House Appropriations Committee Releases the FY22 State and Foreign Operations (SFOPs) Appropriations Bill

The House Committee on Appropriations released its FY 2022 State, Foreign Operations, and Related Programs (SFOPs) appropriations bill on June 28, 2021 and accompanying report on June 30, 2021. 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 $10.6 billion, an increase of $1.4 billion (16%) above the FY 2021 enacted level and $591 million (6%) above President Biden’s FY 2022 request, which was released on May 28, 2021. The bill provides higher levels of funding for almost all program areas compared to both the FY 2021 enacted level and the FY 2022 request, with global health security receiving most of the increase. Key highlights are as follows (Unless otherwise specified, funding comparisons are for the GHP account only. See Table for additional detail on global health funding):

  • Funding for global health security totals $1 billion, an increase of $810 million (426%) above the FY 2021 enacted level ($190 million) and $95 million (10%) above the FY 2022 request ($905 million).
  • Bilateral HIV funding through the President’s Emergency Plan for AIDS Relief (PEPFAR) is $4,850 million ($4,520 million through State and $330 million through USAID), $150 million (3%) above the FY 2021 enacted level and FY 2022 request.
  • 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 2021 enacted level and FY 2022 request. The Global Fund was the only area that did not increase.
  • Funding for tuberculosis (TB) totals $469 million, $150 million (3%) above the FY 2021 enacted level and FY 2022 request ($319 million).
  • Funding for malaria totals $820 million, $50 million (6%) above the FY 2021 enacted level and FY 2022 request ($770 million).
  • The House bill includes $880 million for maternal and child health (MCH), $24.5 million (3%) above the FY 2021 enacted level ($865.5 million) and essentially matching the FY 2022 request ($879.5 million). Specific areas under MCH include:
    • Gavi, the Vaccine Alliance funding totals $290 million, matching the FY 2021 enacted and FY 2022 request levels.
    • Polio funding totals $65 million, matching the FY 2021 enacted level. The President’s FY 2022 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 2021 enacted level and FY 2022 request.
  • Funding for nutrition totals $160 million, $10 million (7%) above the FY 2021 enacted level and FY 2022 request ($150 million).
  • Bilateral family planning and reproductive health (FP/RH) funding totals $760 million in the House FY22 SFOPs bill, all of which is provided through the GHP account. This amount is $185 million (32%) above the FY 2021 enacted level ($575 million, of which $524 million is through the GHP account and $51 million is through the ESF account) and $176 million (30%) above the FY 2022 request ($584 million, of which $550 million is through the GHP account and $33.7 million is through the ESF account).
  • Funding for the United Nations Population Fund (UNFPA) totals $70 million, $37.5 million (115%) above the FY 2021 enacted level ($32.5 million) and $14 million (25%) above the FY 2022 request. The House FY 2022 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 $30 million, $5 million (20%) above the FY 2021 enacted level and FY 2022 request ($25 million).
  • Funding for neglected tropical diseases (NTDs) totals $112.5 million, $10 million (10%) above the FY 2021 enacted level and FY 2022 request ($102.5 million).
  • The House bill states that up to $90 million may be made available through the GHP account for the Emergency Reserve Fund, a mechanism that is used to quickly respond to emerging infectious disease outbreaks. The FY 2022 request provided $90 million for the Emergency Reserve Fund through the GHP account.

The SFOPs bill also includes the following policy provisions:

  • Removes the Helms amendment restrictions, which prohibit the use of foreign assistance to pay for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortion (see KFF fact sheet on major statutory requirements and policies pertaining to U.S. global FP/RH efforts here).
  • Repeals the Mexico City Policy (see KFF explainer here).
  • Provides the authority to transfer an amount “not to exceed an aggregate total of $200,000,000 of the funds appropriated by this Act” for international infectious disease outbreaks.
  • States that an unspecified amount of funding from the GHP account “may be made available for a contribution to an international financing mechanism for pandemic preparedness.”

Resources:

  • House FY 2022 State, Foreign Operations, and Related Programs (SFOPs) Appropriations Bill – Text
  • House FY 2022 State, Foreign Operations, and Related Programs (SFOPs) Appropriations Bill – Report

The Table (.xls) below compares global health funding in the FY 2022 House bill to the FY 2021 enacted funding amounts as outlined in the “Consolidated Appropriations Act, 2021” (P.L. 116-260; KFF summary here) and the FY 2022 request (KFF summary here).

See the KFF budget tracker for details on historical annual appropriations for global health programs.

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: KFF Analysis of FY22 House Appropriations for Global Health
Department / Agency / Area FY21
Enactedi
(millions)
FY22
Request
(millions)
FY22
Houseii
(millions)
Difference
(millions)
FY22 House
– FY21 Enacted
FY22 House
– FY22 Request
State, Foreign Operations, and Related Programs (SFOPs) – Global Health
HIV/AIDS $4,700.0 $4,700.0 $4,850.0 $150
 (3%)
$150
 (3%)
State Department $4,370.0 $4,370.0 $4,520.0 $150
(3%)
$150
(3%)
USAID $330.0 $330.0 $330.0 $0
(0%)
$0
(0%)
of which Microbicides $45.0 $45.0 $45.0 $0
(0%)
$0
(0%)
Global Fund $1,560.0 $1,560.0 $1,560.0 $0
 (0%)
$0
 (0%)
Tuberculosisiii $321.0  –  –
Global Health Programs (GHP) account $319.0 $319.0 $469.0 $150
(47%)
$150
(47%)
Economic Support Fund (ESF) account Not specified $2.0 Not specified  –  –
Malaria $770.0 $770.0 $820.0 $50
 (6%)
$50
 (6%)
Maternal & Child Health (MCH)iv $1,039.5  –  –
GHP account $855.5 $879.5 $880.0 $24.5
(3%)
$0.5
(<1%)
of which Gaviv $290.0 $290.0 $290.0 $0
(0%)
$0
(0%)
of which Polio $65.0 $65.0 $65.0 $0
(0%)
$0
(0%)
UNICEFvi $139.0 $139.0 $139.0 $0
(0%)
$0
(0%)
ESF account Not specified $21.0 Not specified  –  –
of which Polio Not specified $0.0 Not specified  –  –
Nutritionvii $154.8  –  –
GHP account $150.0 $150.0 $160.0 $10
(7%)
$10
(7%)
ESF account Not specified $4.0 Not specified  –  –
AEECA account Not specified $0.8 Not specified  –  –
Family Planning & Reproductive Health (FP/RH)viii $607.5 $639.7 $830.0 $222.5
 (37%)
$190.3
 (30%)
Bilateral FP/RHviii $575.0 $583.7 $760.0 $185
(32%)
$176.3
(30%)
GHP accountviii $524.0 $550.0 $760.0 $236
(45%)
$210
(38%)
ESF accountviii $51.1 $33.7 Not specified  –  –
UNFPAix $32.5 $56.0 $70.0 $37.5
(115%)
$14
(25%)
Vulnerable Children $25.0 $25.0 $30.0 $5
 (20%)
$5
 (20%)
Neglected Tropical Diseases (NTDs) $102.5 $102.5 $112.5 $10
 (10%)
$10
 (10%)
Global Health Security  – $913.3  –  –  –
GHP account $190.0 $905.0 $1,000.0 $810
(426%)
$95
(10%)
USAID GHP accountx $190.0 $655.0 $1,000.0 $810
(426%)
$345
(53%)
State GHP accountxi  – $250.0  –  –
ESF account Not specified $8.3 Not specified  –  –
Emergency Reserve Fund xii $90.0 xii  –  –
SFOPs Total (GHP account only) $9,196.0 $10,051.0 $10,641.5 $1,445.5
 (16%)
$590.5
 (6%)
Notes:
i – The FY21 final bill includes a provision giving the Secretary of State the ability to transfer up to $200,000,000 from the ‘Global Health Programs’, ‘Development Assistance’, ‘International Disaster Assistance’, ‘Complex Crises Fund’, ‘Economic Support Fund’, ‘Democracy Fund’, ‘Assistance for Europe, Eurasia and Central Asia’, ‘Migration and Refugee Assistance’, and ‘Millennium Challenge Corporation’ accounts “to respond to a Public Health Emergency of International Concern.”
ii – The FY22 House SFOPs bill provides the authority to transfer an amount “not to exceed an aggregate total of $200,000,000 of the funds appropriated by this Act” for international infectious disease outbreaks. The FY22 House SFOPs bill states that an unspecified amount of funding from the GHP account “may be made available for a contribution to an international financing mechanism for pandemic preparedness.”
iii – 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 FY19, TB funding under the ESF account totaled $3.6 million).
iv – 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 FY19, MCH funding under the ESF account totaled $14.42 million).
v – The FY21 final bill text provides additional funding to Gavi to support coronavirus response efforts, stating, “For an additional amount for ‘Global Health Programs’, $4,000,000,000, to remain available until September 30, 2022, to prevent, prepare for, and respond to coronavirus, including for vaccine procurement and delivery: Provided, That such funds shall be administered by the Administrator of the United States Agency for International Development and shall be made available as a contribution to the GAVI, Alliance.”
vi – UNICEF funding in the FY21 final bill and FY22 House bill includes 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 – The FY21 final bill states that “not less than $575,000,000 should be made available for family planning/reproductive health.” The FY22 request funding amounts are based on a bilateral total of $583.7 million as specified in the FY22 OMB Budget Appendices for the Department of State and Other International Programs. The FY22 House SFOPs bill text states that “not less than $760,000,000 shall be made available for family planning/reproductive health.” According to the FY22 House SFOPs bill report, $760 million is provided through the GHP account; however, it is possible that the administration could provide additional funding for FPRH activities through the ESF account.
ix – The FY21 final bill and FY22 House SFOPs bill texts state 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.”
x – According to the Department of State, Foreign Operations, and Related Programs FY22 Congressional Budget Justification, $300 million of this funding is “for contributions to support multilateral initiatives leading the global COVID response through the Act-Accelerator platform.”
xi – According to the Department of State, Foreign Operations, and Related Programs FY22 Congressional Budget Justification, this funding is “to support a new health security financing mechanism, which would be developed alongside U.S. partners and allies, to ensure global readiness to respond to the next outbreak.”
xii – The FY21 final 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 FY22 House SFOPs bill text states that “up to $90,000,000 of the funds made available under the heading ‘Global Health Programs’ may be made available for the Emergency Reserve Fund.”

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