House Appropriations Committee Approves FY21 State and Foreign Operations (SFOPs) Appropriations Bill

UPDATED: The House Committee on Appropriations approved the FY 2021 State & Foreign Operations (SFOPs) appropriations bill (and accompanying report) on July 9, 2020 (a draft version of the bill was released on July 6 and the accompanying report was released on July 8). The SFOPs bill includes funding for U.S. global health programs at the State Department and the U.S. Agency for International Development (USAID). Funding for these programs, through the Global Health Programs (GHP) account, which represents the bulk of global health assistance, totaled $9.2 billion, an increase of $64.5 million (1%) above the FY 2020 enacted level and $3.2 billion (53%) above the President’s FY 2021 request. The bill provides higher levels of funding for almost all program areas compared to the FY 2021 request. The bill also provides $10 billion in emergency funding for global COVID-19 response efforts through the Department of State and USAID. 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):

  • Bilateral HIV funding through the President’s Emergency Plan for AIDS Relief (PEPFAR) is $4,700 million ($4,370 million through State and $330 million through USAID), matching the FY 2020 enacted level, and $1,520 million (48%) above the FY 2021 request ($3,180 million).
  • The House bill includes $1,560 million for the U.S. contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), matching the FY 2020 enacted level and $902 million (137%) above the FY 2021 request ($657.6 million).
  • Funding for tuberculosis (TB) totals $310 million, matching the FY 2020 enacted level, and $35 million (13%) above the FY 2021 request ($275 million).
  • Funding for malaria totals $755 million, $15 million (2%) below the FY 2020 enacted level ($770 million), and $46.5 million (7%) above the FY 2021 request ($708.5 million).
  • The House bill includes $850 million for maternal and child health (MCH), matching the FY 2020 enacted level and $190 million (29%) above the FY 2021 request ($660 million). Specific areas under MCH include:
    • Gavi, the Vaccine Alliance funding totals $290 million, matching the FY 2020 enacted and FY 2021 request levels.
    • Polio funding totals $61 million, matching the FY 2020 enacted level. The President’s FY 2021 request did not specify funding for polio.
    • Funding for the U.S. contribution to the United Nations Children’s Fund (UNICEF) provided through the International Organizations and Programs (IO&P) account totals $139 million, matching the FY 2020 enacted level. The President’s FY 2021 request did not specify funding for UNICEF.
  • Funding for nutrition totals $145 million, $5 million (3%) below the FY 2020 enacted level ($150 million), and $55 million (61%) above the FY 2021 request ($90 million).
  • Bilateral family planning and reproductive health (FP/RH) funding totals $750 million ($585.5 million through GHP and $164.5 million through the Economic Support Fund account), $175 million (30%) above the FY 2020 enacted level ($575 million). The FY 2021 request specified FP/RH funding through the GHP account only ($237 million); the House bill provides $585.5 million for FP/RH through the GHP account, $348.5 million (147%) above the FY 2021 request.
  • Funding for the United Nations Population Fund (UNFPA) totals $55.5 million, $23 million (71%) above the FY 2020 enacted level ($32.5 million). The President’s FY 2021 request proposed eliminating funding for UNFPA. In FY 2020 the Trump Administration invoked the Kemp-Kasten amendment to withhold UNFPA funding (learn more about the Kemp Kasten amendment here). The House FY 2021 bill notes that if this funding is not provided to UNFPA it “shall be transferred to the ‘Global Health Programs’ account and shall be made available for family planning, maternal, and reproductive health activities.”
  • Funding for the vulnerable children program totals $24 million, $1 million (4%) below the FY 2020 enacted level. The President’s FY 2021 request proposed eliminating funding for this program.
  • Funding for neglected tropical diseases (NTDs) totals $102.5 million, matching the FY 2020 enacted level and $28 million (37%) above the FY 2021 request ($75 million).
  • Funding for global health security totals $125 million, an increase of $25 million (25%) above the FY 2020 enacted level ($100 million) and $35 million (39%) above the FY 2021 request ($90 million).
  • The House bill states that “up to $50,000,000 of the funds made available under the heading ‘Global Health Programs’ may be made available for the Emergency Reserve Fund.” The FY 2021 request provided $25 million for the Emergency Reserve Fund through the GHP account, $25 million below the House level.
  • Funding for the World Health Organization (WHO) totals $319 million ($200 million through GHP and $119 million through the Contributions to International Organizations account). Funding for the WHO in the FY 2020 enacted bill and FY 2021 request was provided through the CIO account only — $122.7 million in the FY 2020 enacted bill ($3.8 million above the House level) and $57.9 million in the FY 2021 request ($61 million below the House level). The President has moved to suspend funding to the WHO and formally withdraw U.S. membership from the organization (learn more about the U.S. government and WHO here).
  • Coronavirus pandemic preparedness and response emergency funding for global efforts totals $10 billion, of which $2.5 billion is provided through the GHP account at USAID, including:
    • $150 million transferred to the Emergency Reserve Fund, based on a determination by the Secretary of State,
    • $750 million for Gavi, the Vaccine Alliance, and
    • $800 million for the Global Fund.
    • Additional funding provided through other accounts is detailed in Table 2 below.

The SFOPs bill also includes the following policy provisions:

  • The Global HER Act, which would permanently repeal the Protecting Life in Global Health Assistance, also known as the Mexico City Policy, reinstated by President Trump in January 2017 (learn more about the Mexico City Policy here)
  • The bill includes a prohibition on the use of current or prior funds for implementing the Mexico City Policy.

Resources:

Table 1 (.xls) below compares global health funding in the FY 2021 House 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 FY 2021 request (KFF summary here). Table 2 provides a summary of emergency funding in the FY 2021 House SFOPs appropriations bill.

Note: Some funding amounts (e.g. global health funding provided through the Economic Support Fund account at USAID) will be determined at the agency level, and are not earmarked by Congress in the SFOPs 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
 SFOPs – Global Health
HIV/AIDS $4,700.0 $3,180.3 $4,700.0 $0
 (0%)
$1519.7
 (47.8%)
State Department $4,370.0 $3,180.3 $4,370.0 $0
(0%)
$1189.7
(37.4%)
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 $1,560.0 $657.6 $1,560.0 $0
 (0%)
$902.4
 (137.2%)
Tuberculosisii  –   –  –  –
Global Health Programs (GHP) account $310.0 $275.0 $310.0 $0
(0%)
$35
(12.7%)
Economic Support Fund (ESF) account Not specified Not specified Not specified  –  –
Malaria $770.0 $708.5 $755.0 $-15
 (-1.9%)
$46.5
 (6.6%)
Maternal & Child Health (MCH)iii iv  –  –  –
GHP accountv $851.0 $659.6 $850.0 $-1
(-0.1%)
$190.4
(28.9%)
of which Gavi $290.0 $290.0 $290.0 $0
(0%)
$0
(0%)
of which Poliov $61.0 Not specified $61.0 $0
(0%)
 –
UNICEFvi $139.0 Not specified $139.0 $0
(0%)
 –
ESF account Not specified Not specified Not specified  –  –
of which Poliov v Not specified Not specified  –  –
Nutritionvii  –  –  –  –
GHP account $150.0 $90.0 $145.0 $-5
(-3.3%)
$55
(61.1%)
ESF account Not specified Not specified Not specified  –  –
Family Planning & Reproductive Health (FP/RH) $607.5  – $805.5 $198
 (32.6%)
 –
Bilateral FPRH $575.0  – $750.0 $175
(30.4%)
 –
GHP account $524.0 $237.0 $585.5 $61.5
(11.7%)
$348.5
(147%)
ESF account $51.1 Not specified $164.5 $113.5
(222.3%)
 –
UNFPAviii $32.5 $0.0 $55.5 $23
(70.8%)
$55.5
(NA)
Vulnerable Children $25.0 $0.0 $24.0 $-1
 (-4%)
$24.0
(NA)
Neglected Tropical Diseases (NTDs) $102.5 $75.0 $102.5 $0
 (0%)
$27.5
 (36.7%)
Global Health Security $100.0 $90.0 $125.0 $25
 (25%)
$35
 (38.9%)
GHP account $100.0 $90.0 $125.0 $25
(25%)
$35
(38.9%)
Emergency Reserve Fund ix $25.0 ix  –  –
World Health Organization (WHO)x $122.7 $57.9 $318.9 $196.2
 (159.9%)
$261
 (450.9%)
GHP accountx  –  – $200.0  –  –
Contributions to International Organizations (CIO) account $122.7 $57.9 $118.9 $-3.8
(-3.1%)
$61
(105.4%)
SFOPs Total (GHP account only) $9,092.5 $5,998.0 $9,157.0 $64.5
 (0.7%)
$3159
 (52.7%)
Notes:
i – In the FY21 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 FY21 Request reflects the amounts requested by the administration for ESDF.
ii – 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 FY18, TB funding under the ESF account totaled $4 million).
iii – 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 FY18, MCH funding under the ESF account totaled $15.5 million).
iv – It is not possible to calculate total MCH funding in the FY21 request because UNICEF, which has historically received funding through the International Organizations and Programs (IO&P) account, was not specified in the FY21 request.
v – The minority summary of the FY20 conference agreement states that part of the increase in MCH funding is “due to a shift of $7.5 million for polio prevention programs from the Economic Support Fund account to the Global Health Programs account.”
vi – UNICEF funding in the FY20 Conference Agreement and FY21 House bill both include an earmark of $5 million for programs addressing female genital mutilation.
vii – 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).
viii – In FY20 the Trump Administration invoked the Kemp-Kasten amendment to withhold UNFPA funding. The FY21 House bill text states that if this funding is not provided to UNFPA it “shall be transferred to the ‘Global Health Programs’ account and shall be made available for family planning, maternal, and reproductive health activities.”
ix – The explanatory statement accompanying the FY20 Conference Agreement states that the “agreement includes authority to reprogram $10,000,000 of Global Health Program funds to the Emergency Reserve Fund if necessary to replenish amounts used during fiscal year 2020 to respond to emerging health threats.” The House FY21 appropriations bill states that “up to $50,000,000 of the funds made available under the heading ‘Global Health Programs’ may be made available for the Emergency Reserve Fund.”
x – The FY20 enacted WHO amount is an estimate. The House FY21 appropriations bill states that of the GHP funding provided to USAID, “not less than $200,000,000 shall be available for grants or contributions to the World Health Organization, which shall be allocated and allotted not later than 60 days after the date of enactment of this Act.” This amount is not included in the GHP total in this table.
Updated: July 8, 2020
Table 2: KFF Analysis of Coronavirus Pandemic Preparedness and Response Emergency Funding
in House FY21 SFOPs Appropriations Bill
Department / Agency / Area FY21
House
(millions)
Total Funding $10,018.60
Department of State $959.40
Diplomatic Programs $955.00
Office of Inspector General $4.40
USAID $108.00
Operating Expenses $105.00
Office of Inspector General $3.00
Bilateral Economic Assistance $7,670.00
Global Health Programs (GHP)  Account $2,500.00
of which Emergency Reserve Fund $150.00
of which GAVI $750.00
of which Global Fund $800.00
Development Assistance $900.00
of which Basic and Higher Education $150.00
International Disaster Assistance $1,125.00
Economic Support Fund $1,500.00
Assistance for Europe, Eurasia and Central Asia $500.00
Migration and Refugee Assistance $1,125.00
Inter-American Foundation $10.00
United States African Development Foundation $10.00
Multilateral Assistance $1,281.20
International Organizations & Programs (IO&P) $1,281.20
Updated: July 15, 2020

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