Senate Appropriations Committee Approves FY 2020 State and Foreign Operations (SFOPs) Appropriations Bill

UPDATED: The Senate Appropriations Committee approved the FY 2020 State & Foreign Operations (SFOPs) appropriations bill (and accompanying report) on September 26, 2018 (a draft version of the bill and report were released on September 18, 2019). The SFOPs bill includes funding for U.S. global health programs at the State Department and the U.S. Agency for International Development (USAID).[i] Funding for these programs, through the Global Health Programs (GHP) account, which represents the bulk of global health assistance, totaled $9.1 billion, an increase of $279 million above the FY 2019 enacted level, $2.8 billion above the President’s FY 2020 request, and $181 million below the House FY 2020 level.

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

  • Funding for most global health programs at State and USAID increased compared to the FY19 enacted level, with the exception of bilateral HIV funding at the State Department, which declined slightly, and neglected tropical diseases (NTDs) programs, which remained flat. In all cases, funding was above the President’s FY 2020 request, which had proposed significant cuts; funding levels varied compared to the House FY20 appropriations bill.
  • Bilateral HIV funding through the President’s Emergency Plan for AIDS Relief (PEPFAR) is $4,650 million in the Senate FY20 bill, $50 million below the FY19 enacted and FY20 House levels ($4,700 million), but $1,300 million above the FY20 Request ($3,350 million).
  • 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 enacted level ($1,350 million), $602 million above the FY20 Request ($958 million), and matching the FY20 House level.
    • The report accompanying the bill states that the committee “anticipates that the United States will pledge not less than [$1.56 billion] for each of the three fiscal years pertaining to the Global Fund’s Sixth Replenishment . . . [and] does not support the administration’s proposal to amend the longstanding matching rates for U.S. contributions to the Global Fund and expects the United States to continue to match other donor contributions at a rate of $1 for every $2 received from other donors.
  • Funding for tuberculosis (TB) totals $310 million, $8 million above the FY19 enacted level, $49 million above the FY20 Request ($261 million), and matching the FY20 House level.
  • Funding for malaria totals $789 million, $34 million above the FY19 enacted and FY20 House levels ($755 million), and $115 million above the FY20 Request ($674 million).
  • The bill includes $847 million for maternal and child health (MCH), an increase of $12 million above the FY19 enacted level ($835 million), $227 million above the FY20 Request ($629 million), and $3 million below the FY20 House level ($850 million). Specific areas under MCH include:
    • Gavi, the Vaccine Alliance funding totals $290 million, matching the FY19 enacted and FY20 House levels, and $40 million above the FY20 Request ($250 million).
    • Polio funding through the GHP account totals $61 million, $2 million above the FY19 enacted and FY20 House level ($59 million).[ii] The President’s FY 2020 Request did not specify funding for polio.
    • The bill includes $137.5 million for the U.S. contribution to the United Nations Children’s Fund (UNICEF) provided through the International Organizations and Programs (IO&P) account, matching the FY19 enacted level and $10 million below the House FY20 level ($147.5 million). While the FY20 Request did not specify a funding amount for UNICEF and proposed to eliminate the IO&P account, it is possible that organizations such as UNICEF could receive funding through other accounts.
  • Funding for nutrition totals $150 million, $5 million above the FY19 enacted and FY20 House level ($145 million), and $71.5 million above the FY20 Request ($78.5 million).
  • Bilateral family planning and reproductive health (FP/RH) funding totals $633 million ($582 million through the GHP account and $51 million through the ESF account), $58 million above the FY19 enacted level, and $374 million above the FY20 Request ($259 million), but $117 million below the FY20 House level ($750 million).[ii]
  • Funding for the United Nations Population Fund (UNFPA) totals $32.5 million, matching the FY19 enacted level, but $23 million below the FY20 House level ($55 million); the FY20 Request proposed eliminating funding for UNFPA.
  • Funding for the vulnerable children program totals $26 million, $2 million above the FY19 enacted and FY20 House level ($24 million); the FY20 Request proposed eliminating funding for this program.
  • Funding for neglected tropical diseases (NTDs) totals $102.5 million, matching the FY19 enacted and FY20 House level, and $27.5 million above the FY20 Request ($75 million).
  • Funding for global health security totals $100 million in the bill. While this is a decrease compared to the FY19 enacted level ($138 million), $38 million of the FY19 amount was provided through a one-time transfer of unspent emergency Ebola funding. The Senate FY20 amount is an increase compared to the FY20 Request ($90 million) and matches the FY20 House level.
Resources:
  • FY2020 State and Foreign Operations Appropriations Bill – Draft Bill
  • FY2020 State and Foreign Operations Appropriations Bill – Draft Report

The table (.xls) below compares global health funding in the FY 2020 Senate SFOPs appropriations bill to the FY 2019 enacted funding amounts as outlined in the “Consolidated Appropriations Act, 2019” (P.L. 116-6; KFF summary here), the President’s FY 2020 request (KFF summary here), and the House FY 2020 SFOPs bill (KFF summary here).

Table: KFF Analysis of FY20 Senate SFOPs Funding for Global Health
Department / Agency / Area FY19
Enactedi
(millions)
FY20
Requestii
(millions)
FY20
Houseiii
(millions)
FY20
Senate
(millions)
Difference
(millions)
FY20 Senate
– FY19 Enacted
FY20 Senate
– FY20 Request
FY20 Senate
– FY20 House
 SFOPs – Global Health
HIV/AIDS $4,700.0 $3,350.0 $4,700.0 $4,650.0 $-50
(-1%)
$1300
(39%)
$-50
(-1%)
State Department $4,370.0 $3,350.0 $4,370.0 $4,320.0 $-50
(-1%)
$970
(29%)
$-50
(-1%)
USAID $330.0 $0.0 $330.0 $330.0 $0
(0%)
$0
(0%)
of which Microbicides $45.0 $0.0 $45.0 $45.0 $0
(0%)
$0
(0%)
Global Fund $1,350.0 $958.4 $1,560.0 $1,560.0 $210
(16%)
$601.6
(63%)
$0
(0%)
Tuberculosisiv $262.0  –
Global Health Programs (GHP) account $302.0 $261.0 $310.0 $310.0 $8
(3%)
$49
(19%)
$0
(0%)
Economic Support Fund (ESF) account Not specified $1.0 Not specified Not specified
Malaria $755.0 $674.0 $755.0 $789.0 $34
(5%)
$115
(17%)
$34
(5%)
Maternal & Child Health (MCH)v vi  –
GHP account $835.0 $619.6 $850.0 $847.0 $12
(1%)
$227.4
(37%)
$-3
(-0.4%)
of which Gavi $290.0 $250.0 $290.0 $290.0 $0
(0%)
$40
(16%)
$0
(0%)
of which Polio $51.5 $16.0 $59.0 $61.0 $9.5
(18%)
$45
(282%)
$2
(3%)
UNICEFvii $137.5 Not specified $147.5 $137.5 $0
(0%)
$-10
(-7%)
ESF account Not specified $75.5 Not specified Not specified
of which Polio $7.5 $7.0 Not specified Not specified
Nutritionviii $89.7  –
GHP account $145.0 $78.5 $145.0 $150.0 $5
(3%)
$71.5
(91%)
$5
(3%)
ESF account Not specified $11.2 Not specified Not specified
Family Planning & Reproductive Health (FP/RH)ix $607.5 $259.0 $805.5 $665.1 $57.6
(9%)
$406.1
(157%)
$-140.5
(-17%)
Bilateral FPRH $575.0 $259.0 $750.0 $632.6 $57.6
(10%)
$373.6
(144%)
$-117.5
(-16%)
GHP account $524.0 $237.0 $750.0 $581.5 $57.6
(11%)
$344.5
(145%)
$-168.5
(-22%)
ESF account $51.1 $22.0 Not specified $51.1 $0
(0%)
$29.1
(132%)
UNFPA $32.5 $0.0 $55.5 $32.5 $0
(0%)
$-23.0
(-41%)
Vulnerable Children $24.0 $0.0 $24.0 $26.0 $2
(8%)
$2
(8%)
Neglected Tropical Diseases (NTDs) $102.5 $75.0 $102.5 $102.5 $0
(0%)
$27.5
(36.7%)
$0
(0%)
Global Health Security $138.0 $90.0 $100.0 $100.0 $-38
(-28%)
$10
(11%)
$0
(0%)
GHP account $100.0 $90.0 $100.0 $100.0 $0
(0%)
$10
(11%)
$0
(0%)
Ebola transfer $38.0 $0.0 $0.0 $0.0 $-38
(-100%)
Emergency Reserve Fundx $2.0 $0.0 $10.0 $0.0 $-2
(-100%)
$-10
(-100%)
Ebola transfer $2.0 $0.0 $0.0 $0.0 $-2
(-100%)
Unallocated $52.6
Total (GHP account only) $8,837.5 $6,343.5 $9,296.5 $9,116.0 $278.5
 (3%)
$2762.5
 (44%)
$-180.5
 (-2%)
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 – The House FY20 SFOPs bill proposes to move the Economic Support Fund (ESF) from “Bilateral Economic Assistance” to “Security Assistance” and “redirects development, and most democracy and governance, funding that is long-term in nature to the Development Assistance or Democracy Fund accounts.” If the House FY20 bill is approved by Congress, it is possible that global health funding previously provided under the ESF account may be provided under the Development Assistance (DA) account.
iv – 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).
v – 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).
vi – 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.
vii – UNICEF funding in the FY19 Enacted and FY20 Senate totaled $137.5 million, of which $5 million is earmarked for programs addressing female genital mutilation.
viii – 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).
ix – In prior fiscal years, bilateral FP/RH funding has been provided through both the GHP and ESF accounts. The report accompanying the House FY20 SFOPs bill states that “The Committee recommendation includes $750,000,000 for reproductive health and voluntary family planning in this Act.” All of this funding is included under the GHP account. The bill summary released by the House Committee on Appropriations states that the $750 million for FP/RH is an increase of $175 million above total funding provided in FY19 (GHP and ESF accounts).
x – The draft House FY20 appropriations bill states that “up to $10,000,000 of the funds made available under the header ‘Global Health Programs’ may be made available for the Emergency Reserve Fund.” Based on the language in the bill and the GHP totals presented in the report, this is not a specified funding line but is an authority given to the administration to transfer funds specified for other purposes under the GHP account to the Emergency Reserve Fund.
Updated: September 27, 2019
[i] Total funding for global health is not currently available as some funding provided through USAID and DoD is not yet available.

[ii] The House FY20 SFOPs bill proposes to move the Economic Support Fund (ESF) from “Bilateral Economic Assistance” to “Security Assistance” and “redirects development, and most democracy and governance, funding that is long-term in nature to the Development Assistance or Democracy Fund accounts.” If the House FY20 bill is approved by Congress, it is possible that global health funding previously provided under the ESF account may be provided under the Development Assistance (DA) account.