House Appropriations Subcommittee Approves FY 2020 State & Foreign Operations (SFOPs) Appropriations Bill; Full Committee Approves Health & Human Services (HHS) Appropriations Bill

UPDATE: The House Appropriations Committee approved the FY 2020 SFOPs appropriations bill (and accompanying report) on May 16, 2019. Please see the updated KFF analysis for additional details on global health funding amounts in the House FY 2020 SFOPs bill.

ORIGINAL POST: The House Appropriations Subcommittee approved the FY 2020 State & Foreign Operations (SFOPs) appropriations bill on May 10, 2019, while the full committee approved the FY 2020 Labor, Health and Human Services, and Education (LHHS) appropriations bill (and accompanying report) on May 8, 2019. These two bills include most funding for U.S. global health programs. The SFOPs bill includes funding at the State Department and the U.S. Agency for International Development (USAID), while the LHHS appropriations bill includes funding at the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH).[i]

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

SFOPs: STATE DEPARTMENT & USAID

  • Funding provided to the State Department and USAID 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.
  • Details included in the bill are as follows:
    • Bilateral HIV funding through the President’s Emergency Plan for AIDS Relief (PEPFAR) at the State Department is $4,370 million in the SFOPs bill, matching the FY19 level and $1,020 million above the President’s FY 2020 request. Additional bilateral HIV funding provided through USAID is not yet known.
    • 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 President’s FY 2020 request ($958 million).
    • Bilateral Family Planning and Reproductive Health (FP/RH) funding provided through the GHP account totaled $750 million, an increase of $226 million above the FY19 enacted level ($524 million) and $513 million above the FY20 Request ($237 million). Historically, additional FP/RH funding has been provided through the Economic Support Fund (ESF) account ($51 million in FY19), but such amounts are not yet known.
    • The bill included $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.
    • The bill also included the following policy provisions: a permanent repeal of the Mexico City Policy (MCP), as reinstated by President Trump via executive order on January 22, 2017 (see KFF’s Mexico City Policy explainer), and a prohibition on using any current or prior SFOPs appropriations to implement the MCP.

Labor HHS: CDC & NIH

  • Funding provided to CDC for global health totaled $514 million, an increase of $25 million above the FY 2019 enacted level ($489 million) and $57 million above the President’s FY 2020 request.
  • Funding for the Fogarty International Center (FIC) at NIH totaled $85 million, a $7 million increase above the FY 2019 enacted level ($78 million) and $18 million above the President’s FY 2020 request ($67 million).

Resources:

The table (.xls) below compares global health funding in the FY 2020 House SFOPs and LHHS appropriations bills 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 and HHS Funding for Global Health
Department / Agency / Area FY19
Enactedi
(millions)
FY20
Requestii
(millions)
FY20
House
(millions)
Difference
(millions)
FY20 House
– FY19 Enacted
FY20 House
– FY20 Request
 SFOPs – Global Health
HIV/AIDS $4,700.0 $3,350.0  –  –  –
State Department $4,370.0 $3,350.0 $4,370.0 $0
(0%)
$1,020
(30.4%)
USAID $330.0 $0.0 Not specified  –  –
of which Microbicides $45.0 $0.0 Not specified  –  –
Global Fund $1,350.0 $958.4 $1,560.0 $210.0
(15.6%)
$601.6
(62.8%)
Tuberculosisiii  –  –  –  –
Global Health Programs (GHP) account $302.0 $261.0 Not specified  –  –
Economic Support Fund (ESF) account Not specified Not specified Not specified  –  –
Malaria $755.0 $674.0 Not specified  –  –
Maternal & Child Health (MCH)iv v  –  –  –
GHP account $835.0 $619.6 Not specified  –  –
of which Gavi $290.0 $250.0 Not specified  –  –
of which Polio $51.5 Not specified Not specified  –  –
UNICEFvi $137.5 Not specified Not specified  –  –
ESF account Not specified Not specified Not specified  –  –
of which Polio $7.5 Not specified Not specified  –  –
Nutritionvii  –  –  –  –
GHP account $145.0 $78.5 Not specified  –  –
ESF account Not specified Not specified Not specified  –  –
Family Planning & Reproductive Health (FP/RH) $607.5  –  –  –  –
GHP account $524.0 $237.0 $750.0 $226.1
(43.1%)
$513
(216.5%)
ESF account $51.1 Not specified Not specified  –  –
UNFPA $32.5 $0.0 $55.5 $23.0
(70.8%)
$55.5
(NA)
Vulnerable Children $24.0 $0.0 Not specified  –  –
Neglected Tropical Diseases (NTDs) $102.5 $75.0 Not specified  –  –
Global Health Security $138.0 $90.0  –  –  –
GHP account $100.0 $90.0 Not specified  –  –
Ebola transfer $38.0 $0.0 Not specified  –  –
Emergency Reserve Fund $2.0 $0.0 $10.0 $8.0
(400%)
$10.0
(NA)
Ebola transfer $2.0 $0.0  –  –  –
Total (GHP account only) $8,837.5 $6,343.5 $9,296.5 $459
(5.2%)
$2,953
(46.6%)
Health & Human Services (HHS)
Centers for Disease Control & Prevention (CDC) – Total Global Health $488.6 $457.0 $513.6 $25.0
(5.1%)
$56.6
(12.4%)
Global HIV/AIDS $128.4 $69.5 $128.4 $0
(0%)
$58.9
(84.7%)
Global Tuberculosisviii  – $7.2  –  –  –
Global Immunization $226.0 $206.0 $226.0 $0
(0%)
$20
(9.7%)
Polio $176.0 Not specified $176.0 $0
(0%)
 –
Other Global Vaccines/Measles $50.0 Not specified $50.0 $0
(0%)
 –
Parasitic Diseases $26.0 $24.5 $26.0 $0
(0%)
$1.5
(6.3%)
Global Public Health Protectionix $108.2 $149.8 $133.2 $25.0
(23.1%)
$-16.6
(-11.1%)
Global Disease Detection and Emergency Response $98.4 Not specified $123.4 $25.0
(25.4%)
 –
of which Global Health Security (GHS) $50.0 $99.8 Not specified  –  –
Global Public Health Capacity Development $9.8 Not specified $9.8 $0
(0%)
 –
National Institutes of Health (NIH) – Total Global Health $880.2 $760.1 Not specified  –  –
HIV/AIDS $590.1 $511.1 Not specified  –  –
Malaria $212.0 $182.0 Not specified  –  –
Fogarty International Center (FIC) $78.1 $67.0 $84.9 $6.8
(8.7%)
$17.9
(26.8%)
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 – 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).
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 FY17, MCH funding under the ESF account totaled $56.54 million).
v – 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.
vi – UNICEF funding in the FY19 Enacted totaled $137.5 million, of which $5 million is earmarked 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 administration is proposing to create a new “Global Tuberculosis” funding line under global health programs at CDC and to transfer $7.2 million from the “HIV/AIDS, Viral Hepatitis, STI and TB Prevention” funding line to “Global Tuberculosis”.
ix – In the CDC FY20 congressional justification, this funding line is titled “Global Disease Detection and Other Programs”. 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 draft House FY20 bill. However, the draft bill includes $99.8 million for “global public health protection,” and the committee report specifies $123.4 million for “Global Disease Detection and Emergency Response.” These totals will be updated as more information becomes available.

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

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