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UPDATED: House-Senate Conference Committee releases FY 2012 Appropriations Agreement

UPDATE: The President signed the bill into law (Public Law #112-74) on December 23, 2011 after the Conference Agreement passed the House (296-121) on December 16, 2011 and the Senate (67-32) on December 17, 2011. Additionally, the Senate voted against (43-56) a resolution (H.Con.Res. 94) that would have applied a 1.83% across-the-board rescission to all FY 2012 appropriations except the Department of Defense (DoD), Military Construction, and Veterans Affairs.
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Representative Hal Rogers (R-KY, 5th; Chairman House Committee on Appropriations) released a statement announcing that a joint House-Senate Conference Committee had reached agreement on final FY 2012 Appropriations legislation (H.R. 2055), which includes funding for global health programs through the State Department, U.S. Agency for International Development (USAID), the Department of Health and Human Services (HHS), and the Department of Defense (DoD). While total funding for the Global Health Initiative (GHI) is not yet available, the appropriations detailed in this agreement totaled $8.3 billion.

According to the Conference Report and the Joint Statement of Managers, the legislation also:

  • Directs that no FY 2012 global health funds may be used for needle exchange programs;
  • Includes additional Congressional oversight before the Administration makes a multi-year funding pledge;
  • Requires the Administration to report back to Congress with an analysis of the potential costs/savings of transitioning the Office of the Global AIDS Coordinator (OGAC) into USAID; and
  • Requires the Administration to report back to Congress with an analysis of transitioning the leadership of the Global Health Initiative (GHI) to USAID as outlined in the Quadrennial Diplomacy and Development Review (QDDR).

Global health appropriations as provided in the Conference Report (House Report 112-331) and Joint Statement of Managers are summarized as follows:

Area

Part of the GHI*

FY11 Enacted (millions)

FY12 Request (millions)

FY12 Conference Agreement
(millions)**

Difference
(millions)

Conference – FY11

Conference – Request

State & Foreign Operations

Maternal & Child Health (MCH)

X

$548.9

$846.0

$605.6

$56.7
 (10.3%)

$-240.5
 (-28.4%)

        GAVI (non-add)

X

$90.0

$115.0

$100.0

$10
 (11.1%)

$-15
 (-13%)

Nutrition

X

$89.8

$150.0

$95.0

$5.2
 (5.8%)

$-55
 (-36.7%)

Vulnerable Children

X

$15.0

$15.0

$17.5

$2.5
 (16.9%)

$2.5
 (16.7%)

HIV/AIDS

X

$4,935.1

$4,991.9

$4,842.9

$-92.3
 (-1.9%)

$-149
 (-3%)

        USAID

X

$349.3

$350.0

$350.0

$0.7
 (0.2%)

$0
 (0%)

        State Department

X

$4,585.8

$4,641.9

$4,492.9

$-93
 (-2%)

$-149
 (-3.2%)

Global Fund

X

$748.5

$1,000.0

$1,050.0

$301.5
 (40.3%)

$50
 (5%)

Family Planning/Reproductive Health (FP/RH)***

 

$615.0

$769.1

$610.0

$-5
 (-0.8%)

$-159.1
 (-20.7%)

        GHCS Account

X

$524.0

$625.6

$524.0

$0
 (0%)

$-101.7
 (-16.2%)

        Other Bilateral Accounts

 

$51.1

$96.0

$51.1

$0
 (0%)

$-45
 (-46.8%)

        UNFPA

 

$40.0

$47.5

$35.0

$-5
 (-12.5%)

$-12.5
 (-26.3%)

Tuberculosis

X

$224.6

$236.0

$236.0

$11.5
 (5.1%)

$0
 (0%)

Malaria

X

$618.8

$691.0

$650.0

$31.2
 (5%)

$-41
 (-5.9%)

Neglected Tropical Diseases (NTDs)

X

$76.8

$100.0

$89.0

$12.2
 (15.8%)

$-11
 (-11%)

Pandemic Preparedness

X

$47.9

$60.0

$58.0

$10.1
 (21.1%)

$-2
 (-3.3%)

MCC

 

$898.2

$1,125.1

$898.2

$0
 (0%)

$-226.9
 (-20.2%)

Water

 

-

-

$315.0

-

-

Health and Human Services (HHS)

CDC Global Health

 

$340.3

$381.2

$348.9

$8.6
 (2.5%)

$-32.4
 (-8.5%)

        of which HIV

X

$118.7

$118.0

$117.8

$-0.9
 (-0.8%)

$-0.2
 (-0.2%)

NIH – Global Fund

X

$297.3

$300.0

$0.0

$-297.3
 (-100%)

$-300
 (-100%)

NIH – Fogarty International Center

 

$69.4

$71.3

$69.6

$0.2
 (0.3%)

$-1.7
 (-2.4%)

Department of Defense (DoD)

HIV

X

$10.0

$0.0

$8.0

$-2
 (-20%)

-

The Global Health Initiative

  • Area: ,
  • Organization/Initiative: , , , , , , ,
  • Issue/Condition: , , , , , , , ,
  • Summary of the FY11 Full-Year Continuing Appropriations Act (H.R. 1473)

    Representative Harold Rogers (R-KY, 5th) introduced the “Department of Defense and Full-Year Continuing Appropriations Act, 2011” (H.R. 1473) authorizing appropriations for the remaining six months of FY 2011 (the first 6 months of FY 2011 were funded under FY 2010 levels). The proposed funding totals for global health (as compared to FY 2010 totals) included in this appropriations bill are provided in the table below.

    Note: The appropriations bill (H.R. 1473) includes an across-the-board rescission of 0.2 percent to all discretionary spending; the global health funding totals for FY 11 (H.R. 1473) listed below include this rescission.

    Timeline of the bill:

    - Introduced and referred to the House Committee on the Budget and the House Committee on Ways and Means on April 11, 2011.

    - Passed by the House (260-167) and the Senate (81-19) on April 14, 2011.

    - Signed by the President (Public Law No: 112-10) on April 15, 2011.

    White House releases FY 2012 Budget Request

    The White House released the FY 2012 budget request, which included the following funding totals for the U.S. Global Health Initiative (GHI) and other global health and related activities:

    b>Global Health Initiative (GHI) total: $9.8 billion, including

    - $8.7155 billion from State & Foreign Operations Global Health & Child Survival (GHCS) account, and

    - Over $1.0693 billion from HHS, DoD, and other State & Foreign Operations accounts.

    - PEPFAR: Included in the GHI total is $7.154 billion for PEPFAR of which $1.3 billion is for the Global Fund ($1.0 billion from the State Department and $300 million from HHS).

    Additional funding details on the GHI and other global health related accounts:

    State and Foreign Operations funding for the global health:

    - Global Health & Child Survival (GHCS): $8.7155 billion

    • USAID: $3.0736 billion
      • Maternal & Child Health: $846.0 million
      • Nutrition: $150.0
      • Vulnerable Children: $15.0 million
      • HIV/AIDS: $350.0 million
      • Family Planning/Reproductive Health: $625.6 million
      • Malaria: $691.0 million
      • Tuberculosis: $236.0 million
      • Neglected Tropical Diseases (NTDs): $100.0 million,
      • Pandemic Influenza and Other Emerging Threats: $60 million
    • Department of State: $5.6419 billion
      • HIV/AIDS: $5.6419 billion (includes $1.0 billion for the Global Fund)

    Millennium Challenge Corporation: $1.125 billion

    • Health and Human Services (HHS) funding for global health:
      • National Institutes of Health (NIH):
        • HIV/AIDS Research: $489.4 million
        • Malaria Research: $110.2 million
        • Global Fund: $300.0 million
      • Centers for Disease Control and Prevention (CDC) ($ total): $381.2 million
        • Global AIDS Program: $118.0 million
        • Global Immunization Program: $163.6 million
        • Global Disease Detection & Emergency Response: $44.2 million
        • Parasitic Diseases & Malaria: $19.6 million
          • Malaria: $9.2 million
        • Global Public Health Capacity Development: $35.8 million
    • Fogarty International: $71.3 million
    President Obama, Secretary Clinton, and Secretary Sebelius discuss global health issues during UNGA

    President Obama: During remarks to the United Nations General Assembly (UNGA), President Barack Obama stated that “to stop disease that spreads across borders, we must strengthen our system of public health.”  President Obama also stated that the U.S. would continue its efforts to combat HIV/AIDS, tuberculosis, and malaria, would focus on the health of mothers and children, and highlighted the recent agreement between the U.S. and the World Health Organization (WHO) to assist developing nations in meeting the International Health Regulations (IHR). 

    Secretary Clinton: Secretary of State Hillary Clinton provided remarks at the High-Level Meeting on Nutrition highlighting U.S. efforts to improve nutrition through global partnerships such as the Scaling Up Nutrition (SUN) movement and the 1,000 Day Partnership.  Secretary Clinton also stated “the United States is firmly committed to our investments in global nutrition, and we believe fervently that improving nutrition for pregnant women and children under two is one of the smartest investments anyone can make.”  At an event prior to the High-Level Meeting titled “Women and Agriculture: A Conversation on Improving Global Food Security,” Secretary Clinton discussed the role of women in improving food security and announced “that the United States is allocating $5 million this year for a new gender program within Feed the Future [FtF].”

    Secretary Sebelius: Secretary of Health and Human Services (HHS) Kathleen Sebelius provided remarks at a UNGA High-Level Meeting on Non-communicable Diseases (NCDs), stating the Obama Administration “has made chronic disease a focus in our research and global health programs” and highlighted two soon to be announced efforts aimed at promoting smoke-free workplaces and in support of tobacco cessation efforts.

    Additional Information:

    White House

    • Read a White House fact sheet outlining, among other things, the U.S. commitment to “Global Health Security.” (September 20, 2011)

    State Department

    USAID

    CRS releases report on USAID’s global health programs and funding

    The Congressional Research Service (CRS) released a report titled “USAID Global Health Programs: FY2001-FY2012 Request.” In addition to providing an overview of USAID’s role in U.S. global health assistance, the report summarizes USAID funding for global health efforts from FY2001 to FY2012, and highlights several budget related policy questions.

    CRS releases report on FY2012 State and Foreign Operations appropriations

    The Congressional Research Service (CRS) released a report titled “State, Foreign Operations, and Related Programs: FY2012 Budget and Appropriations”. According to the summary, “[t]his report analyzes the FY2012 request, including State Department, international broadcasting, and foreign aid highlights, recent-year funding trends, and congressional action related to FY2012 State-Foreign Operations legislation.”

    Health efforts highlighted during Lower Mekong Initiative Ministerial Meeting

    Efforts to address pandemic threats and the health impacts of cookstoves were highlighted during the fourth Ministerial Meeting of the Lower Mekong Initiative, a multinational effort between the U.S., Cambodia, Laos, Thailand, and Vietnam aimed at “foster[ing] integrated sub-regional cooperation and capacity building . . . in the areas of education, health, environment, and infrastructure.

    Additional Information:

    • Statement of the Fourth Lower Mekong Initiative Ministerial Meeting
    • Remarks from Secretary Clinton during the Ministerial Meeting
    • State Department fact sheet titled “Lower Mekong Initiative Progress 2010/2011”
    GAO Testimony – Influenza Pandemic: Gaps in Pandemic Planning and Preparedness Need to Be Addressed

    At a hearing before the House Committee on Homeland Security, GAO staff testified on U.S. planning and preparedness efforts to address a potential influenza pandemic. Among other findings, GAO staff testified that “efforts are underway to improve the surveillance and detection of pandemic-related threats, but targeting assistance to countries at the greatest risk has been based on incomplete information, particularly from developing countries.”

    White House announces H1N1 Flu Preparedness Summit

    The White House announced that it will hold an H1N1 Flu Preparedness Summit on July 9, 2009 “to launch a national influenza campaign by bringing federal, state and local officials, emergency managers, educators and others together with the nation’s public health experts to build on and tailor states’ existing pandemic plans, share lessons learned and best practices during the spring and summer H1N1 wave, and discuss preparedness priorities.”

    U.S. to provide Pan-American Health Organization with antiviral medication to combat H1N1 influenza

    Secretary of Health and Human Services (HHS) Kathleen Sebelius “announced that the United States will provide 420,000 treatment courses of Tamiflu (Oseltamavir) to the Pan-American Health Organization (PAHO) to fight the novel H1N1 influenza in Latin America and the Caribbean.”