On September 7, 2017, the Senate Committee on Appropriations approved both the FY 2018 State & Foreign Operations (SFOPs) and  the FY 2018 Labor, Health & Human Services (LHHS) appropriations bills. The SFOPs bill includes funding for U.S. global health programs at the State Department and the U.S. Agency for International Development (USAID), while the LHHS appropriations bill includes funding for global health programs at the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH).[i] Funding for all program areas was above the President’s FY 2018 budget request and either matched or exceeded final FY 2017 levels.

Key highlights from the bills are as follows (see table for additional detail):

• Funding provided to the State Department and USAID through the Global Health Programs (GHP) account, which represents the bulk of global health assistance, totaled $8.6 billion, $135 million (1.5%) below the FY 2017 enacted level, $2.1 billion (32.6%) above the President’s FY 2018 request, and $269 million (3.2%) above the FY 2018 House level. Most of the decrease compared to the FY 2017 level was offset by one-time transfers from unspent emergency Ebola funding.
• Funding provided to CDC for global health totaled $433.6 million, $1.5 million (-0.3%) below the FY 2017 enacted level ($435.1 million), $83.6 million (23.9%) above the President’s FY 2018 request, and $1.5 million (-0.3%) below the FY 2018 House level.
• Funding for the Fogarty International Center (FIC) at the National Institutes of Health (NIH) totaled $74.4 million, $2.2 million (3.0%) above the FY 2017 enacted levels ($72.5 million) and $1 million (1.4%) above the FY 2018 House level; the administration proposed to eliminate FIC in the President’s FY 2018 request.
• Details on global health funding in the Senate SFOPs appropriations bill are as follows:
  • Funding for Tuberculosis, Gavi, the Vaccine Alliance, Global Health Security, and Family Planning and Reproductive Health (FP/RH) were above the FY 2017 enacted level and FY 2018 House bill, while funding for all other global health programs at State and USAID remained flat; funding for all program areas were above the President’s FY 2018 request.
  • Bilateral HIV funding through the President’s Emergency Plan for AIDS Relief (PEPFAR) was $4,650 million in the Senate FY 2018 bill, matching the FY 2017 enacted and FY 2018 House levels and $800 million above the President’s FY 2018 request.
  • The bill included $1,350 million as the U.S. contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), matching the FY 2017 enacted and FY 2018 House levels and $225 million above the President’s FY 2018 request.
  • The bill provided $261 million in total funding for Tuberculosis, of which $20 million was provided through a one-time transfer of unspent emergency Ebola funding. The FY 2018 total funding level for Tuberculosis was $20 million above the FY 2017 enacted and FY 2018 House levels and $82.6 million above the President’s FY 2018 request.
  • The bill provided $755 million for Malaria activities, of which $100 million was provided through a one-time transfer of unspent emergency Ebola funding. The FY 2018 total funding level for Malaria matched the FY 2017 enacted and FY 2018 House levels and was $81 million above the President’s FY 2018 request.
  • The bill provided $202.5 million in total funding for Global Health Security (GHS), of which $130 million was provided through a one-time transfer of unspent emergency Ebola funding. The FY 2018 GHS total funding level was $60 million above the FY 2017 enacted level and $130 million above the President’s FY 2018 request.
  • The bill included $967.0 million for Maternal and Child Health (MCH), $7.5 million above the FY 2017 enacted level. It is not possible to calculate total MCH funding in either the President’s FY 2018 request or House due to uncertainty over the source of funding for the U.S. contribution to UNICEF. Specific areas under MCH include:
    • Gavi, the Vaccine Alliance was $15 million above the FY 2017 enacted level ($275 million) and matched the FY 2018 request and House levels ($290 million).
    • Polio, matched the FY 2017 enacted and FY 2018 House levels ($51.5 million in the GHP account and $7.5 million in the ESF account) and was $15 million above the FY 2018 request.
    • The bill provided $137.5 million as the U.S. contribution to the UNICEF through the International Organizations and Programs (IO&P) account. The FY 2018 request and House bill proposed to eliminate the IO&P account, but allowed for contributions to UNICEF through other accounts (the FY 2018 request did not specify an account while the FY 2018 House bill included UNICEF under the GHP account).
  • Funding for Nutrition totaled $125 million in the bill, matching the FY 2017 enacted and FY 2018 House levels and $46.5 million (59.2%) above the FY 2018 request.
  • Funding for Vulnerable Children totaled $23 million, matching the FY 2017 enacted and FY 2018 House levels. Funding for Vulnerable Children was eliminated in the FY 2018 request.
  • Funding for Neglected Tropical Diseases (NTDs) was $100 million, matching the FY 2017 enacted and FY 2018 House levels and $25 million above the FY 2018 request.
  • Family Planning and Reproductive Health (FP/RH) funding in the bill totaled $622.5 million from all accounts, which was $15 million above the FY 2017 enacted level ($575 million) and $162 million above the FY 2018 House ($461 million); funding for FP/RH was eliminated in the President’s FY 2018 Request.
    • Of the $622.5 million in FP/RH funding, $585 million was provided for bilateral programs ($544 through the GHP account and $41 million through the ESF account).
    • The Senate FY 2018 bill included $37.5 million as the U.S. contribution to UNFPA, which was $5 million above the FY 2017 enacted level ($32.5 million). Both the FY 2018 request and House bill eliminated funding to UNFPA.

The Senate SFOPs bill also included the following policy provision:

• Repeal of the Mexico City Policy (also known as the “Global Gag Rule”) that President Trump reinstated via executive order on January 22, 2017.

Resources:

• FY2018 State and Foreign Operations Appropriations Bill – Full Committee Draft
• FY2018 State and Foreign Operations Appropriations Bill – Full Committee Report
• FY2018 Labor, Health and Human Services, and Education Appropriations Bill – Full Committee Draft
• FY2018 Labor, Health and Human Services, and Education Appropriations Bill – Full Committee Report

The table (.xls) below compares the FY 2018 Senate SFOPs and LHHS appropriations bills to the FY 2017 enacted funding amounts as outlined in the “Consolidated Appropriations Act, 2017” (P.L. 115-31; KFF summary here), President’s FY 2018 request (KFF summary here), and the FY 2018 House SFOPS and LHHS appropriations bills (KFF summary here).

[i] Total funding for global health is not currently available as some funding provided through USAID and DoD is not yet available.