Senate Appropriations Committee Releases FY23 State and Foreign Operations (SFOPs) and Labor, Health and Human Services (Labor HHS) Appropriations Bills

The Senate Committee on Appropriations released its FY 2023 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 July 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), 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). 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 $10.5 billion, an increase of $680 million above the FY 2022 enacted level, but $67 million below the FY 2023 request and $467 million below the FY 2023 House level. The bill provides higher levels of funding for almost all program areas compared to the FY 2022 enacted level, with the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and family planning and reproductive health (FP/RH) receiving the largest increases. The bill also codifies the prohibition of the Mexico City Policy (see KFF explainer here). In addition to regular appropriations for global health, the SFOPs bill provides $950 million in emergency global health security supplemental funding and $5 billion in emergency coronavirus response supplemental funding. Total global health funding at CDC and NIH through the Labor HHS bill is not yet known, as funding for some programs at NIH is determined at the agency level rather than specified by Congress in annual appropriations bills. Of the known amounts, the Senate bill totals $850 million, which is $117 million above the FY 2022 enacted level, $7 million above the FY 2023 request, but $7 million below FY 2023 House level. Funding for all global health programs at CDC and NIH in the Senate bill either increased or remained flat compared to the FY 2022 enacted level. See Table 1 below for additional detail on global health funding and Tables 2 and 3 for additional detail on emergency global health security and emergency coronavirus response supplemental funding (Downloadable tables here). See the KFF budget tracker for details on historical annual appropriations for global health programs.

Table 1: KFF Analysis of Global Health Funding in the FY23 Senate Appropriations Bill
Department / Agency / Area FY22
Omnibusi
(millions)
FY23 Request (millions) FY23 Housei
(millions)
FY23 Senate
(millions)
Difference:
FY23 Senate – FY22 Omnibus
Difference:
FY23 Senate – FY23 Request
Difference:
FY23 Senate – FY23 House
State, Foreign Operations, and Related Programs (SFOPs) – Global Health
HIV/AIDSii  – $4,700.0  –  –  –  –  –
State Department $4,390.0 $4,370.0 $4,395.0 $4,370.0 $-20
(-0.5%)
$0
(0%)
$-25
(-0.6%)
USAID $330.0 $330.0 $330.0 $330.0 $0
(0%)
$0
(0%)
$0
(0%)
of which Microbicides $45.0 $45.0 $45.0 $45.0 $0
(0%)
$0
(0%)
$0
(0%)
ESF Account Not specified $0.5 Not specified Not specified  –  –  –
Global Fund $1,560.0 $2,000.0 $2,000.0 $2,000.0 $440
 (28.2%)
$0
 (0%)
$0
 (0%)
Tuberculosisii $352.0  –  –  –  –  –
Global Health Programs (GHP) account $371.1 $350.0 $469.0 $400.0 $29
(7.8%)
$50
(14.3%)
$-69
(-14.7%)
Economic Support Fund (ESF) account Not specified $2.0 Not specified Not specified  –  –  –
Malaria $775.0 $780.0 $820.0 $800.0 $25
 (3.2%)
$20
 (2.6%)
$-20
 (-2.4%)
Maternal & Child Health (MCH)ii $1,044.0  –  –  –  –  –
GHP account $890.0 $879.5 $890.0 $900.0 $10
(1.1%)
$20.5
(2.3%)
$10
(1.1%)
of which Gavi $290.0 $290.0 $290.0 $290.0 $0
(0%)
$0
(0%)
$0
(0%)
of which Polio $75.0 Not specified $75.0 $85.0 $10
(13.3%)
 – $10
(13.3%)
UNICEFiii $139.0 $135.5 $145.0 $139.0 $0
(0%)
$3.5
(2.6%)
$-6
(-4.1%)
ESF account Not specified $29.0 Not specified Not specified  –  –  –
of which Polio Not specified $0.0 Not specified Not specified  –  –  –
Nutritionii $161.0  –  –  –  –  –
GHP account $155.0 $150.0 $160.0 $160.0 $5
(3.2%)
$10
(6.7%)
$0
(0%)
ESF account Not specified $10.3 Not specified Not specified  –  –  –
AEECA account Not specified $0.8 Not specified Not specified  –  –  –
Family Planning & Reproductive Health (FP/RH)iv $607.5 $653.0 $830.0iv $710.0iv $102.5
 (16.9%)
$57
 (8.7%)
$-120
 (-14.5%)
Bilateral FP/RHiv $575.0 $597.0 $760.0iv $650.0iv $75
(13%)
$53
(8.9%)
$-110
(-14.5%)
GHP accountiv $524.0 $572.0 $760.0iv $650.0iv $126.1
(24.1%)
$78
(13.6%)
$-110
(-14.5%)
ESF accountiv $51.1 $25.0 Not specifiediv Not specifiediv  –  –  –
UNFPAv $32.5 $56.0 $70.0 $60.0 $27.5
(84.6%)
$4
(7.1%)
$-10
(-14.3%)
Vulnerable Children $27.5 $25.0 $30.0 $30.0 $2.5
 (9.1%)
$5
 (20%)
$0
 (0%)
Neglected Tropical Diseases (NTDs) $107.5 $114.5 $112.5 $114.5 $7
 (6.5%)
$0
 (0%)
$2
 (1.8%)
Global Health Security  – $1,003.8  –  –  –  –  –
USAID GHP accountvi $700.0 $745.0 $1,000.0 $745.0 $45
(6.4%)
$0
(0%)
$-255
(-25.5%)
State GHP accountvii $250.0 Not specified Not specified  –  –  –
ESF account Not specified $6.0 Not specified Not specified  –  –  –
AEECA account Not specified $2.8 Not specified Not specified  –  –  –
Emergency Reserve Fund viii ix x x  –  –  –
Health Resilience Fundxi $10.0 $10.0 $10.0  – $0
 (0%)
$0
 (0%)
SFOPs Total (GHP account only)xii $9,830.0 $10,576.0 $10,976.5 $10,509.5 $679.5
 (6.9%)
$-66.5
 (-0.6%)
$-467
 (-4.3%)
Labor Health & Human Services (Labor HHS)
Centers for Disease Control & Prevention (CDC) – Total Global Health $646.8 $747.8 $757.8 $760.8 $114
 (17.6%)
$13
 (1.7%)
$3
 (0.4%)
Global HIV/AIDS $128.9 $128.4 $128.9 $128.9 $0
(0%)
$0.5
(0.4%)
$0
(0%)
Global Tuberculosis $9.7 $9.2 $14.7 $14.7 $5
(51.4%)
$5.5
(59.6%)
$0
(0%)
Global Immunization $228.0 $226.0 $230.0 $233.0 $5
(2.2%)
$7
(3.1%)
$3
(1.3%)
Polio $178.0 $176.0 $180.0 $183.0 $5
(2.8%)
$7
(4%)
$3
(1.7%)
Other Global Vaccines/Measles $50.0 $50.0 $50.0 $50.0 $0
(0%)
$0
(0%)
$0
(0%)
Parasitic Diseases $27.0 $31.0 $31.0 $31.0 $4
(14.8%)
$0
(0%)
$0
(0%)
Global Public Health Protection $253.2 $353.2 $353.2 $353.2 $100
(39.5%)
$0
(0%)
$0
(0%)
Global Disease Detection and Emergency Response Not specified Not specified Not specified Not specified  –  –  –
of which Global Health Security (GHS) Not specified Not specified Not specified Not specified  –  –  –
Global Public Health Capacity Development Not specified Not specified Not specified Not specified  –  –  –
National Institutes of Health (NIH) – Total Global Health  –  –  –  –  –
HIV/AIDS Not specified $614.8 Not specified Not specified  –  –  –
Malaria Not specified Not specified Not specified Not specified  –  –  –
Fogarty International Center (FIC) $86.9 $95.8 $99.6 $89.6 $2.7
(3.1%)
$-6.2
(-6.5%)
$-10
(-10.1%)
Labor HHS Total Not yet known Not yet known Not yet known Not yet known  –
Notes:
i – The FY22 Omnibus, FY23 House, and FY23 Senate bills 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. The FY23 Senate bill states that “not less than $650,000,000 shall be made available for family planning/reproductive health.” According to the bill report, $650 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, FY23 House bill, and FY23 Senate bill 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.” The FY23 Senate report includes $100,000,000 for a U.S. contribution to the Coalition for Epidemic Preparedness Innovations.
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 and Senate FY23 bills state 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.” The FY23 Senate SFOPs report calls this the Health Reserve Fund and states that the HRF will “support cross-cutting health activities, including health service delivery, the 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.”
Table 2: KFF Analysis of Emergency Global Health Security Supplemental Funding in the FY23 Senate SFOPs Bill
Department/Agency/Area FY23 Senate
(in millions)
Global Health Programsi $950
Department of State $550
Financial Intermediary Fund (FIF) for pandemic preparedness and global health security $550
USAIDii $400
Of which to strengthen the global health workforce and related health systems capacity $200
Notes:
i – The FY23 Senate bill states that “$100,000,000 shall be made available for a contribution to the Coalition for Epidemic Preparedness Innovations” but does not specify whether that funding is provided through USAID or State. The FY23 Senate bill states that “not less than $100,000,000 shall be made available for the Emergency Reserve Fund” but does not specify whether that funding is provided through USAID or State.
ii – The FY23 Senate bill states that “not less than $400,000,000 shall be apportioned directly to the United States Agency for International Development.”
Table 3: KFF Analysis of Coronavirus Response Supplemental Funding in the FY23 Senate SFOPs Bill
Department/Agency/Area FY23 Senate
(in millions)
Total Funding $5,000
Department of State $90
Diplomatic Programs $15
Migration and Refugee Assistance $75
USAID $4,910
Operating Expenses $35
Global Health Programs $4,875
Notes:
i – The FY23 Senate bill states that these “funds may be made available as contributions, including to the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and to The GAVI Alliance.”

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