Advocacy Update

Advocacy Update – September 25, 2017

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

House passes Mini Omnibus for FY18

In mid-September, the House made unexpected progress in the annual appropriations process, and passed a mini Omnibus bill, made up of eight spending bills, for Fiscal Year (FY) 2018. The Omnibus included funding for global health in the State and Foreign Operations and the Labor, Health and Human Services, and Education sections of the bill. To put this in perspective, the last time the House completed the appropriations process before the end of the fiscal year was in 2009.

Overall in State and Foreign Operations, which funds USAID and the State Department, funding for global health programs decreased slightly ($8.3 billion for FY18 compared to $8.7 billion for FY17). While most global health programs were flat funded, Family Planning had a 25% cut at $461 million. In the Labor, Health, and Human Services section, top-line funding for NIH increased by $1.1 billion to $35.2 billion. For the CDC, the Center for Global Health was flat funded and funding for the Center for Emerging Zoonotic and Infectious Diseases slightly decreased.

Global health also received some attention in the amendment process. Representative David Engel (D-NY) introduced an amendment to increase funding for TB at USAID from $241 million to $450 million. Although the amendment failed, it was an opportunity to highlight the need for additional funding for TB. Representative Claudia Tenney (R-NY) proposed an amendment to increase funding for community block grants by offsetting funding for CDC global health by $14 million, which could have had an impact on the Center for Global Health’s ability to respond during an outbreak. After a floor debate on the need for increased funding for CDC community block grants, the amendment was withdrawn.

The Senate, while not as far along as the House, has made gradual progress on appropriations. Earlier this month, Congress passed a Continuing Resolution to keep the government funded through December 8, giving the two chambers time to negotiate the differences between their respective spending bills. For the latest on appropriations in the Senate read the Advocacy update from September 11.

View the full Funding Chart.

FY19 Budget Recommendations

Although we are still waiting to see how the FY18 budget process will play out, work has already begun on the FY19 budget. It is our understanding that the Office of Management and Budget (OMB) instructed federal agencies to use the FY18 President’s budget as the starting point for coming up with their requests for the coming fiscal year. The President’s budget cut foreign assistance, which includes the global health accounts, approximately 30%, so we can expect to see similar recommendations in the FY19 budget.

In late August, GHC sent to the Office of Management and Budget (OMB) recommendations for FY19 for the global health accounts at USAID, State Department, as well as the Center for Global Health at CDC, and a few key accounts at NIH. Recognizing the limitations placed on the agencies, GHC recommended at a minimum funding levels that match FY17 levels (for a few accounts, GHC used the House FY18 number if it was higher. At the time, the Senate numbers were not available), but also included higher funding recommendations to demonstrate what is needed to have the greatest impact.

GHC met with OMB in early September to discuss our recommendations and why investing in global health and development is critical.

To compare the FY19 recommendations with the President’s FY18 budget, please refer to the full funding chart above.

Civil Society Recommendations for Six-Month Review of Mexico City Policy

Global Health Council released a statement of principles, endorsed by over 100 civil society organizations, on the upcoming six-month review of the impact of the expanded Mexico City Policy. The State Department proposed a six-month review of the policy’s impact on U.S. global health programs, which have saved and improved the lives of millions around the world. As the timeline approaches for the six-month review, the statement of principles provides recommendations for a review that is meaningful and comprehensive, and proposes an annual review to understand how the policy affects U.S. programs and their outcomes long-term. Read GHC’s press release.

GHC has shared and discussed the statement with State Department, USAID, and others.

Redesign Process: GHC Releases Statement on Importance of Global Health

Earlier this month, federal agencies submitted to OMB their proposals for a “redesign” or restructuring of their respective internal structures, including offices, programs, etc. The foreign assistance community has been closely following the process as it relates to the State Department and USAID, and the role that foreign assistance will have in U.S. engagement globally.

While the process has not been entirely transparent, civil society was invited to several stakeholder listening sessions to provide comments and ask questions of the “Redesign” team at State and USAID. These sessions were not entirely productive as the community was not provided detailed information on the team’s specific plans for restructuring, making it difficult to provide meaningful comments.

GHC released a statement, endorsed by a number of organizations, to USAID and State emphasizing the importance of global health in development. As we did not have details on how, or even if, global health programming would be restructured, the statement is purposely broad. The statement was also shared with OMB, which will make any final decisions on restructuring.

It is unclear at this time, if any of the proposals will be shared publicly, but watch this space for updates as the process moves forward.

Advocacy Update ~ September 11, 2017

This post was written by Danielle Heiberg, GHC Senior Advocacy Manager.

Last week, Congress returned from August recess and got to work, tackling not only the aftermath of Hurricane Harvey and the debt ceiling, but also appropriations for Fiscal Year (FY) 2018, which begins on October 1.

The legislation to provide disaster relief funds to those affected by Hurricane Harvey, includes a short term deal to raise the debt limit through December and a continuing resolution (CR) to keep the government open until December 8. In the Senate, Senator Rand Paul (R-KY) had proposed an amendment to offset the funds needed for Hurricane Harvey relief by cutting from USAID funding. The Senate voted to table the amendment by 87-10, with the 10 no votes all cast by Republicans.

The Senate Appropriations Committee also took up the State and Foreign Operations (SFOPs) and Labor, Health and Human Services, and Education (Labor-H) appropriations bills, which funds programs at NIH and CDC. Similar to the House, the Senate rejected President Trump’s budget that recommended drastic cuts to much of global health programs, and foreign assistance in general. The Committee recommended mostly flat funding for global health programs at USAID and the State Department, and recommended increased funding to TB and flat funding for Malaria by using unobligated funds from the Ebola Emergency Response fund. In the Labor-H bill, the Committee recommended increased funding for the Fogarty International Center (which was zeroed out in the President’s budget); increased funding for NIAID; and decreased funding for the Global Public Health Protection and Global Disease Detection in the Center for Global Health at CDC. See full funding chart below.

Of particular note in the SFOPs bill, was an amendment passed by the full committee to allocate “not less than” $585 million for bilateral family planning/reproductive health programs; repeals the Mexico City Policy (or Global Gag Rule); and mandates a U.S. contribute to UNFPA of $37.5 million. The amendment, introduced by Senator Jeanne Sheehan (D-NH), passed mostly along party lines, but with Senator Joe Manchin (D-WV) voting no, and Senators Lisa Murkowski (R-AK) and Susan Collins (R-ME) voting yes. As the House was voting on the floor on their version of the SFOPs bill, which contains language diametrically opposite to this amendment, the language will most likely be stripped out during final negotiations between the two chambers.

Also of significance is the strong language that the Committee inserted in the SFOPs report to blunt some of the actions taken by the Trump administration, especially in regards to the administration’s “redesign,” or reorganization plans, and the fear that the administration may simply not spend appropriated funds. The SFOPs report included language that the Committee feels that the President’s proposed International Affairs budget does not reflect “our increased attention to public safety and national security [that] sends a clear message to the world – a message of American strength and resolve.” The Committee also stressed that “diplomacy and development remain cost effective national security tools.”

In regards to reorganization, the Committee cited that their questions remain “largely unanswered” and is “concerned that the administration has a predetermined outcome for the reorganization or redesign.” The Committee included language that any reorganization plan is “subject to prior consultation and regular notification procedures.”

The Committee also included language reminding the administration of the Budget and Impoundment Control Act of 1974, which limits “the authority of the administration to reduce or withhold funding provided in law by action or inaction.”

Meanwhile, on the other side of Capitol Hill, the House began work on a minibus (or an “octobus” as some called it), to deal with the remaining eight appropriations bills, which includes SFOPs and Labor-H. The House voted on a number of amendments to the bill, but did not get to amendments for SFOPs until late Thursday. Of particular note, an amendment from Congressman Eliot Engel (D-NY) to increase funding to TB failed. An amendment in Labor-H offered by Congresswoman Claudia Tenney (R-NY) would cut $14 million from CDC global health to increase funding for community block grants is expected to be voted on this week. The House has an additional 400 amendments to vote on, before final passage of the minibus.

With the CR in place until early December, Congress has a few months to work out final numbers and language. However, it will be crunch time to pass the final FY18 bills and negotiate a new debt ceiling, coupled with a desire to return home for the holidays.

Appropriations Budget Table (as of September 2017)

* House: Includes $250 million from remaining Ebola response funds; Senate: Includes $100 million from remaining Ebola response funds
** Includes $20 million from remaining Ebola response funds;
*** Funding from remaining Ebola response funds; An additional $130 million reserve fund is also made available for “programs to prevent, prepare for, and respond to unanticipated and emerging health threats only if the Secretary of State determines and reports to the Committee that it is in the national interest to respond to such threats”
**** The International Organizations and Programs (IO&Ps) is zeroed out. The House recommended funding for UNICEF in the Global Health Programs account.

The Reach Act: Investing in Maternal and Child Health

This post was written by Melissa Chacko, Policy Associate at Global Health Council.

Over the past few decades great strides have been made in maternal and child health: since 1990, the deaths of mothers and children under age 5 worldwide have been cut by more than half. The decrease in maternal and child mortality rates is a product of simple evidence-based solutions and inexpensive interventions. However, there is still a significant amount of work to do to ensure that no woman or child dies from a preventable death in our generation. Nearly 300,000 women continue to die annually due to complications during pregnancy or childbirth and 99% of these maternal deaths occur in the developing world. Access to quality care is essential for women and children as they are an integral part to building strong and prosperous communities. To reach the overarching goal of ending preventable deaths may seem idealistic, but it is achievable if we maximize the return on U.S. investments in maternal and child health programs.

In 2014, an advisory panel analyzed USAID’s Maternal and Child Health program, and found areas of improvement that would maximize the progress of the program. Since then, the program has undergone the process of implementing reform and exploring innovative financing tools to bring new resources to the field. However, with these measurements and expansion, also comes a need for greater coordination and accountability.

The Reach Every Mother and Child Act (S.1730) would create that accountability and coordination, as well as codify the reforms, all of which will keep USAID on track to reach its goal of reducing preventable child and maternal deaths and maximizing impact. In early August, Senators Susan Collins (R-ME) and Chris Coons (D-DE) led a bipartisan group of 10 Senators in reintroducing the Reach Every Mother and Child Act.

The Reach Act:

1) Requires a coordinated U.S. government strategy for contributing to reducing preventable child and maternal deaths;
2) Establishes rigorous reporting requirements to improve transparency, accountability, efficiency, and oversight of maternal and child health programs;
3) Ensures USAID focuses on the scale-up of highest impact, evidence-based interventions to maximize the return on existing U.S. investments;
4) Establishes the position of Child and Maternal Survival Coordinator at USAID to reduce duplication of efforts and ensure that resources are being used to maximum impact; and
5) Helps USAID explore and implement innovative financing tools, such as pay for success contracting, to leverage additional public and private resources, complementing existing U.S. assistance.

A similar version of the legislation was introduced in Congress last session (S.1911 and H.R. 3706) and received strong bipartisan support in both chambers.

In almost every field of health, women and children are the most vulnerable in areas that lack essential healthcare resources and systems. We can change this narrative by passing the Reach Act. The lasting impact of this legislation will be seen through the thousands of women and children who will live longer and healthier lives, due to access to quality care. With the Senate back in session, outreach for Senate cosponsors on the Reach Every Mother and Child Act is in full swing. It is important to rally support on this issue and vocalize the importance of bipartisan support on the Reach Act.

We encourage you to contact your Senators to voice your support for the Reach Act. You can find contact information for the Senate here.

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.


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.

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.