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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.
————-

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: , , , , , , , ,
  • FY2012 Consolidated Appropriations Act introduced in the House

    Representative Hal Rogers (R-KY, 5th; Chairman House Committee on Appropriations) introduced the “Consolidated Appropriations Act, 2012” (H.R. 3671), which includes funding for global health programs through the State Department, U.S. Agency for International Development (USAID), and the Department of Health and Human Services (HHS). Chairman Rogers also introduced a resolution (H.Con.Res. 94) that would apply a 1.83% across the board rescission to all FY 2012 appropriations except the Department of Defense (DoD), Military Construction, and Veterans Affairs.

    According to the bill and the Chair’s summary, the bill also:

    • “Directs that no HIV/AIDS funding be provided for needle exchange programs”;
    • “Requires additional congressional oversight before the Administration makes public announcements of multi-year funding pledges”;
    • Requires that the Administration report back to Congress with an analysis of the potential costs (including savings and increases) of transitioning the Office of the Global AIDS Coordinator (OGAC) into USAID; and
    • Requires that the Administration 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 included in the bill are as follows:

    Department / Agency

    Part of the GHI*

    FY11 Enacted (millions)

    FY12 Request (millions)

    FY12 House Bill (H.R. 3671) (millions)**

    Difference
    (millions)

    House – FY11

    House – Request

    State & Foreign Operations

    USAID-GHCS

    X

    $2,495.0

    $3,073.6

    $2,625.0

    $130
     (5.2%)

    $-448.6
     (-14.6%)

    State GHCS

    X

    $5,334.3

    $5,641.9

    $5,542.9

    $208.5
     (3.9%)

    $-99
     (-1.8%)

            of which GF

    X

    $748.5

    $1,000.0

    $1,050.0

    $301.5
     (40.3%)

    $50
     (5%)

    FP/RH***

     

    $615.0

    $769.1

    $610.0

    $-5
     (-0.8%)

    $-159.1
     (-20.7%)

            of which UNFPA

     

    $40.0

    $47.5

    $35.0

    $-5
     (-12.5%)

    $-12.5
     (-26.3%)

    MCC

     

    $898.2

    $1,125.1

    $898.2

    $0
     (0%)

    $-226.9
     (-20.2%)

    Water (all acounts)

     

    -

    -

    $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

    Total GHI (known amounts)****

     

    $8,255.4

    $9,133.5

    $8,293.7

    $38.3
     (0.5%)

    $-839.9
     (-9.2%)

    *GHI: U.S. Global Health Initiative.
    **The FY 2012 Consolidated Appropriations Act included an across-the-board 0.189% rescission to all funding provided through the Labor-HHS portion of the bill.
    ***The FY 2012 Consolidated Appropriations Act states that “not less than $575,000,000 should be made available for family planning/reproductive health” through all bilateral accounts, but does not delineate this amount by account. UNFPA funding is in addition to the bilateral funding and is provided through the International Organizations and Programs (IO&P) account.
    ****Total funding for the GHI is not currently available as some funding provided through SFOPS, HHS, and DoD were not delineated in the FY 2012 appropriations bills.

    Senate Appropriations Committee introduces Continuing Resolution for the remainder of FY 2011; includes overall increase in global health funding

    The Senate Committee on Appropriations introduced a Continuing Resolution (CR) that would authorize appropriations for the remaining seven months of FY 2011 (the first 5 months of FY 2011 were funded under FY 2010 levels). This legislation would replace the full-year appropriations bill (H.R. 1) that was recently passed by the House on February 19, 2011. Unlike H.R. 1, which proposes to cut global health funding, the Senate CR proposes an overall increase in global health funding (see table below). Additionally, the summary of the CR provided by the Senate Committee on Appropriations categorizes State and Foreign Operations funding as part of National Security.

    House Appropriations Committee releases draft FY 2013 Labor-HHS Appropriations Bill

    The House Committee on Appropriations releaseddraft of the FY 2013 Labor, Health & Human Services, Education and Related Agencies appropriations bill. The draft bill provides the funding levels for global health programs at the Centers for Disease Control and Prevention (CDC) and the John E. Fogarty International Center. Additional funding for global health programs and research conducted by the National Institutes of Health (NIH) is not yet available.

    Area

    FY12 Enacted (millions)

    FY13 Request (millions)

    FY 13 House (millions)

    FY13 Senate (millions)

    Difference (millions)

    House – FY12

    House – Request

    House – Senate

    Centers for Disease Control and Prevention (CDC)

    $347.6

    $362.9

    $332.4

    $362.6

    $-15.2
     (-4.4%)

    $-30.5
     (-8.4%)

    $-30.2
     (-8.3%)

           Global AIDS Program

    $117.1

    $117.2

    $117.2

    $117.1

    $0
     (0%)

    $0
     (0%)

    $0
     (0%)

    John E. Fogarty International Center

    $69.6

    $69.8

    $69.5

    $70.0

    $0
     (0%)

    $-0.2
     (-0.3%)

    $-0.4
     (-0.6%)

    State Department releases fact sheet titled "The United States Commitment to the Global Alliance for Clean Cookstoves – Year Two Progress Report"

    The State Department released a fact sheet titled “The United States Commitment to the Global Alliance for Clean Cookstoves – Year Two Progress Report,” which summarizes the accomplishments and funding amounts provided by the U.S. government agencies involved in the alliance.

    Senate Appropriations Committee approves Labor HHS Appropriations Bill

    The Senate Committee on Appropriations approved the FY 2013 Labor, Health & Human Services, Education and Related Agencies appropriations bill by a vote of 16-14. A report released by the committee provided the funding levels for global health programs at the Centers for Disease Control and Prevention (CDC), which comprises a portion of the Global Health Initiative (GHI) budget, and the John E. Fogarty International Center. Additional funding for global health programs and research conducted by the National Institutes of Health (NIH) is not yet available.

    Area

    Part of the GHI*

    FY12 Enacted (millions)

    FY13 Request (millions)

    FY13 Senate (millions)

    Difference: Senate – FY12 (millions)

    Difference: Senate – Request (millions)

    Centers for Disease Control and Prevention (CDC)

    Global AIDS Program

    X

    $117.1

    $117.2

    $117.1

    $0
     (0%)

    $0
     (0%)

    Global Immunization

     

    $160.3

    $175.4

    $160.3

    $0
     (0%)

    $-15.1
     (-8.6%)

           Polio

     

    $111.3

    $126.4

    $111.3

    $0
     (0%)

    $-15.1
     (-11.9%)

           Measles & Other Diseases

     

    $49.0

    $49.1

    $49.0

    $0
     (0%)

    $-0.1
     (-0.1%)

    Disease Detection & Emergency Response

     

    $41.6

    $41.7

    $46.6

    $5
     (12%)

    $4.9
     (11.9%)

    Parasitic Diseases & Malaria

    **

    $19.4

    $19.4

    $19.4

    $0
     (0%)

    $-0.1
     (-0.3%)

    Global Public Health Capacity Development

     

    $9.2

    $9.2

    $9.2

    $0
     (0%)

    $0
     (-0.2%)

    National Public Health Institutes

     

    $0.0

    $0.0

    $10.0

    -

    -

    Total CDC Funding

     

    $347.6

    $362.9

    $362.6

    $15
     (4.3%)

    $-0.3
     (-0.1%)

    John E. Fogarty International Center

     

    $69.6

    $69.8

    $70.0

    $0.4
     (0.6%)

    $0.2
     (0.3%)

    *GHI: U.S. Global Health Initiative.      
    **CDC funding for malaria is considered to be part of the GHI. The exact amount of malaria funding provided in the Senate Labor-HHS appropriations bill is not yet know.

    GAO releases report on PEPFAR evaluation activities

    The U.S. Government Accountability Office (GAO) released a report titled “President’s Emergency Plan for AIDS Relief: Agencies Can Enhance Evaluation Quality, Planning, and Dissemination,” which details its review of “PEPFAR evaluation activities, . . . the extent to which evaluation findings, conclusions, and recommendations were supported, and . . . the extent to which PEPFAR policies and procedures adhere to established general evaluation principles.”

    Based on its analysis, the GAO recommended “that State work with CDC and USAID to (1) improve adherence to common evaluation standards, (2) develop PEPFAR evaluation plans, (3) provide guidance for assessing and documenting evaluators’ independence and qualifications, and (4) increase online accessibility of evaluation results.”

    White House releases FY 2013 Budget Request

    The White House released the FY 2013 budget request, which included funding for the U.S. Global Health Initiative (GHI) and other global health activities.  Overall, funding for the GHI is down in the FY 2013 request, with most of the reduction coming from HIV/AIDS bilateral amounts.  Most other areas saw decreases as well, except for family planning and funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria and GAVI, which increased.

    Area

    FY12 Estimate (millions)

    FY13 Request (millions)

    Difference: FY13 – FY12 (millions)

    The Global Health Initiative (GHI)

    Total GHI

    $8,827.6

    $8,524.4

    $-303.2
     (-3.4%)

         of which PEPFAR

    $6,632.3

    $6,418.0

    $-214.3
     (-3.2%)

               of which HIV*

    $5,082.4

    $4,536.0

    $-546.4
     (-10.8%)

               of which TB

    $249.8

    $232.0

    $-17.8
     (-7.1%)

               of which Global Fund

    $1,300.0

    $1,650.0

    $350
     (26.9%)


    *Total USG bilateral funding for HIV/AIDS programs.

    Area

    Part of the GHI

    FY12 Estimate (millions)

    FY13 Request (millions)

    Difference: FY13 – FY12 (millions)

    U.S. Agency for International Development (USAID)

    HIV

    X

    $350.0

    $330.0

    $-20
     (-5.7%)

    Tuberculosis

    X

    $249.8

    $232.0

    $-17.8
     (-7.1%)

           GHP account

    X

    $236.0

    $224.0

    $-12
     (-5.1%)

           Other accounts

    X

    $13.8

    $8.0

    $-5.8
     (-42.2%)

    Malaria

    X

    $650.0

    $619.0

    $-31
     (-4.8%)

    MCH

    X

    $605.6

    $578.0

    $-27.6
     (-4.5%)

           of which GAVI

    X

    $130.0

    $145.0

    $15
     (11.5%)

    Nutrition

    X

    $95.0

    $90.0

    $-5
     (-5.3%)

    FP/RH

    X

    $524.0

    $530.0

    $6
     (1.2%)

    NTDs

    X

    $89.0

    $67.0

    $-22
     (-24.7%)

    Vulnerable Children

    X

    $17.5

    $13.0

    $-4.5
     (-25.7%)

    Pandemic Influenza

    X

    $58.0

    $53.0

    $-5
     (-8.6%)

    State Department

    HIV

    X

    $4,242.9

    $3,700.0

    $-542.9
     (-12.8%)

    Global Fund

    X

    $1,300.0

    $1,650.0

    $350
     (26.9%)

    UNFPA

     

    $35.0

    $39.0

    $4
     (11.4%)

    National Institutes for Health (NIH)

    HIV

    X

    $364.5

    $388.9

    $24.4
     (6.7%)

    Malaria

    X

    $147.0

    $147.0

    $0
     (0%)

    Centers for Disease Control and Prevention (CDC)

    HIV

    X

    $117.1

    $117.2

    $0
     (0%)

    Malaria

    X

    $9.3

    $9.4

    $0.1
     (1.1%)

    Department of Defense (DoD)

    HIV

    X

    $8.0

    $0.0

    $-8
     (-100%)

    Malaria

    X

    $0.0

    $0.0

    -

    Secretary Sebelius commemorates new Global Disease Detection Center in India

    During a trip to India, Secretary of Health and Human Services (HHS) Kathleen Sebelius gave a speech at an event commemorating a new Global Disease Detection Center in New Delhi. The new center is the result of a partnership between the U.S. Centers for Disease Control and Prevention (CDC) and India’s National Center for Disease Control (NCDC) and “promises to help India monitor viruses and disease and better handle outbreaks.”

    Learn more about the CDC’s Global Disease Detection and Emergency Response efforts and associated Regional Centers.

    GAO releases report on drug quality in global health programs

    The U.S. Government Accountability Office (GAO) released a report titled “Ensuring Drug Quality in Global Health Programs”, which “examined (1) the regulatory and policy requirements intended to ensure the quality of drugs procured with U.S. aid funds and (2) the systems in place to monitor drug quality in supply chains used by programs receiving U.S. foreign aid funds.” The GAO did not make any recommendations in this report.