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House Appropriations Committee Approves FY 2020 State & Foreign Operations (SFOPs) Appropriations Bill

The House Appropriations Committee approved the FY 2020 State & Foreign Operations (SFOPs) appropriations bill (and accompanying report) on May 16, 2019. The SFOPs bill includes funding for U.S. global health programs at the State Department and the U.S. Agency for International Development (USAID).[i] Funding for these programs, through the Global Health Programs (GHP) account, which represents the bulk of global health assistance, totaled $9.3 billion, an increase of $459 million above the FY 2019 enacted level and almost $3 billion above the President’s FY 2020 request.

Key highlights are as follows (see table for additional detail):

  • While funding for most global health programs at State and USAID remained flat compared to the FY19 level, there were increases for the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), tuberculosis (TB), maternal and child health (MCH), and family planning and reproductive health (FP/RH) programs. In all cases, funding for all programs was above the President’s FY 2020 request, which had proposed significant cuts.
  • Bilateral HIV funding through the President’s Emergency Plan for AIDS Relief (PEPFAR) is $4,700 million in the House FY20 bill, matching the FY19 level and $1,350 million above the FY20 Request ($3,350 million).
  • The bill includes $1,560 million as the U.S. contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), an increase of $210 million above the FY19 level ($1,350 million) and $602 million above the FY20 Request ($958 million).
  • Funding for tuberculosis (TB) totals $310 million, $8 million above the FY19 level and $49 million above the FY20 Request ($261 million).
  • Funding for malaria totals $755 million, matching the FY19 level and $81 million above the FY20 Request ($674 million).
  • The bill includes $850 million for maternal and child health (MCH), an increase of $15 million above the FY19 level ($835 million) and $230.4 million above the FY20 Request ($619.6 million). Specific areas under MCH include:
    • Gavi, the Vaccine Alliance, which is included under MCH funding, totals $290 million, matching the FY19 level and $40 million above the FY20 Request ($250 million).
    • Polio funding through the GHP account, which is included under MCH funding, totals $59 million, matching total polio funding provided in FY19 level ($51.5 million through the GHP account and $7.5 million through the ESF account).[ii] The President’s FY 2020 Request did not specify funding for polio.
    • The bill includes $147.5 million for the U.S. contribution to the United Nations Children’s Fund (UNICEF) provided through the International Organizations and Programs (IO&P) account, $10 million above the FY19 level ($137.5 million). While the FY20 Request did not specify a funding amount for UNICEF and proposed to eliminate the IO&P account, it is possible that organizations such as UNICEF could receive funding through other accounts.
  • Funding for nutrition totals $145 million, matching the FY19 level and $66.5 million above the FY20 Request ($78.5 million).
  • Bilateral family planning and reproductive health (FP/RH) funding totaled $750 million, all of which is provided through the GHP account. This is an increase of $175 million above the FY19 enacted level for all accounts ($575 million; $524 million through the GHP account and $51 million through the ESF account) and $491 million above the FY20 Request ($259 million; $237 million through the GHP account and $22 million through the ESF account).[ii]
  • The bill includes $55.5 million as the U.S. contribution to the United Nations Population Fund (UNFPA), an increase of $23 million above the FY19 level ($32.5 million); the FY20 Request proposed eliminating funding for UNFPA.
  • Funding for the vulnerable children program totals $24 million, matching the FY19 level; the FY20 Request proposed eliminating funding for this program.
  • Funding for neglected tropical diseases (NTDs) totals $102.5 million, matching the FY19 level and $27.5 million above the FY20 Request ($75 million).
  • Funding for global health security totals $100 million in the bill. While this is a decrease compared to the FY19 level ($138 million), $38 million of the FY19 amount was provided through a one-time transfer of unspent emergency Ebola funding. The House FY20 amount increased compared to the FY20 Request ($90 million).
  • The bill also included the following policy provisions:
    • Mexico City Policy: The bill includes a permanent repeal of the Mexico City Policy (MCP), as reinstated by President Trump via executive order on January 22, 2017 (see the KFF MCP explainer), and a prohibition on using any current or prior SFOPs appropriations to implement the MCP.
    • Global Fund: The committee report states that the $1.56 billion is for the first installment of the U.S. contribution to the Global Fund’s sixth replenishment unless the conditions specified in PEPFAR’s authorizing legislation, including that U.S. contributions to the Global Fund cannot exceed 33 percent of total contributions to the Global Fund from all sources, are not met (see the KFF PEPFAR reauthorization side-by-side).
    • Transfer of Funds: While the bill provides the Secretary of State and USAID Administrator the ability to transfer a percentage of the funding amounts specified in the explanatory statement between accounts and/or areas, it specifically states that this authority does not apply to the Global Health Programs (GHP) account. This provision has been included in annual appropriations bills since FY 2017.

Resources:

  • FY2020 State and Foreign Operations Appropriations Bill – Bill
  • FY2020 State and Foreign Operations Appropriations Bill – Report
  • Details on U.S. global health funding provided in the House FY 2020 Labor, Health and Human Services, and Education (LHHS) Appropriations Bill, which was approved by full committee on May 8, 2019 can be found here.

The table (.xls) below compares global health funding in the FY 2020 House SFOPs appropriations bill to the FY 2019 enacted funding amounts as outlined in the “Consolidated Appropriations Act, 2019” (P.L. 116-6; KFF summary here) and the President’s FY 2020 request (KFF summary here).

 

Table: KFF Analysis of FY20 House SFOPs Funding for Global Health
Department / Agency / Area FY19
Enactedi
(millions)
FY20
Requestii
(millions)
FY20
Houseiii
(millions)
Difference
(millions)
FY20 House
– FY19 Enacted
FY20 House
– FY20 Request
 SFOPs – Global Health
HIV/AIDS $4,700.0 $3,350.0 $4,700.0 $0
 (0%)
$1,350.0
 (40%)
State Department $4,370.0 $3,350.0 $4,370.0 $0
(0%)
$1,020.0
(30.4%)
USAID $330.0 $0.0 $330.0 $0
(0%)
$330.0
(NA)
of which Microbicides $45.0 $0.0 $45.0 $0
(0%)
$45.0
(NA)
Global Fund $1,350.0 $958.4 $1,560.0 $210.0
 (16%)
$601.6
 (63%)
Tuberculosisiv  $262.0  –  –  –
Global Health Programs (GHP) account $302.0 $261.0 $310.0 $8.0
(3%)
$49.0
(19%)
Economic Support Fund (ESF) account Not specified $1.0 Not specified  –  –
Malaria $755.0 $674.0 $755.0 $0
 (0%)
$81.0
 (12%)
Maternal & Child Health (MCH)v vi  –  –  –
GHP account $835.0 $619.6 $850.0 $15.0
(2%)
$230.4
(37%)
of which Gavi $290.0 $250.0 $290.0 $0
(0%)
$40
(16%)
of which Polio $51.5 $16.0 $59.0 $7.5
(15%)
 $43
(270%)
UNICEFvii $137.5 Not specified $147.5 $10.0
(7%)
 –
ESF account Not specified $75.5 Not specified  –  –
of which Polio $7.5 $7.0 Not specified  –  –
Nutritionviii $89.7  –  –  –
GHP account $145.0 $78.5 $145.0 $0
(0%)
$66.5
(85%)
ESF account Not specified $11.2 Not specified  –  –
Family Planning & Reproductive Health (FP/RH)ix $607.5 $259.0 $805.5 $198.0
 (33%)
 $546.5
(211%)
Bilateral FP/RH $575.0 $259.0 $750.0 $175.0
(30%)
$491.0
(190%)
GHP account $524.0 $237.0 $750.0 $226.1
(43%)
$513.0
(216%)
ESF account $51.1 $22.0 Not specified  –  –
UNFPA $32.5 $0.0 $55.5 $23.0
(71%)
 $55.5
(NA)
Vulnerable Children $24.0 $0.0 $24.0 $0
 (0%)
$24.0
(NA)
Neglected Tropical Diseases (NTDs) $102.5 $75.0 $102.5 $0
 (0%)
$27.5
 (37%)
Global Health Security $138.0 $90.0 $100.0 $-38.0
 (-28%)
$10.0
 (11%)
GHP account $100.0 $90.0 $100.0 $0
(0%)
$10.0
(11%)
Ebola transfer $38.0 $0.0 $0.0 $-38.0
(-100%)
 –
Emergency Reserve Fundx $2.0 $0.0 $10.0 $8.0
 (400%)
$10.0
(NA)
Ebola transfer $2.0 $0.0 $0.0 $-2.0
(-100%)
$0
(NA)
Total (GHP account only) $8,837.5 $6,343.5 $9,296.5 $459.0
 (5%)
$2,953.0
 (47%)
Notes:
i – The FY19 Enacted includes the transfer of $40.0 million in unspent Emergency Ebola funding including: $2.0 million for the Emergency Reserve Fund and $38.0 million for “programs to accelerate the capacities of targeted countries to prevent, detect, and respond to infectious disease outbreaks.”
ii – In the FY20 Request, the administration proposed to consolidate the Development Assistance (DA), Economic Support Fund (ESF), the Assistance for Europe, Eurasia, and Central Asia (AEECA), and the Democracy Fund (DF) accounts in to one new account — the Economic Support and Development Fund (ESDF). ESF funding for the FY20 Request reflects the amounts requested by the administration for ESDF.
iii – The House FY20 SFOPs bill proposes to move the Economic Support Fund (ESF) from “Bilateral Economic Assistance” to “Security Assistance” and “redirects development, and most democracy and governance, funding that is long-term in nature to the Development Assistance or Democracy Fund accounts.” If the House FY20 bill is approved by Congress, it is possible that global health funding previously provided under the ESF account may be provided under the Development Assistance (DA) account.
iv – Some tuberculosis funding is provided under the ESF account, which is not earmarked by Congress in the annual appropriations bills and determined at the agency level (e.g. in FY17, TB funding under the ESF account totaled $2.64 million).
v – Some MCH funding is provided under the ESF account, which is not earmarked by Congress in the annual appropriations bills and determined at the agency level (e.g. in FY17, MCH funding under the ESF account totaled $56.54 million).
vi – It is not possible to calculate total MCH funding in the FY20 request because UNICEF, which has historically received funding through the International Organizations and Programs (IO&P) account, was not specified in the FY20 request.
vii – UNICEF funding in the FY19 Enacted totaled $137.5 million, of which $5 million is earmarked for programs addressing female genital mutilation.
viii – Some nutrition funding is provided under the ESF account, which is not earmarked by Congress in the annual appropriations bills and determined at the agency level. (e.g. in FY17, nutrition funding under the ESF account totaled $21 million).
ix – In prior fiscal years, bilateral FP/RH funding has been provided through both the GHP and ESF accounts. The report accompanying the House FY20 SFOPs bill states that “The Committee recommendation includes $750,000,000 for reproductive health and voluntary family planning in this Act.” All of this funding is included under the GHP account. The bill summary released by the House Committee on Appropriations states that the $750 million for FP/RH is an increase of $175 million above total funding provided in FY19 (GHP and ESF accounts).
x – The draft House FY20 appropriations bill states that “up to $10,000,000 of the funds made available under the header ‘Global Health Programs’ may be made available for the Emergency Reserve Fund.” Based on the language in the bill and the GHP totals presented in the report, this is not a specified funding line but is an authority given to the administration to transfer funds specified for other purposes under the GHP account to the Emergency Reserve Fund.

[i] Total funding for global health is not currently available as some funding provided through USAID and DoD is not yet available.

[ii] The House FY20 SFOPs bill proposes to move the Economic Support Fund (ESF) from “Bilateral Economic Assistance” to “Security Assistance” and “redirects development, and most democracy and governance, funding that is long-term in nature to the Development Assistance or Democracy Fund accounts.” If the House FY20 bill is approved by Congress, it is possible that global health funding previously provided under the ESF account may be provided under the Development Assistance (DA) account.