. KFF analysis of congressional member websites, Feb. 2019, and personal communication with congressional offices, Jan. 2017; Office of Senator Roger Wicker, “Wicker, Coons Introduce Resolution Supporting World Malaria Day,” press release, April 24, 2015; Office of Senator Bob Casey, Jr., “With School Closed for the Summer, Casey Alerts Central PA Residents to More Than 70 Sites That Ensure Children Don't Go Hungry in Summer Months,” July 14, 2014; Office of Senator Jerry Moran, “Sen. Moran Renews Support for Good Samaritan Hunger Relief Legislation,” press release, April 23, 2015; Office of Senator John Boozman, “Boozman Leads Efforts to Provide Flexibility to Summer Meal Programs,” press release, Aug. 5, 2015; Office of Senator Dick Durbin, “Durbin Joins Hunger Caucus in Urging Members to Raise Awareness,” press release, Nov. 22, 2011; U.S. House of Representatives Committee on House Administration, “Congressional Member and Staff Organizations,” webpage, https://cha.house.gov/member-services/congressional-memberstaff-organizations; Office of Representative Ted Yoho, “A new economic approach to foreign aid,” Special to the Star-Banner Sunday (posted Dec. 25, 2016), dated Jan. 4, 2017, https://yoho.house.gov/media-center/in-the-news/ted-yoho-a-new-economic-approach-to-foreign-aid; Association for Safe International Road Travel, “U.S. Congress,” webpage, http://www.asirt.org/Initiatives/US-Government/US-Congress.

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