Senate Appropriations Committee Releases FY 2021 State and Foreign Operations (SFOPs) and Labor Health and Human Services (Labor HHS) Appropriations Bills

The Senate Appropriations Committee released its FY 2021 State, Foreign Operations, and Related Programs (SFOPs) (links to bill and report) and Labor, Health and Human Services, Education, and Related Agencies (Labor HHS) (links to bill and report) appropriations bills and accompanying reports on November 10, 2020. The SFOPs bill includes funding for U.S. global health programs at the State Department and the U.S. Agency for International Development (USAID), while the Labor HHS bill includes funding for global health programs 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):

  • Funding provided to the State Department and USAID under the SFOPs bill and through the Global Health Programs (GHP) account, which represents the bulk of global health assistance, totals $9.3 billion in the bill, $161 million above the FY20 enacted level, $3.3 billion above the President’s FY21 request, and $96.5 million above the FY21 House level. Funding for most global health programs at State and USAID either increased or remained flat compared to the FY20 enacted level, except for family planning and reproductive health (including UNFPA), which declined; by far, the largest increase is for global health security. The biggest differences between the House and Senate FY 2021 bills is related to family planning (the House would provide more) and global health security (the Senate would provide more). Details on specific programs are as follows (unless otherwise specified, totals represent funding through the Global Health Programs account):
    • Bilateral HIV funding through the President’s Emergency Plan for AIDS Relief (PEPFAR) is $4,700 million in the Senate FY21 bill, matching the FY20 enacted and FY21 House bills, and $1,520 million (48%) above the FY21 Request ($3,180 million).
    • The bill includes $1,560 million as the U.S. contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), matching the FY20 enacted and FY21 House level, and $902 million (137%) above the FY21 Request ($657.6 million).
    • Funding for tuberculosis (TB) totals $325 million, $15 million (5%) above the FY20 enacted and FY21 House level ($310 million), and $50 million (18%) above the FY21 Request ($275 million).
    • Funding for malaria totals $785 million, $15 million (2%) above the FY20 enacted level ($770 million), $76.5 million (11%) above the FY21 Request ($708.5 million), and $30 million (4%) above the FY21 House level ($755 million).
    • The bill includes $865 million for maternal and child health (MCH), an increase of $14 million (2%) above the FY20 enacted level ($851 million), $205 million (31%) above the FY21 Request ($659.6 million), and $15 million (2%) above the FY21 House level ($850 million). Specific areas under MCH include:
      • Gavi, the Vaccine Alliance funding totals $290 million, matching the FY20 enacted, FY21 Request, and FY21 House level.
      • Polio funding through the GHP account totals $65 million, $4 million (7%) above the FY20 enacted and FY21 House level ($61 million). The President’s FY21 Request did not specify funding for polio.
      • The bill includes $139 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 FY20 enacted and FY21 House level. While the FY21 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, matching the FY20 enacted level, $60 million (67%) above the FY21 Request ($90 million), and $5 million (3%) above the FY21 House level ($145 million).
    • Bilateral family planning and reproductive health (FP/RH) funding totals $461 million and is one of the only areas that is a decrease compared to the prior year total ($63 million or 12% below the FY20 enacted level of $524 million). The Senate FY21 FP/RH total is $224 million (95%) above the FY21 Request ($237 million) and $124.5 million (21%) below the FY21 House level ($585.5 million).
    • The bill does not include any funding for the United Nations Population Fund (UNFPA) similar to the FY21 Request; funding for UNFPA in FY20 totals $32.5 million and the FY21 House bill included $55 million. The Senate FY21 bill includes the Kemp Kasten amendment, which the Trump Administration has used in each year between FY17 and FY20 to withhold funding from UNFPA (learn more about the Kemp Kasten amendment here). By contrast, the House FY21 bill did not include the Kemp Kasten Amendment.
    • Funding for the vulnerable children program totals $30 million, $5 million (20%) above the FY20 enacted level ($25 million) and $6 million (25%) above the FY21 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 FY20 enacted and FY21 House level, and $27.5 million (37%) above the FY21 Request ($75 million).
    • Funding for global health security is the largest increase in the bill totaling $275 million, which is $175 million (175%) above the FY20 enacted level, $185 million (206%) above the FY21 Request ($90 million), and $150 million (120%) above the FY21 House level ($125 million).
    • The FY21 Senate bill states that up to $25 million made available under the GHP account may be made available for the Emergency Reserve Fund.
    • Funding for the World Health Organization (WHO) through the International Organizations and Programs (IO&P) account declined but is based on the assessed contribution (see KFF fact sheet on the WHO). WHO funding in the FY21 Senate bill totals $118.9 million, $3.8 million (3%) below the FY20 enacted level ($122.7 million), $61 million (105%) above the FY21 Request ($57.9 million), and $200 million (63%) below the FY21 House level ($200 million through the GHP account and $118.9 million through the IO&P account).
    • The Senate SFOPs bill also includes the Mexico City Policy (MCP) (see the KFF MCP explainer), while the House SFOPs bill includes a prohibition on using any current or prior SFOPs appropriations to implement the MCP.
  • Funding provided to CDC for global health through the Labor HHS bill totals $615.8 million, an increase of $45 million (8%) above the FY20 enacted level ($570.8 million), $83.6 million (16%) above the FY21 Request ($532.2 million), and $43 million (8%) above the House FY21 level ($572.8 million). All of the increase at CDC is for global public health protection, and the Senate would direct more to this area than the House. Global health funding at CDC includes:
    • $128.4 million for global HIV/AIDS, matching the FY20 enacted and FY21 House level and $58.9 million (85%) above the FY21 Request ($69.5 million).
    • $7.2 million for global tuberculosis (TB), matching the FY20 enacted and FY21 Request level and $2 million (22%) below the FY21 House level ($9.2 million).
    • $226 million for global immunization, matching the FY20 enacted and FY21 House level and $20 million (10%) above the FY21 Request ($206 million). Within this total are the following:
      • Funding for polio totals $176 million, matching the FY20 enacted and FY21 House level and $11 million (7%) above the FY21 Request ($165 million).
      • Funding for CDC’s other global vaccines/measles program totals $50 million, matching the FY20 enacted and FY21 House level and $9 million (22%) above the FY21 Request ($41 million).
    • $26 million for parasitic diseases and malaria, matching the FY20 enacted and FY21 House level and $1.5 million (6%) above the FY21 Request ($24.5 million).
    • The entire increase at the CDC is for the global public health protection program which totals $228.2 million, $45 million (25%) above the FY20 enacted and FY21 House level and $3.2 million (1%) above the FY21 Request ($225 million).
  • Funding for the Fogarty International Center (FIC) at NIH totals $83.5 million, $2.7 million (3%) above the FY20 enacted level ($80.8 million), $9.9 million (14%) above the FY21 Request ($73.5 million), and $3 million (4%) below the FY21 House level ($86.5 million).

Resources:

  • FY2021 State, Foreign Operations, and Related Programs Appropriations Bill – Bill
  • FY2021 State, Foreign Operations, and Related Programs Appropriations Bill – Report
  • FY2021 Labor, Health and Human Services, Education, and Related Agencies Appropriations Bill – Bill
  • FY2021 Labor, Health and Human Services, Education, and Related Agencies Appropriations Bill – Report

The table (.xls) below compares global health funding in the FY 2021 Senate SFOPs and Labor HHS appropriations bills to the FY 2020 enacted funding amounts as outlined in the “Consolidated Appropriations Act, 2020” (P.L. 116-94; KFF summary here), the President’s FY 2021 request (KFF summary here), and the House FY 2021 SFOPs and Labor HHS bills (KFF summary here and here).

 

Table: KFF Analysis of FY21 Senate Appropriations for Global Health
Department / Agency / Area FY20
Enacted
(millions)
FY21
Requesti
(millions)
FY21
House
(millions)
FY21
Senateii
(millions)
Difference
(millions)
FY21 Senate
– FY20 Enacted
FY21 Senate
– FY21 Request
FY21 Senate
– FY21 House
 SFOPs – Global Health
HIV/AIDS $4,700.0 $3,180.3 $4,700.0 $4,700.0 $0
 (0%)
$1519.7
 (47.8%)
$0
 (0%)
State Department $4,370.0 $3,180.3 $4,370.0 $4,370.0 $0
(0%)
$1189.7
(37.4%)
$0
(0%)
USAID $330.0 $0.0 $330.0 $330.0 $0
(0%)
$330.0
(N/A)
$0
(0%)
of which Microbicides $45.0 $0.0 $45.0 $45.0 $0
(0%)
$45.0
(N/A)
$0
(0%)
Global Fund $1,560.0 $657.6 $1,560.0 $1,560.0 $0
 (0%)
$902.4
 (137.2%)
$0
 (0%)
Tuberculosisiii  –   –  –  –  –  –
Global Health Programs (GHP) account $310.0 $275.0 $310.0 $325.0 $15
(4.8%)
$50
(18.2%)
$15
(4.8%)
Economic Support Fund (ESF) account Not specified Not specified Not specified Not specified  –  –  –
Malaria $770.0 $708.5 $755.0 $785.0 $15
 (1.9%)
$76.5
 (10.8%)
$30
 (4%)
Maternal & Child Health (MCH)iv v  –  –  –  –  –
GHP accountvi $851.0 $659.6 $850.0 $865.0 $14
(1.6%)
$205.4
(31.1%)
$15
(1.8%)
of which Gavi $290.0 $290.0 $290.0 $290.0 $0
(0%)
$0
(0%)
$0
(0%)
of which Poliovi $61.0 Not specified $61.0 $65.0 $4
(6.6%)
 – $4
(6.6%)
UNICEFvii $139.0 Not specified $139.0 $139.0 $0
(0%)
 – $0
(0%)
ESF account Not specified Not specified Not specified Not specified  –  –  –
of which Poliovi vi Not specified Not specified Not specified  –  –  –
Nutritionviii  –  –  –  –  –  –
GHP account $150.0 $90.0 $145.0 $150.0 $0
(0%)
$60
(66.7%)
$5
(3.4%)
ESF account Not specified Not specified Not specified  Not specified  –  –  –
Family Planning & Reproductive Health (FP/RH)ix $607.5  – $805.5 $461.0 $-146.5
 (-24.1%)
 – $-344.5
 (-42.8%)
Bilateral FPRHix $575.0  – $750.0 $461.0 $-114
(-19.8%)
 – $-289
(-38.5%)
GHP accountix $524.0 $237.0 $585.5 $461.0 $-63
(-12%)
$224
(94.5%)
$-124.5
(-21.3%)
ESF accountix $51.1 Not specified $164.5 $0.0 $-51.1
(-100%)
 – $-164.5
(-100%)
UNFPAx $32.5 $0.0 $55.5 $0.0 $-32.5
(-100%)
$0.0
(N/A)
$-55.5
(-100%)
Vulnerable Children $25.0 $0.0 $24.0 $30.0 $5
 (20%)
$30.0
(N/A)
$6
 (25%)
Neglected Tropical Diseases (NTDs) $102.5 $75.0 $102.5 $102.5 $0
 (0%)
$27.5
 (36.7%)
$0
 (0%)
Global Health Security $100.0 $90.0 $125.0 $275.0 $175
 (175%)
$185
 (205.6%)
$150
 (120%)
GHP account $100.0 $90.0 $125.0 $275.0 $175
(175%)
$185
(205.6%)
$150
(120%)
Emergency Reserve Fund xi $25.0 xi xi  –  –  –
World Health Organization (WHO)xii $122.7 $57.9 $318.9 $118.9 $-3.8
 (-3.1%)
$61
 (105.4%)
$-200
 (-62.7%)
GHP accountxii Not specified Not specified $200.0 Not specified  –  –  –
Contributions to International Organizations (CIO) account $122.7 $57.9 $118.9 $118.9 $-3.8
(-3.1%)
$61
(105.4%)
$0
(0%)
SFOPs Total (GHP account only) $9,092.5 $5,998.0 $9,157.0 $9,253.5 $161
 (1.8%)
$3255.5
 (54.3%)
$96.5
 (1.1%)
Labor Health & Human Services (Labor HHS)
Centers for Disease Control & Prevention (CDC) – Total Global Health $570.8 $532.2 $572.8 $615.8 $45
 (7.9%)
$83.6
 (15.7%)
$43
 (7.5%)
Global HIV/AIDS $128.4 $69.5 $128.4 $128.4 $0
(0%)
$58.9
(84.7%)
$0
(0%)
Global Tuberculosisxiii $7.2 $7.2 $9.2 $7.2 $0
(0%)
$0
(0%)
$-2
(-21.5%)
Global Immunization $226.0 $206.0 $226.0 $226.0 $0
(0%)
$20
(9.7%)
$0
(0%)
Polio $176.0 $165.0 $176.0 $176.0 $0
(0%)
$11
(6.7%)
$0
(0%)
Other Global Vaccines/Measles $50.0 $41.0 $50.0 $50.0 $0
(0%)
$9
(22%)
$0
(0%)
Parasitic Diseases $26.0 $24.5 $26.0 $26.0 $0
(0%)
$1.5
(6.3%)
$0
(0%)
Global Public Health Protection $183.2 $225.0 $183.2 $228.2 $45
(24.6%)
$3.2
(1.4%)
$45
(24.6%)
Global Disease Detection and Emergency Response $173.4 Not specified Not yet known $218.4 $45
(26%)
 –  –
of which Global Health Security (GHS) $125.0 $175.0 Not yet known Not yet known  –  –  –
Global Public Health Capacity Development $9.8 Not specified Not yet known $9.8 $0
(0%)
 –  –
National Institutes of Health (NIH) – Total Global Health Not yet known Not yet known Not yet known Not yet known  –  –  –
HIV/AIDS Not yet known Not yet known Not yet known Not yet known  –  –  –
Malaria $208.0 Not yet known Not yet known Not yet known  –  –  –
Fogarty International Center (FIC) $80.8 $73.5 $86.5 $83.5 $2.7
(3.3%)
$9.9
(13.5%)
$-3
(-3.5%)
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 – The FY21 Senate bill states that funding from Global Health Programs, Development Assistance, International Disaster Assistance, Complex Crisis Fund, Economic Support Fund, Democracy Fund, Assistance for Europe, Eurasia and Central Asia, Migration and Refugee Assistance, and Millennium Challenge Corporation may be used to address an infectious disease or public health emergency as determined by the Secretary of State and not to exceed $50,000,000 in total funding.
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 FY18, TB funding under the ESF account totaled $4 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. n FY18, MCH funding under the ESF account totaled $15.5 million).
v – 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.
vi – 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.”
vii – UNICEF funding in the FY20 Conference Agreement both include an earmark of $5 million 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 – The FY21 Senate bill text states that “not more than $461,000,000 shall be made available for family planning/reproductive health.”
x – 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.”
xi – 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.” The FY21 Senate bill text states that “up to $25,000,000 of the funds made available under the heading ‘Global Health Programs’ may be made available for the Emergency Reserve Fund.”
xii – 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.”
xiii – In FY20, the administration proposed to formally transfer $7.2 million from the “HIV/AIDS, Viral Hepatitis, STI and TB Prevention” account to “Global Tuberculosis” activities under “Global Health Programs” at CDC. The FY20 conference agreement formalizes this transfer.

[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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