House Appropriations Committee Releases the FY23 State and Foreign Operations (SFOPs) Appropriations Bill

The House Committee on Appropriations released its FY 2023 State, Foreign Operations, and Related Programs (SFOPs) appropriations bill on June 21, 2022 and accompanying report on June 28, 2022. 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 nearly $11 billion, an increase of $1.1 billion (12%) above the FY 2022 enacted level and $400.5 million (4%) above President Biden’s FY 2023 request, which was released on March 28, 2022. The bill provides higher levels of funding for almost all program areas compared to both the FY 2022 enacted level and the FY 2023 request, with family planning and reproductive health (FP/RH) and global health security receiving the largest increases. The bill also removes the Helms amendment (see KFF fact sheet on major statutory requirements and policies pertaining to U.S. global FP/RH efforts here) and repeals the Mexico City Policy (see KFF explainer here). See the table below (downloadable version here) for additional detail on global health funding. See the KFF budget tracker for details on historical annual appropriations for global health programs.

Table: KFF Analysis of Global Health Funding in the FY23 House State, Foreign Operations, and Related Programs (SFOPs)
Appropriations Bill
Department / Agency / Area FY22
Omnibusi
(millions)
FY23 Request (millions) FY23 Housei
(millions)
Difference:
FY23 House –
FY22 Omnibus
Difference:
FY23 House –
FY23 Request
HIV/AIDSii $4,700.0
State Department (GHP Account) $4,390.0 $4,370.0 $4,395.0 $5
(0.1%)
$25
(0.6%)
USAID (GHP Account) $330.0 $330.0 $330.0 $0
(0%)
$0
(0%)
of which Microbicides $45.0 $45.0 $45.0 $0
(0%)
$0
(0%)
ESF Account Not specified $0.5 Not specified  –  –
Global Fund $1,560.0 $2,000.0 $2,000.0 $440
 (28.2%)
$0
 (0%)
Tuberculosisii $352.0  –  –  –
GHP account $371.1 $350.0 $469.0 $98
(26.4%)
$119
(34%)
ESF account Not specified $2.0 Not specified  –  –
Malaria $775.0 $780.0 $820.0 $45
 (5.8%)
$40
 (5.1%)
Maternal & Child Health (MCH)ii $1,044.0  –  –  –
GHP account $890.0 $879.5 $890.0 $0
(0%)
$10.5
(1.2%)
of which Gavi $290.0 $290.0 $290.0 $0
(0%)
$0
(0%)
of which Polio $75.0 $65.0 $75.0 $0
(0%)
$10
(15.4%)
UNICEFiii $139.0 $135.5 $145.0 $6
(4.3%)
$9.5
(7%)
ESF account Not specified $29.0 Not specified  –  –
of which Polio Not specified $0.0 Not specified  –  –
Nutritionii $161.0  –  –  –
GHP account $155.0 $150.0 $160.0 $5
(3.2%)
$10
(6.7%)
ESF account Not specified $10.3 Not specified  –  –
AEECA account Not specified $0.8 Not specified  –  –
Family Planning & Reproductive Health (FP/RH)iv $607.5 $653.0 $830.0iv $222.5
 (36.6%)
$177
 (27.1%)
Bilateral FP/RHiv $575.0 $597.0 $760.0iv $185
(32.2%)
$163
(27.3%)
GHP accountiv $524.0 $572.0 $760.0iv $236.1
(45.1%)
$188
(32.9%)
ESF accountiv $51.1 $25.0 Not specifiediv  –  –
UNFPAv $32.5 $56.0 $70.0 $37.5
(115.4%)
$14
(25%)
Vulnerable Children $27.5 $25.0 $30.0 $2.5
 (9.1%)
$5
 (20%)
Neglected Tropical Diseases (NTDs) $107.5 $114.5 $112.5 $5
 (4.7%)
$-2
 (-1.7%)
Global Health Security  – $1,003.8  –  –  –
USAID GHP accountvi $700.0 $745.0 $1,000.0 $300
(42.9%)
$255
(34.2%)
State GHP accountvii Not specified $250.0 Not specified  –  –
ESF account Not specified $6.0 Not specified  –  –
AEECA account Not specified $2.8 Not specified  –  –
Emergency Reserve Fund viii ix x  –  –
Health Resilience Fundxi Not specified $10.0 $10.0  – $0
 (0%)
SFOPs Total (GHP account only)xii $9,830.0 $10,576.0 $10,976.5 $1,146.5
 (11.7%)
$400.5
 (3.8%)
Notes:
i – The FY22 Omnibus and FY23 House bill both include 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 – Some HIV, tuberculosis, MCH, nutrition funding, and global health security funding is provided under the ESF and AEECA accounts, which is not earmarked by Congress in the annual appropriations bills and is determined at the agency level.
iii – UNICEF funding in the FY22 Omnibus and FY22 House bill includes an earmark of $5 million for programs addressing female genital mutilation.
iv – The FY22 Omnibus states that “not less than $575,000,000 should be made available for family planning/reproductive health.” The FY23 House bill states that “not less than $760,000,000 shall be made available for family planning/reproductive health.” According to the House 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.
v – The FY22 Omnibus and FY23 House bill both 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.”
vi – According to the Department of State, Foreign Operations, and Related Programs FY23 Congressional Budget Justification, $250 million of this funding is “for contributions to support multilateral initiatives leading the global COVID response through the Act-Accelerator platform.”
vii – According to the Department of State, Foreign Operations, and Related Programs FY23 Congressional Budget Justification, this funding is “to support a new health security financing mechanism, being developed alongside U.S. partners and allies, to ensure global readiness to respond to the next outbreak.”
viii – The FY22 Omnibus states that “up to $100,000,000 of the funds made available under the heading ‘Global Health Programs’ may be made available for the Emergency Reserve Fund.”
ix – The FY23 Request states that “this request includes $90.0 million in non-expiring funds to replenish the Emergency Reserve Fund to ensure that USAID can quickly and effectively respond to emerging infectious disease outbreaks posing severe threats to human health.”
x – The House FY23 bill 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.”
xi – The FY23 Request states that the Health Resilience Fund (HRF) “will support cross-cutting health systems strengthening in challenging environments or countries emerging from crisis.” The FY23 House SFOPs report states that the HRF will “support cross-cutting global health activities including health service delivery, health workforce, health information systems, access to essential medicines, health systems financing, and governance, in challenging environments and countries in crisis.”
xii – The FY22 Omnibus “includes $100,000,000 for a U.S. contribution to support a multilateral vaccine development partnership for epidemic preparedness innovations.” The FY23 House bill states that “funds appropriated by this Act under the heading ‘Global Health Programs’ may be made available for a contribution to an international financing mechanism for pandemic preparedness.”

 

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