House Appropriations Committee Approves FY 2021 Health and Human Services (HHS) Appropriations Bill

The House Appropriations Committee approved the FY 2021 Labor, Health and Human Services, and Education (LHHS) appropriations bill (and accompanying report) on July 13, 2020. The LHHS appropriations bill includes funding for U.S. global health programs provided to the Centers for Disease Control and Prevention (CDC) and some funding for global health research activities provided to the National Institutes of Health (NIH). The bill also includes emergency funding for COVID-19 response efforts. Key highlights are as follows (see Table 1 for additional detail on global health funding and Table 2 for additional detail on emergency funding for COVID-19):

  • Funding provided to CDC for global health totaled $572.8 million, a slight increase of $2 million (0.4%) above the FY 2020 enacted level ($570.8 million) and $40.6 million (8%) above the President’s FY 2021 request ($532.2 million). This includes:
    • $128.4 million for global HIV/AIDS, matching the FY 2020 enacted level and $58.9 million (85%) above the FY 2021 Request ($69.5 million).
    • $9.2 million for global tuberculosis (TB), $2 million (27%) above the FY 2020 enacted and FY 2021 Request levels ($7.2 million).
    • $226 million for global immunization, matching the FY 2020 enacted level and $20 million (10%) above the FY 2021 Request ($206 million). Within this total are the following:
      • Funding for polio totals $176 million, matching the FY 2020 enacted level and $11 million (7%) above the FY 2021 Request ($165 million).
      • Funding for CDC’s other global vaccines/measles program totals $50 million, matching the FY 2020 enacted level and $9 million (22%) above the FY 2021 Request ($41 million).
    • $26 million for parasitic diseases and malaria, matching the FY 2020 enacted level and $1.5 million (6%) above the FY 2021 Request ($24.5 million).
    • $183.2 million for the global public health protection program, which includes funding for global health security, matching the FY 2020 enacted level and -$41.8 million (-19%) below the FY 2021 Request ($225 million). [1]
    • Funding for the Fogarty International Center (FIC) at NIH totaled $86.5 million, a $5.7 million (7%) increase above the FY 2020 enacted level ($80.8 million) and $12.9 million (18%) above the FY 2021 Request ($73.5 million).
    • Emergency funding for COVID-19 response efforts totaled $24.5 billion, of which $1 billion was for global disease detection and emergency response at CDC. See Table 2 for detailed funding on non-global-health funding.

Resources:

  • FY2020 Labor, Health and Human Services, and Education Appropriations Bill
  • FY2020 Labor, Health and Human Services, and Education Appropriations Report

Table 1 (.xls) below compares global health funding in the FY 2021 House LHHS appropriations bill to the FY 2020 enacted funding amounts as outlined in the “Consolidated Appropriations Act, 2020” (P.L. 116-94; KFF summary here) and the President’s FY 2021 request (KFF summary here). Table 2 provides a summary of emergency funding in the FY 2021 House LHHS appropriations bill.

Table 1: KFF Analysis of FY21 House Appropriations for Global Health
Department / Agency / Area FY20
Enacted
(millions)
FY21
Requesti
(millions)
FY21
House
(millions)
Difference
(millions)
FY21 House
– FY20 Enacted
FY21
House
– FY21 Request
Health & Human Services (HHS)
Centers for Disease Control & Prevention (CDC) – Total Global Health $570.8 $532.2 $572.8 $2
 (0.4%)
$40.6
 (7.6%)
Global HIV/AIDS $128.4 $69.5 $128.4 $0
(0%)
$58.9
(84.7%)
Global Tuberculosisi $7.2 $7.2 $9.2 $2
(27.4%)
$2
(27.4%)
Global Immunization $226.0 $206.0 $226.0 $0
(0%)
$20
(9.7%)
Polio $176.0 $165.0 $176.0 $0
(0%)
$11
(6.7%)
Other Global Vaccines/Measles $50.0 $41.0 $50.0 $0
(0%)
$9
(22%)
Parasitic Diseases $26.0 $24.5 $26.0 $0
(0%)
$1.5
(6.3%)
Global Public Health Protectionii $183.2 $225.0 $183.2 $0
(0%)
$-41.8
(-18.6%)
Global Disease Detection and Emergency Response $173.4 Not specified Not yet known  –  –
of which Global Health Security (GHS) $125.0 $175.0 Not yet known  –  –
Global Public Health Capacity Development $9.8 Not specified Not yet known  –  –
National Institutes of Health (NIH) – Total Global Health Not yet known Not yet known Not yet known  –  –
HIV/AIDS Not yet known Not yet known Not yet known  –  –
Malaria $208.0 Not yet known Not yet known  –  –
Fogarty International Center (FIC) $80.8 $73.5 $86.5 $5.7
(7.1%)
$12.9
(17.6%)
Notes:
i – In FY20, the administration proposed to formally transfer $7.2 million from the “HIV/AIDS, Viral Hepatitis, STI and TB Prevention” account to “Global Tuberculosis” activities under “Global Health Programs” at CDC. The FY20 conference agreement formalizes this transfer.
ii –  The full breakdown in funding for “Global Public Health Protection,” which includes “Global Disease Detection and Emergency Response,” “Global Health Security,” and “Global Public Health Capacity” is not yet known for the House FY21 bill.
Table 2: KFF Analysis of Emergency Funding in  House FY21 LHHS Appropriations Bill
Department / Agency / Area FY21
House
(millions)
Total Funding $24,425.00
CDC-Wide Activities $9,000.00
State and Local Public Health Departments $2,000.00
State and Local Public Health Laboratories $1,000.00
Global Disease Detection and Emergency Response $1,000.00
Vaccination Campaigns $4,000.00
Public Health Data Modernization Initiative $400.00
Public Health Workforce $200.00
Infectious Disease Rapid Response Reserve Fund $400.00
Tribes, Tribal Organizations, Urban Indian Health Organizations, or Health Service Providers to Tribesi $150.00
NIH – Office of the Directorii $5,000.00
Public Health and Social Services Emergency Fund $4,500.00
BARDA – Advanced Research and Development and Advanced Manufacturing of Vaccines and Therapeutics $3,500.00
BARDA – Vaccine Facility Enhancements $500.00
BARDA – Advanced Research and Development of Antibiotics $500.00
Public Health Emergency Fund $5,000.00
State Unemployment Insurance and Employment Service Operationsiii $925.00
Notes:
i – The FY21 House bill text states that “of the amount made available under this heading for specified programs, not less than $150,000,000 shall be allocated to Tribes, Tribal organizations, urban Indian health organizations, or health service providers to Tribes.” This amount is not in addition to the other amounts listed under CDC-wide activities.
ii – The FY21 House bill text states that these funds may be used to offset the costs related to reductions in laboratory productivity resulting from interruptions or shutdowns of research activity in FY20.
iii – The FY21 House report states that the bill “provides contingency funding for increased workloads that States may face in the administration of UI. The Committee recommendation includes bill language so that, during fiscal year 2021, for every 100,000 increase in the total average weekly insured unemployment (AWIU) above 1,728,000, an additional $28,600,000 shall be made available to States from the Unemployment Trust Fund. Under current economic conditions, the Congressional Budget Office estimates that this will result in an additional $925,000,000 to flow to States.”

[1] Funding for “Global Public Health Protection,” includes “Global Disease Detection and Emergency Response,” “Global Health Security,” and “Global Public Health Capacity”. The full breakdown among areas is not yet known for the House FY21 bill.