Health Diplomacy Bulletin #22
November 30, 2018
Issue No. 22
- As AIDS Day Approaches, House and Senate Pass PEPFAR Reauthorization
- With a bill that is short and sweet, the House and Senate voted to reauthorize PEPFAR through 2023.
- Vice President Pence gives PEPFAR a ringing endorsement.
- As a Dec. 7 deadline nears, global health is still not funded for all of fiscal 2019, but a continuation of last year’s level is likely.
- Nov. 6 elections put Democrats in charge of the House, with a new line-up of leaders for U.S. global health efforts.
PEPFAR, Global Fund Reauthorization Passes House
With the 30th anniversary of World AIDS Day coming Dec. 1, the Senate on Wednesday passed, by unanimous consent, the bill that reauthorizes PEPFAR for another five years. The bill passed the House on a voice vote on Nov. 13. It represents what the community of global health supporters has been calling “Reauthorization Lite.”
Here is the text, which is short and sweet. It extends the program through 2023, at which point it will be 20 years since it was initiated by President George W. Bush.
Passing reauthorization without a hitch was a significant achievement at a time when the U.S. Treasury is facing trillion-dollar deficits starting in 2020. Rep. Chris Smith, who co-chairs the Pro-Life Caucus and the Foreign Affairs Committee’s panel on Africa, Global Health, Global Human Rights and International Organizations, deserves special credit for sponsoring the original House measure. He has been among the most prominent conservative advocates for PEPFAR in Congress over the past 15 years.
A Tweet by Liz Schrayer, president of the U.S. Global Leadership Coalition, gave a shout-out to Smith, as well as to Rep. Ed Royce (R-Calif), the departing chair of the House Foreign Affairs Committee; retiring Florida Republican Rep. Ileana Ros-Lehtinen; and Rep. Karen Bass (D-, who is expected to become the next chair of the Africa Subcommittee that Smith now heads.
Retiring Sen. Bob Corker (R-Tenn), chair of the Foreign Relations Committee, and the panel’s top Democrat, Sen. Bob Menendez (D-NJ), who was just re-elected, took leadership roles in achieving Senate passage.
Besides extending authorizations through 2023, the bill’s only change of note is related to the Global Fund to Fight AIDS, Tuberculosis and Malaria. The legislation establishes that the 33% cap on U.S. contributions to the fund is calculated for the entire period since 2004 (rather than 2009, as in the 2013 reauthorization). The change from 2009 to 2004 was inserted in each of the previous appropriations bills in recent years, so the reauthorization bills will simply make the practice permanent. The effect is that, as long as other countries continue their donations, the U.S. will be authorized to give the Global Fund $1.35 billion annually.
Pence: ‘This Extraordinary Humanitarian Effort’
The bill, of course, needs the signature of Donald Trump to become law. On Thursday, Vice President Mike Pence, gave assurances that the President, who is in Argentina for the G20 summit meeting, would sign soon. “We’re grateful for the strong and bipartisan support in the Congress for this extraordinary humanitarian effort by the American people,” Pence said. “President Trump believes this reauthorization is a critical component of our administration’s commitment to combat AIDS.”
Pence has been an advocate for PEPFAR right from the start. He voted to initiate the program in 2003 and then for reauthorization in 2008. Bono, the U2 singer and co-founder of the One campaign met with Pence last year at the Munich Security Conference and praised him for his support of PEPFAR. “Twice on the House floor you defended [PEPFAR],” Bono said. “That’s how we know you.”
Also on Thursday, Pence announced that $100 million will go to religious groups working to combat the spread of HIV/AIDS.
The State of Funding for This Year
Authorization is not appropriation. Congress has to pass spending bills each year to get actual dollars to discretionary programs like PEPFAR – or else, it has to approve a stop-gap measure, in the form of a continuing resolution (CR), to keep the funds flowing. Fiscal 2019 began on Oct. 1, but so far only five of the 12 appropriations bills have passed the House and Senate and been signed into law. The approved bills include the largest – for the Defense Department – as well as others such as legislation funding the Health and Human Services and Energy Departments.
But the State Department and foreign operations, from which most of the funds for global health flow, have not been funded. Instead, PEPFAR and other global health programs continue to receive money from the Treasury at fiscal 2018 levels. But those funds will run out on Dec. 7 (creating a “government shutdown”) unless appropriations or another CR passes.
The likely outcome is what happened last year. The White House asks for major cuts to global health – over $1 billion in reductions for PEPFAR and the Global Fund – but actual funding ends up the same as the previous year.
Supportive Members of Congress Rise to Leadership With Nov. 6 Elections
With the congressional elections on Nov. 6, Democrats regained their majority in the House of Representatives. The biggest change for global health is the imminent ascension of Rep. Nita Lowey as chair of the full Appropriations Committee.
Lowey, a 15-term New York Democrat, has long been her party’s leader on the Appropriations Subcommittee on State, Foreign Operations, and Related Programs. That panel has jurisdiction over nearly all global health programs in the U.S. government, including PEPFAR.
Lowey has been a strong advocate for global health. With support from Republicans, the subcommittee has consistently resisted attempts by the Trump Administration to cut budgets, and she understands the key role global health plays in national security. Last year, for example, in arguing for maintaining traditional levels of spending for PEPFAR and other programs, she said she was worried that, if the U.S. reduced its commitment, other countries might fill the gap and that “we risk that the void will be filled by those who oppose our interests.”
Lowey will likely retain her chair of the subcommittee, where the number-two Democrat is Rep. Barbara Lee (D-Calif), an original co-author of PEPFAR. In May, Lee commented on the 15th anniversary of the program by saying, “The United States must double down on our commitment to fighting this disease and empowering those living with HIV/AIDS. Our work will not be finished until we eradicate this disease from every corner of the Earth.”
Rep. Hal Rogers (R-Ky), currently the chairman of the subcommittee, won a 20th term on Nov. 6; he is expected to continue as ranking member. Just behind Rogers among Republicans on the subcommittee is Rep. Kay Granger of Texas, who currently chairs the Appropriations Subcommittee on Defense.
On the authorization side, the new chairman of the House Foreign Affairs Committee will almost certainly be Rep. Eliot Engel, who whose New York districts abuts Lowey’s. Engel has worked closely with Royce, the current chairman, who did not stand for re-election. Also, like Lowey, Engel was present at the creation of PEPFAR and has been an enthusiastic backer. Three Republicans are vying for the ranking-member position on the full committee: Reps. Mike McCaul (Texas), Joe Wilson (SC), and Ted Yoho (Fla). McCaul formerly headed the Homeland Security Committee.
In the Senate, as we noted, Corker is retiring, and Sen. Jim Risch (R-Idaho), next in line by seniority, is expected to succeed him as chairman of the Foreign Relations Committee. Little is known about Risch’s position on global health issues.
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