White House Releases FY20 Budget Request

The White House released its FY 2020 budget request to Congress on March 11, 2019, which includes significant cuts to global health programs compared to FY 2019 enacted levels (the overall levels in the request are similar to the FY 2019 budget request).

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

  • Funding provided to the State Department and the U.S. Agency for International Development (USAID) (through the Global Health Programs account), which represents the bulk of global health assistance, would decline by $2.5 billion (-28%), from $8,837 million in FY 2019 to $6,344 million, which would be the lowest level of funding since FY 2007. Funding declined for each global health program area as follows:
    • Funding for bilateral HIV programs through the President’s Emergency Plan for AIDS Relief (PEPFAR) would decline overall by $1,350 million (-29%), from $4,700 million in FY19 to $3,350 million in the FY20 Request. This includes a decrease of $1,020 million (-23%) at State and $330 million (-100%) at USAID.
    • The U.S. contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) would decline by $392 million (-29%), from $1,350 million in FY19 to $958 million in the FY20 Request. In addition, the administration proposes to make a pledge of up to $3.3 billion over three years for the next Global Fund replenishment period, matching $1 for every $3 contributed by other donors (in the previous replenishment period under the Obama administration, the U.S. pledged up to $4.3 billion, matching $1 for every $2 provided by other donors). For the first year of this pledge, the administration is proposing to provide a total of $1.1 billion to the Global Fund: $958 million from FY20 and $142 million in unmatched carryover funding from the previous pledge period.
    • Funding for family planning and reproductive health (FP/RH) would decline by $287 million (-55%), from $524 million in FY19 to $237 million in the FY20 Request.
    • Funding for global health security (GHS) would decline by $48 million (-35%), from $138 million in FY19 (which included a transfer of $38 million from unspent Emergency Ebola funding) to $90 million in the FY20 Request.
    • Funding for tuberculosis would decline by -$41 million (-14%), from $302 million in FY19 to $261 million in the FY20 Request.
    • Funding for malaria would decline by -$81 million (-11%) from $755 million in FY19 to $674 million in the FY20 Request
    • Funding for maternal and child health (MCH) would decline by -$215 million (-26%) from $835 million in FY19 to $620 million in the FY20 Request. Gavi, the Vaccine Alliance, which is included under MCH funding, would decrease by $40 million (-14%).
    • Funding for neglected tropical diseases (NTDs) would decline by -$28 million (-27%) from $103 million in FY19 to $75 million in the FY20 Request
    • Funding for nutrition would decline by -$66.5 million (-46%) from $145 million in FY19 to $79 million in the FY20 Request.
    • Funding for vulnerable children would be eliminated.
  • Funding for global health provided to the Centers for Disease Control and Prevention (CDC) would decline by $32 million (-6%), from $489 million in FY 2019 to $457 million in FY 2020. The FY20 Request includes $100 million for global health security activities at CDC.
  • Funding for the Fogarty International Center (FIC) at the National Institutes of Health (NIH) totaled $67 million, $11 million (-14%) below the FY 2019 enacted levels ($78 million).

Note: This summary will be updated as more information becomes available.

Resources:

The table (.xls) below compares the FY 2020 request to the FY 2019 enacted funding amounts as outlined in the “Consolidated Appropriations Act, 2019” (P.L. 116-6; KFF summary here) and the FY 2019 request (KFF summary here). Note that total funding for global health is not currently available as some funding provided through USAID, Health and Human Services (HHS), and the Department of Defense (DoD) is not yet available.

Table: KFF Analysis of FY20 Budget Request for Global Health
Department / Agency / Area FY19
Requesti
(millions)
FY19
Enactedii
(millions)
FY20
Requesti
(millions)
Difference
(millions)
FY20 Request
– FY19 Request
FY20 Request
– FY19 Enacted
 SFOPs – Global Health
HIV/AIDS $3,850.0 $4,700.0 $3,350.0 $-500
 (-13%)
$-1350
 (-28.7%)
State Departmentiii $3,850.0 $4,370.0 $3,350.0 $-500
(-13%)
$-1020
(-23.3%)
USAID $0.0 $330.0 $0.0 $0
(0%)
$-330
(-100%)
of which Microbicides $0.0 $45.0 $0.0 $0
(0%)
$-45
(-100%)
Global Fund $925.1 $1,350.0 $958.4 $33.3
 (3.6%)
$-391.6
 (-29%)
Tuberculosisiv $180.8  – 
Global Health Programs (GHP) account $178.4 $302.0 $261.0 $82.6
(46.3%)
$-41
(-13.6%)
Economic Support Fund (ESF) account $2.4 Not specified Not specified  –  –
Malaria $674.0 $755.0 $674.0 $0
 (0%)
$-81
 (-10.7%)
Maternal & Child Health (MCH)v  vi  –
GHP account $619.6 $835.0 $619.6 $0
(0%)
$-215.4
(-25.8%)
of which Gavi $250.0 $290.0 $250.0 $0
(0%)
$-40
(-13.8%)
of which Polio $21.3 $51.5 Not specified  –  –
UNICEFvii Not specified $137.5 Not specified  –  –
ESF account $71.4 Not specified Not specified  –  –
of which Polio $3.5 $7.5 Not specified  –  –
Nutritionviii $101.3  –  –  –
GHP account $78.5 $145.0 $78.5 $0
(0%)
$-66.5
(-45.9%)
ESF account $22.8 Not specified Not specified  –  –
Family Planning & Reproductive Health (FP/RH) $330.5 $607.5  –  –  –
GHP account $302.0 $524.0 $237.0 $-65
(-21.5%)
$-287
(-54.8%)
ESF account $28.5 $51.1 Not specified  –  –
UNFPA $0.0 $32.5 $0.0 $0
(0%)
$-32.5
(-100%)
Vulnerable Children $0.0 $24.0 $0.0 $0
(0%)
$-24
 (-100%)
Neglected Tropical Diseases (NTDs) $75.0 $102.5 $75.0 $0
 (0%)
$-27.5
 (-26.8%)
Global Health Security $72.5 $138.0 $90.0 $17.5
 (24.2%)
$-48
 (-34.8%)
GHP account $0.0 $100.0 $90.0 $90.0
(N/A)
$-10
(-10%)
Ebola transfer $72.5 $38.0 $0.0 $-72.5
(-100%)
$-38
(-100%)
Emergency Reserve Fund $0.0 $2.0 $0.0 $0
 (0%)
$-2
 (-100%)
Ebola transfer $0.0 $2.0 $0.0 $0
(0%)
$-2
(-100%)
Total (GHP account only) $6,702.6 $8,837.5 $6,343.5 $-359.1
 (-5.4%)
$-2,493.9
 (-28.2%)
Health & Human Services (HHS)
Centers for Disease Control & Prevention (CDC) – Total Global Health $408.8 $488.6 $457.0 $48.2
 (11.8%)
$-31.6
 (-6.5%)
Global HIV/AIDS $69.5 $128.4 $69.5 $0
(0%)
$-58.9
(-45.8%)
Global Tuberculosisix  –  – $7.2  –  –
Global Immunization $206.0 $226.0 $206.0 $0
(0%)
$-20
(-8.8%)
Polio $165.0 $176.0 Not specified  –  –
Other Global Vaccines/Measles $41.0 $50.0 Not specified  –  –
Parasitic Diseases $24.5 $26.0 $24.5 $0
(-0.2%)
$-1.5
(-6%)
Global Public Health Protectionx $108.8 $108.2 $149.8 $41
(37.6%)
$41.6
(38.4%)
Global Disease Detection and Emergency Response Not specified $48.4 Not specified  –  –
Global Public Health Capacity Not specified $9.8 Not specified  –  –
Global Health Security $58.8 $50.0 $99.8 $41
(69.7%)
$49.8
(99.5%)
National Institutes of Health (NIH) – Total Global Health $765.1  –   –  –
HIV/AIDS $511.0 $590.1 Not specified  –  –
Malaria $184.0 Not yet known Not specified  –  –
Fogarty International Center (FIC) $70.1 $78.1 $67.0 $-3.1
(-4.4%)
$-11.1
(-14.2%)
Notes:
i – In the FY19 and FY20 Requests, 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 FY19 Request reflects the amounts requested by the administration for ESDF.
ii – 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.”
iii – The FY19 Request includes $400 million in the “Addendum to the President’s FY19 Budget to Account for the Bipartisan Budget Act of 2018.”
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 $3.4 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 $53.92 million).
vi – It is not possible to calculate total MCH funding in the FY19 request because UNICEF, which has historically received funding through the International Organizations and Programs (IO&P) account, was not specified in the FY19 request.
vii – UNICEF funding in the FY19 Enacted 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 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”.
x – In the CDC FY20 congressional justification, this funding line is titled “Global Disease Detection and Other Programs”.