Advocacy Update

Advocacy Update ~ March 26, 2018

This post was written by Danielle Heiberg, Senior Policy & Advocacy Manager, and Melissa Chacko, Policy Associate.

FY18 Omnibus Bill Passes

Six months into the fiscal year (FY), and five Continuing Resolutions and two government shutdowns later, we finally have a spending bill for FY 2018. With hours to spare before another potential shutdown, President Trump signed the $1.3 trillion package on Friday afternoon, but not before threatening to veto it earlier in the day.

Congress sent a strong message to the administration by rejecting the more than one-third cut that had been proposed in the President’s budget released last May. Overall, the omnibus bill contained $55.9 billion for the International Affairs Budget; this is $2.1 billion (3.8%) increase from FY 2017 enacted levels if you exclude the ISIS and famine supplementals.

For Global Health Programs at USAID and State, funding largely reflected levels determined by the Senate last year, with flat funding across all accounts and minor increases to maternal and child health (including the U.S. contribution to Gavi) and tuberculosis as compared to FY 2017 enacted. In addition, Congress provided additional funding to the Global Health Security account, using unobligated Ebola funds ($100 million) and replenishing the Emergency Response Fund ($35 million), for a total of $207.5 million. Of particular note for global health security activities is language requesting within six months a strategy from NSC, agencies, and the inter-agency group.

In the Labor, Health and Human Services section of the bill, CDC’s Center for Global Health and Emerging Infectious and Zoonotic Diseases both saw increases. In particular, Global Public Health was increased to continue critical global health security activities. Key accounts at NIH, including the Fogarty International Center also saw increases.

See related resources below:

Tillerson Out as Secretary of State, Pompeo Nominated for the Role; New CDC Director Named

In mid-March, President Trump fired Secretary of State Rex Tillerson and announced that CIA Director Mike Pompeo would be nominated to step into the role. Tillerson will formally remain in the position until March 31, but is delegating the running of the State Department to Deputy Secretary of State John Sullivan. Tillerson was instrumental in leading a “redesign,” or reorganization, plan at the agency, but it remains to be seen how or in what way those plans will continue under his successor. A confirmation hearing for Pompeo is expected in April. Normally during this time of year, the Secretary of State testifies before Congress on the President’s budget for the upcoming fiscal year; however, with the change in leadership, it is unclear if a hearing will be held to on the agency’s proposed budget.

In addition, last week, HHS Secretary Alex Azar named Dr. Robert Redfield as the new Director of CDC. Dr. Redfield recently served as a professor at the University of Maryland School of Medicine in Baltimore and is co-founder of the Institute for Human Virology. While Redfield has an extensive background in research, his broader public health experience in the U.S. or abroad is unclear. Some media and members of Congress have pointed to controversy around his screening proposals and vaccine research early in the U.S. AIDS epidemic. Others have noted his extensive work on addiction as a co-morbidity to HIV.

USAID Administrator Testifies on FY 2019 Foreign Assistance Budget 

Last week, the Honorable Mark A. Green, USAID Administrator, testified at a House Foreign Affairs Committee hearing on the FY 2019 Foreign Assistance Budget. While Committee members appreciated Administrator Green’s efforts to stretch USAID dollars to maximize results, the committee emphasized that the proposed one-third cut to USAID funding will “hamstring USAID’s efforts on these fronts.” Administrator Green agreed that this budget does not allow USAID to do everything and highlighted the importance of leveraging resources through domestic resource mobilization and the private sector. There was little emphasis on global health, but he did emphasize the agency’s commitment to women and girls. A few members, including Congresswoman Lois Frankel, inquired about the reinstatement and expansion of the Mexico City Policy. Administrator Green reaffirmed that the State Department and USAID will put out a more detailed evaluation of the rule at the end of the year.

A week before the hearing, members of Global Health Council met with Administrator Green to hear about his vision for global health and the agency. The small group discussion focused on agency funding and reform as well as the process and timeline for how countries transition from U.S. development assistance. Global Health Council was encouraged by the discussion and will continue to engage with Administrator Green and senior leadership at USAID on these issues.


Advocacy Update ~ March 12, 2018

This post was written by Danielle Heiberg, Senior Policy & Advocacy Manager, and Melissa Chacko, Policy Associate.


Are we Nearing a Vote on a Final Bill for FY18?

As we get closer to March 23, when the current Continuing Resolution (CR) expires, it seems that Congress is close to voting on a final spending package for the remainder of Fiscal Year (FY) 2018. We are hearing that the spending bill will be released on March 14 and the House of Representatives will vote on it shortly thereafter. This will give the Senate about a week to vote on the legislation in order to avoid another government shutdown.

The topline numbers, known as 302b, for each spending bill have not been released, so at this time we still don’t know how the International Affairs budget, and therefore the Global Health Programs at State and USAID, will fare.

As Congress finalizes FY18 appropriations and starts on the FY19 appropriations process, it is prime time for the global health community to advocate on Capitol Hill for maintaining robust global health funding. Global Health Council created a graphic with a list of “Hill Days” when the community is advocating on Capitol Hill. View the graphic.

Tentative Hearing Schedule Released

Originally scheduled for late February, the hearings to discuss the FY19 budget with Secretary Rex Tillerson and Administrator Mark Green were rescheduled to mid-March in both the House Foreign Affairs and Senate Foreign Relations Committees. At this time, hearings before the Appropriations committees have not been set.

Tentative dates are:

Secretary Tillerson:
-Senate Foreign Relations Committee – Thursday, March 15 – 10:00 am
-House Foreign Affairs Committee – Tuesday, March 20 – 9:30 am

Administrator Mark Green:
-Senate Foreign Relations Committee – Tuesday, March 20 – TBD
-House Foreign Affairs Committee – Wednesday, March 21 – 9:30 am

Representative Smith Introduces Cardiovascular Disease Resolution

At the end of February, Representative Chris Smith (R-NJ) introduced H.Res.752, a resolution recognizing the rise of cardiovascular disease (CVD) as the world’s leading cause of preventable death and disability. The resolution calls on the Department of State, USAID, and CDC to comprehensively examine the impact of CVDs on health and development in U.S. priority assistance countries. It also calls for the development of a coordinated strategy by integrating CVD into existing programs. Read the resolution.

Advocacy Update ~ February 26, 2018

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

FY18 Appropriations Update

Since Congress passed a budget deal raising spending caps, it has been a waiting game for the top line allocations, knowns as 302(b), for each spending bill. Of particular concern in the budget deal is a cut to funding for Overseas Contingency Operations, which means a reduction to the State, Foreign Operations bill, which funds USAID and the State Department, unless base funding for this account is increased.

The current Continuing Resolution is set to expire March 23, and appropriators will be working throughout March to come up with the final spending package for the remainder of Fiscal Year (FY) 2018.

FY19 President’s Budget Released

On February 12, President Trump released a proposed budget for FY2019. Similar to last year, the International Affairs Account was cut 30% from FY2017 enacted levels. Global health programs at USAID and the State Department were cut about $2 billion, with proposed cuts in every account. In addition, global health programs at the National Institutes for Health and the Centers for Disease Control and Prevention were also cut. While the budget narrative discussed the importance of global health, and more broadly development and humanitarian assistance, these proposed cuts do not match the narrative.

A quick glance at a few accounts:

1) Recommended U.S. contributions to Gavi, the Vaccine Alliance and The Global Fund to Fight AIDS, Malaria and Tuberculosis were cut to $250 million and $925 million respectively.
2) $302 million recommended for Family Planning/Reproductive Health, which is $300 million less or a 50% reduction than FY 2017 enacted. FP/RH was zeroed out in the FY18 proposed budget. In addition, U.S voluntary contributions to UNFPA did not receive a request.
3) Zeroed out funding for HIV/AIDS programs at USAID in addition to cuts to both PEPFAR and The Global Fund. In an addendum to the budget (see below), an additional $400 million is provided to PEPFAR, bringing it to the same level as the FY2018 proposed budget.
4) A 6% cut for CDC Center for Global Health, however, does include $109 million for CDC Global Public Health Protection, including $59 million for GHSA from other accounts.
5) Recommended funding for The Fogarty Center, which was zeroed out in the FY2018 request, is $70 million, a $2 million decrease from FY2017 enacted.

Last year, Congress soundly rejected the President’s budget, and while we are still awaiting final FY2018 funding levels, appropriations committees, for the most part, maintained level funding for these accounts. The President’s Budget was finalized before Congress passed the Budget deal in early February. As a result, non-defense discretionary spending was raised by an additional $300 billion. The White House also released an addendum with instructions on how the additional funding could be spent.

Additional Materials

FY19 White House Budget Request
Addendum to President’s FY2019 Budget
State/USAID Congressional Budget Justification
HHS Budget Briefer
GHC Full funding chart (as of February 2018)
GHC Statement

Secretary of State Rex Tillerson to Testify

Secretary of State Rex Tillerson will be on Capitol Hill to testify on the FY2019 foreign affairs budget. He will appear before the House Foreign Affairs Committee on Tuesday and the Senate Foreign Relations Committee on Wednesday.

USAID Administrator Mark Green is expected to testify on Capitol Hill the week of March 5. Exact times have not yet been set by the committees.

1) HFAC Hearing – FY 2019 Foreign Affairs BudgetPOSTPONED (Webcast link will be uploaded soon.)

2) SFRC Hearing – Review of the FY 2019 State Department Budget Request and Redesign Plans –  POSTPONED

3) House Committee Budget Hearing (FY 19 Budget Hearing) – Department of State and Foreign Assistance with Secretary TillersonPOSTPONED


Advocacy Update ~ February 12, 2018

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

6 More Weeks of FY18 Appropriations Discussions

On Friday morning, President Trump signed into law a budget deal that includes a six-week stopgap spending bill, the fifth Continuing Resolution (CR) for this fiscal year (FY). This CR will keep the government open through March 23. This latest activity came about after extensive debates on lifting the spending caps and a push by House Democrats for a floor vote on the Deferred Action for Childhood Arrivals program. The budget deal and CR was temporarily threatened by Senator Rand Paul, who blocked a vote until after midnight on Thursday night, resulting in a brief government shutdown – the second one of the fiscal year.

The budget deal resolves the challenge Congress was facing on spending caps and sequestration. The legislation a $320 billion package that raises discretionary and non-defense discretionary spending over the next two years. Breaking this down, defense spending will rise by $80 billion and non-defense discretionary (NDD) spending will rise by $63 billion for FY18, with $21 billion in NDD targeted for domestic priorities. For FY19, defense spending will increase an additional $85 billion and NDD spending will go up an additional $68 billion.

While the increase in NDD spending allows leeway for appropriators to maintain level funding in the International Affairs account (150 account), final allocations, known as 302(b), for each spending bill, still need to be determined. With about one-third of the increase in NDD spending already targeted for specific programs, it doesn’t leave much left to be allocated to other accounts. Moreover, the budget deal includes a cut to the Overseas Contingency Operations (OCO) in the 150 account, meaning that our best hope for level funding for this account is to increase base spending. The 302(b) levels are expected tonight or Tuesday morning. Then appropriators will spend the next six weeks finalizing FY2018 spending bills, most likely wrapping all spending bills into an omnibus bill.

View GHC Appropriations Chart.

President’s FY19 Budget

The President’s FY19 Budget is expected to be released today. It’s unclear if a full budget or a “skinny” budget, with just topline numbers, will be made available. Justifications for the recommendations are not expected until spring. Similar to last year, we expect to see around a one-third cut to the International Affairs budget. GHC will release an analysis of the budget when it is available.

State Department Releases 6-month Review of Mexico City Policy

Last week the State Department released a review of the first six months of the implementation of the expansion of the Mexico City Policy (renamed to the Protecting Life in Global Health Assistance). With the review covering May-September 2016, and many awards, particularly within PEPFAR, not yet subjected to the policy, it wasn’t expected that anything more than a superficial analysis could be provided. The review cites that only four NGOs declined to comply with the policy, but over 500 prime recipients of U.S. funding have not yet had to determine compliance. The review primarily acknowledged the need for clarification on parts of the language dealing with financial support, training, and termination due to non-compliance.

The State Department committed to another review to be completed by December 15, 2018. GHC will continue to advocate with the State Department and other agencies for a thorough and transparent review in order to fully understand the impact of and how to mitigate harm from this expanded policy.

Read the Six Month Review.

Read GHC’s statement.

CDC Plans to Pull Back from 39 of 49 Country Posts

In January, the Wall Street Journal reported that CDC would downsize its programs in 39 of the 49 countries where CDC maintains an overseas presence to support global health security activities. The downsizing is in anticipation of the expiring five year Ebola supplemental package at the end of FY19. The remaining ten countries that the CDC plans to focus on are India, Thailand, Vietnam, Jordan, Kenya, Uganda, Liberia, Nigeria, Senegal and Guatemala. In response to this potential scale back, Global Health Council, the Global Health Security Consortium, Next Generation Global Health Security Network, and the Global Health Technologies Coalition sent a letter to HHS Secretary Alex Azar, and others in the administration, to share the concerns on the pending funding cliff and asked for an open dialogue with HHS to discuss how to move forward. Read the letter here. The letter was circulated on news platforms such as the Washington Post and CNN.

Dr. Anne Schuchat Assumes Acting Director Role at CDC

Dr. Anne Schuchat will serve as acting director of CDC following the resignation of Dr. Brenda Fitzgerald at the end of January. Dr. Fitzgerald’s resignation came shortly after Politico published reports that exposed her investments in a tobacco company after she accepted the director’s position.

Advocacy Update ~ January 29, 2018

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

Deal or No Deal? FY18 Budget Update

Congress was unable to pass a Continuing Resolution (CR) by the midnight deadline on January 19, leading to a “mini-shutdown” of the federal government. Although a compromise was reached a few days later and the government reopened, a final spending package for federal agencies is still weeks away. A number of issues, including the Deferred Action for Childhood Arrivals (DACA), as well as how much to raise spending caps, continue to bog down the work on Fiscal Year (FY) 2018. The current CR runs until February 8 and over the next few weeks, Congress will continue to focus on these unresolved issues. On spending caps, Democrats continue to push for parity between defense and non-discretionary defense (NDD) spending levels. Republicans counter, that defense spending has been hit harder due to sequestration and the defense cap needs to be raised. Even if a budget agreement is passed by February 8, the work is not over. Another CR lasting into March will be needed to give appropriators time to finish work on spending bills. The outlook on this timeline is tentative as we wait to see how the debate unfolds over the next few weeks.

President’s FY19 Budget

The President’s Budget for FY19 is delayed by a week. Originally set for February 5, the White House announced that due to the government shutdown the release date is now February 12.

Update on Redesign
Late last week, the U.S. Agency for International Development (USAID) temporarily suspended its engagement with the State Department on the restructuring, or redesign, of the federal agency. In an email to USAID staff working on the redesign process, the head of the team instructed personnel to discontinue work on joint agency process. USAID clarified that this is only temporary as it awaits clarification from the State Department on the roles and responsibilities of staff assigned to the process.

Updates on Pending Legislation

Reach Every Mother and Child Act

Support of The Reach Every Mother and Child Act continues to grow, with 101 cosponsors in the House (H.R. 4022) and 18 cosponsors in the Senate (S.1730). The Reach Act aims to reduce preventable maternal and child deaths through evidence-based and cost effective solutions.

End Neglected Tropical Diseases Act

Representatives Chris Smith (R-NJ) and Gregory Meeks (D-NY) circulated a Dear Colleague Letter to members of Congress in December asking for support of the End Tropical Diseases Act (H.R. 1415). The bill, which was marked up in November by the House Foreign Affairs Committee, aims to expand programs to address neglected tropical diseases (NTDs) which disproportionately impact individuals living in extreme poverty, especially in developing countries.

Global Health Innovation Act

The Global Health Innovation Act (H.R. 1660) introduced by Representative Albio Sires (D-NJ) passed in the House on January 17. The bill supports global health research and development by encouraging the development of health products that are affordable, accessible, and culturally appropriate in low-resource health systems. This bill will require the U.S. Agency for International Development (USAID) to submit a report on the development and use of global health innovations at the agency.

Alex Azar Confirmed as Health and Human Services Secretary

Alex Azar, former president of Eli Lilly U.S., was confirmed as Health and Human Services (HHS) Secretary on January 24. Before his time at Eli Lilly, Alex Azar served in HHS under President George W. Bush. He replaces Tom Price who resigned in September 2017.