Advocacy Update

Advocacy Update ~ August 7, 2017

This post was written by Danielle Heiberg, Senior Advocacy Manager, and Melissa Chacko, Policy Associate at Global Health Council.

FY18 Appropriations: House Appropriations Committee Approves Bills
In mid-July, the House Appropriations committee approved the Fiscal Year (FY) 2018 State and Foreign Operations bill, which includes funding for USAID, State Department and other international activities. The House rejected the deep cuts proposed by President Trump earlier this year, signaling continued bipartisan support for foreign assistance. (Funding chart.)

On the surface, overall funding for global health programs at both USAID and State appears relatively flat ($8.32 billion for FY18 compared to $8.72 billion in FY17). However, the House recommended that approximately $322.5 million of unspent Ebola response funds be repurposed for Malaria and the Emergency Reserve Fund (which was also cut from $70 million to $10 million), so new funding for global health is actually down. This is also worrisome as this is bolstering accounts with funding that will not be available beyond FY19.

Most programs are at level funding, with the exception of Family Planning/Reproductive Health, which was recommended at a ceiling of not more than $461 million, a cut of 25%. With the ban on contributions to UNFPA (instituted by the Trump administration earlier this year), all funds would be available for bilateral activities. The bill also includes language expanding the Mexico City Policy to include all global health assistance and restricting voluntary contributions to UNFPA; if the language remains in the final bill, it will legislatively impose these two policies for the fiscal year. During the markup, amendments were offered to remove this language, but were defeated along party lines.

The House recommended the full commitment to Gavi, the Vaccine Alliance at $290 million (a $15 million increase); however, because the increase to Maternal and Child Health (MCH) is minimal, overall base funding for MCH is decreased ($814.5 million for FY18 compared to $814 million in FY17).

Also of note was included language of “extraordinary measures” that would allow the Secretary of State to take funding from other accounts, including ‘‘Global Health Programs,’’ ‘‘Development Assistance,’’ ‘‘International Disaster Assistance,’’ ‘‘Economic Support Fund,’’ ‘‘Democracy Fund,’’ ‘‘Assistance for Europe, Eurasia and Central Asia,’’ ‘‘Migration and Refugee Assistance,” “Millennium Challenge Corporation,” if an “international infectious disease outbreak is sustained, severe, and is spreading internationally, or that it is in the national interest to respond to a Public Health Emergency of International Concern.” This language could be a mechanism to move money from other accounts during an outbreak and avoid passing emergency appropriations.

The Appropriations committee also approved the Labor, Health and Human Services, and Education bill, which includes funding for NIH and CDC, and again the committee signaled its support for these programs. Topline NIH funding was increased by $1.1 billion, with Fogarty International Center and the National Institute of Allergy and Infectious Diseases receiving small increases. The Center for Global Health and Global HIV/AIDS, both in CDC, were flat funded, while recommended funding for the National Center for Emerging Zoonotic and Infectious Diseases was decreased by 14.5%.

Meanwhile, on the other side of Capitol Hill, the Senate has allocated $51.2 billion as the top-line spending for its version of the State and Foreign Operations bill. This is a 1.7% cut if you exclude the ISIS supplemental and famine relief funding that was included in the FY17 omnibus (or 10.8% if you include it). The Senate will not markup this appropriations bill until it returns from August recess.

In addition to following the FY18 process, GHC and the global health advocacy community have also begun work on the FY19 budget. The global health community will be submitting FY19 recommendations to the Office of Management and Budget (OMB) later this month.

Resouces:

Reach Act Reintroduced in Senate
Senators Susan Collins (R-ME) and Chris Coons (D-DE), led a bipartisan group of 10 Senators – Jerry Moran (R-KS), Jeanne Shaheen (D-NH), Marco Rubio (R-FL), Richard Blumenthal (D-CT), Mike Enzi (R-WY), Johnny Isakson (R-GA), Richard Durbin(D-IL), and Chris Murphy (D-CT) – in reintroducing the Reach Every Mother and Child Act (S.1730) on August 2. The Reach Act aims to accelerate the reduction of preventable maternal and child deaths, keeping USAID on track to end these deaths within a generation. The legislation is supported by more than 50 diverse non-profit and faith-based organizations working to end preventable maternal, newborn, and child mortality at home and overseas. Click here for GHC’s statement on the Reach Act.

Senate Confirmed Ambassador Mark Green to Lead USAID
Ambassador Mark Green’s nomination to lead USAID was unanimously approved by the Senate confirmation on August 3. Ambassador Green has previously served as the U.S. Ambassador to Tanzania, as a U.S. Congressman, and as the President of the International Republican Institute. Read GHC’s statement on Ambassador Green’s confirmation.

Statement on Global Health Security Agenda
The current endpoint for the Global Health Security Agenda (GHSA) is 2019. GHC’s Global Health Security Roundtable, Global Health Security Agenda Consortium, Global Health Security Agenda Private Sector Roundtable, and Next Generation Global Health Network released a statement in support of extending the GHSA beyond 2019 for a minimum of five years. In addition to building upon the successes of the GHSA, the statement emphasizes that GHSA “2.0” must focus on meaningful action, political will, and financing strategies to enact national roadmaps and fill existing gaps. Read the joint statement.

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Advocacy Update ~ July 10, 2017

This post was written by Danielle Heiberg, Senior Advocacy Manager at Global Health Council.

FY18 Appropriations
Capitol Hill was quiet last week because of the July 4th holiday. There is talk that the House State and Foreign Operations Subcommittee will hold a hearing to markup the FY18 appropriations bill in mid-July, with the full committee markup to shortly follow. There are also rumors that the Senate may delay its August recess by a week to address appropriations. Congress has few working days left to finish up the appropriations process before the start of the new fiscal year on October 1.

CDC Director Nominated
On Friday, Health and Human Services Secretary Tom Price, named Dr. Brenda Fitzgerald as Director of the Centers for Disease Control and Prevention (CDC) and Administrator of the Agency for Toxic Substances and Disease Registry (ATSDR). Dr. Fitzgerald is currently the Commissioner of the Georgia Department of Public Health. Read the official announcement.

Mark Green Nomination
After postponing the meeting to vote on Ambassador Mark Green’s nomination to serve as Administrator of USAID, the Senate Foreign Relations Committee has scheduled the vote for Wednesday, July 12. View the committee schedule.

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Advocacy Update – June 19, 2017

This post was written by Danielle Heiberg, Senior Advocacy Manager, Global Health Council.

FY18 Hearings and USAID Administrator Nomination Hearing Part of Busy Week on Capitol Hill

Last week was a busy one on Capitol Hill. Secretary of State Rex Tillerson testified at four separate hearings on the proposed FY18 budget for the State Department (including USAID’s budget). He appeared before the State and Foreign Operations Appropriations Subcommittee in the House and Senate, as well as the Senate Foreign Relations Committee (SFRC) and the House Foreign Affairs Committee (HFAC). Secretary Price testified before the Senate Labor, Health and Human Services Appropriations Subcommittee to answer questions on the proposed budget for the Department of Health and Human Services.

Later in the week, Mark Green appeared before SFRC regarding his nomination to serve as Administrator of USAID.

Finally, the Africa, Global Health, Global Human Rights and International Organizations subcommittee of HFAC marked up the End Neglected Tropical Diseases Act (H.R.1415).

Tillerson Testifies on FY18 Budget for State and USAID

Secretary of State Rex Tillerson faced four different committees (State and Foreign Operations Appropriations Subcommittee in the House and Senate, as well as the Senate Foreign Relations Committee (SFRC) and the House Foreign Affairs Committee (HFAC)) last week to answer question on the administration’s proposed FY18 budget for the Department of State and USAID.

Republicans and Democrats alike lambasted the proposed cuts, of up to a third, to the foreign affairs budget. Citing multiple humanitarian crises, ISIS, and global health concerns, Chairman Lindsay Graham (R-SC) pointed out that these cuts would put lives at risk. Secretary Tillerson defended the cuts by stating that “Our budget will never determine our ability to be effective. Our people will.” He also stressed the need for other countries to do more.

Since the hearings focused on the entire budget for State and USAID, global health was only a small part of the hearings. Members raised questions about cuts to PEPFAR, maternal and child health programs, as well as the zeroing out of family planning funding. Senator Jeanne Shaheen (D-NH) and Congressman Ami Bera (D-CA) both raised questions about the expansion of the Mexico City Policy to cover all global health funding and the impact the expansion would have. Tillerson stated that the expansion would be minimal and that the State Department would assess in six months.

Price Testifies on FY18 Budget for Department of Health and Human Services

Secretary of Health and Human Services Tom Price testified before the Senate Appropriations Subcommittee on Labor, Health and Human Services on Thursday to answer questions about the FY18 budget for the Department of Health and Human Services, which includes funding for NIH and CDC. While much of the focus was on Republican-led legislation to replace Obamacare, several Senators did voice opposition to cuts to NIH and CDC and expressed support for the two agencies.

Green Nomination to Lead USAID Advances to Full Senate for Vote

Last Thursday, the Honorable Mark Green testified before the Senate Foreign Relations Committee on his nomination to serve as Administrator of USAID. Green is a former Ambassador to Tanzania and a former Congressman representing Wisconsin.

With the Trump administration recommending cuts of up to one-third for the foreign affairs budget, questions regarding the President’s proposed FY18 budget were a critical part of the hearing. Green stated that the organizing principle of foreign assistance should be on ending its need to exist, he assured the Committee that “USAID will not walk away from our commitment to humanitarian assistance, and we will always stand with people everywhere when disaster strikes.”

Senators also raised questions regarding the possible restructuring of USAID and the State Department, including the possibility that the two could be merged. When asked about restructuring, Green responded, “I believe that the State Department and USAID need to be closely aligned, but I believe they have different cultures.”

Green’s nomination was passed by the Committee and now advances to the full Senate.  

NTDs Bill Marked Up

Late last week the Africa, Global Health, Global Human Rights and International Organizations subcommittee of the House Foreign Affairs Committee marked up the End Neglected Tropical Diseases Act (H.R.1415). Introduced by Congressmen Christopher Smith (R-NJ) and Gregory Meeks (D-NY), the legislation would implement R&D and implementation activities to end neglected tropical diseases (NTDs). Overall the Committee was supportive of the bill, recognizing that diseases no know borders, and passed the legislation without amendment. The bill now advances to the full Committee for consideration. Since Title II falls under the jurisdiction of the Energy and Commerce Committee, the bill will also need to be considered and passed by that Committee.

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Advocacy Update ~ June 5, 2017

By Danielle Heiberg, Senior Advocacy Manager, Global Health Council

Trump Releases FY18 Budget
On May 23, President Trump released his recommended budget for Fiscal Year (FY) 2018. As expected, he drastically cut nondefense discretionary funding while increasing spending on defense and border security.

Standard Provisions Released for Mexico City Policy
In mid-May, USAID released the standard provisions for the expanded Mexico City Policy. Renamed the “Protecting Life in Global Health Assistance,” the expansion of this policy requires that all foreign NGOs certify that they do not provide abortion services, counsel or refer for abortion, or advocate for abortion law reform, even if using non-U.S. funds, in order to be eligible for U.S. bilateral global health assistance from any funding account or for any purpose. Very few exemptions were made: water and sewer infrastructure, Food for Peace, and American Schools and Hospitals abroad. Read PAI’s analysis. From the Kaiser Family Foundation: What is the Scope of the Mexico City Policy: Assessing Abortion Laws in Countries that Receive U.S. Global Health Assistance.

GHC will host a community meeting to discuss the standard provisions on June 6. Email advocacy@globalhealth.org for more information.

Frontline Health Workers Resolution Introduced
In May, Congresswoman Nita Lowey (D-NY) and Congressman Mario Diaz-Balart (R-FL) introduced a resolution acknowledging the contributions of frontline health workers to global health (H.Res.342). The resolution recognizes the role that frontline health workers have in advancing U.S. national security and global health goals.

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Trump Administration Releases FY18 Budget

On May 23, the Trump administration released its recommended budget for Fiscal Year (FY) 2018. “A New Foundation for American Greatness” includes sharp increases for defense and border security, while drastically cutting nondefense discretionary spending.

Overall Foreign Assistance was cut approximately 32 percent, with a cut of 26 percent to global health programs at USAID and the State Department. Of note, funding for family planning, vulnerable children, and the HIV/AIDS program at USAID were zeroed out.

Also of concern, is the zeroing out of the Development Assistance Account, USAID’s core poverty reduction tool and which includes programs for food security, WASH, and education among others. The administration proposes to roll development assistance into the Economic Support Funds to create a new account: Economic Support and Development Funds. This account would be administered by the State Department, which places more importance on strategic objectives and partnerships and minimizes the importance of development in how the U.S. engages globally.

Global health at the Department of Health and Human Services did not fare any better. The National Institutes of Health is facing a 21 percent cut, with the Fogarty International Center zeroed out. An approximate 20 percent cut was proposed for Global Health at the Centers for Disease Control and Prevention.

As the process moves to Capitol Hill, GHC will follow the appropriations process. From our meetings with Congressional offices, we know that global health and foreign assistance is widely supported, and the initial reaction from Congress to the President’s budget indicates that the final numbers will look much different.

Appropriations Budget Table (as of May 2017)

Key accounts (in thousands):

* Includes $250 million from remaining Ebola response funds
** Funding from remaining Ebola response funds
*** The International Organizations and Programs (IO&Ps) is zeroed out. UNICEF will most likely be funded through Maternal and Child Health.

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