House Passes $516B Spending Bill With Global Health Provisions

The House on Monday voted 253-154 to approve a $516 billion fiscal year 2008 spending bill that combines 10 unfinished spending measures with the FY 2008 foreign operations spending bill (HR 2764), the New York Times reports (Hulse, New York Times, 12/18). The measure would fund the Department of State, USAID, and other global health and international aid programs. It also affects the Millennium Challenge Corporation, which aims to encourage economic and political reforms in developing countries, CQ Today reports.

The proposed bill would provide $6.5 billion for U.S. and global health activities, which is $1.4 billion more than in 2007 and $796 million more than President Bush's request, including emergency spending, according to the House Appropriations Committee. Five billion dollars in foreign operations spending would go to the President's Emergency Plan for AIDS Relief -- at least $1.2 billion more than the program received last year -- CQ Today reports (Graham-Silverman, CQ Today, 12/17).

According to the Washington Post, conservatives "in and out of Congress criticized" the bill, including a provision that would "sever[e] overseas AIDS relief from abstinence-education mandates" (Weisman, Washington Post, 12/18). By law, at least one-third of HIV prevention funds that focus countries receive through PEPFAR must be used for abstinence-until-marriage programs (Kaiser Daily HIV/AIDS Report, 11/30).

Under the bill, the Global Fund To Fight AIDS, Tuberculosis and Malaria would receive about $841 million. The amount includes $546 million in the State-Foreign Operations section and $295 million in the Labor-HHS-Education section of the bill. Bush had requested $300 million for the Global Fund, all of which was allocated in the Labor-HHS bill, CQ Today reports (CQ Today, 12/17).

In addition, the measure would provide $1.8 billion for global health and child survival programs, including $347 million for HIV/AIDS programs. Funding for maternal and child health programs would increase by $101 million, and malaria and TB funding would increase by $101 million and $72 million, respectively (House Appropriations Committee release, 12/16). The measure would reduce funding for MCC to $1.54 billion -- about half of Bush's requested $3 billion. MCC is "cut below the president's request because of the availability of unobligated balances," the Appropriations Committee said. A proposal to change the way MCC funding is dispersed was dropped, according to CQ Today (CQ Today, 12/17).

The measure also would increase funding for AIDS Drug Assistance Programs -- federal- and state-funded programs that provide HIV/AIDS-related medications to low-income, uninsured and underinsured HIV-positive individuals -- by $19 million to $809 million, CQ HealthBeat reports (Reichard, CQ HealthBeat, 12/17). In addition, the measure would lift a ban on needle-exchange programs in Washington, D.C.

Reaction
"I'm pleased to report that we're making some pretty good progress toward coming up with a fiscally sound budget -- one that meets priorities, helps on some emergencies and enables us to say that we've been fiscally sound with the people's money," Bush said Monday.

Some Republicans in the Senate and House called on Bush to veto the final measure. Even Democratic leaders were "only mildly supportive" of the compromise measure, the Post reports. "In an adult world, win, lose or draw, we have an obligation to complete our work," House Appropriations Committee Chair David Obey (D-Wis.) said, adding, "In an adult world, we have an obligation to compromise and move on" (Washington Post, 12/18).

The measure now goes to the Senate, where Republicans are expected to add funding for the war in Iraq. The White House on Monday said Bush would sign the bill only if Iraq funding is included, CQ Today reports (Wayne, CQ Today, 12/17).

Senators, HIV/AIDS Advocates Call for PEPFAR Reauthorization at Senate Committee Hearing
In related news, senators and HIV/AIDS experts on Thursday at a Senate Foreign Relations Committee hearing called on Congress to promptly reauthorize PEPFAR, CQ HealthBeat reports. Sen. Robert Menendez (D-N.J.), who chaired the hearing, said the challenges the U.S. faced when PEPFAR was created in 2003 remain as "relevant and as devastating as ever."

Nils Daulaire, president and CEO of the Global Health Council, said "expedient and thoughtful" reauthorization is critical over "the next several months." Helen Smits, vice chair of the Committee for the Evaluation of PEPFAR Implementation at the Institute of Medicine, said that if the program is not reauthorized quickly, nongovernmental organizations working in recipient countries might be forced to lay off employees.

The witnesses who testified before the committee also said that the next step in fighting the HIV/AIDS epidemic would have to involve efforts to strengthen health care systems in developing countries. Sen. John Sununu (R-N.H.) said there is a need to "develop systems that can adequately address the scope of the HIV/AIDS epidemic." He also called for a health care capacity large enough to implement PEPFAR goals (Gensheimer, CQ HealthBeat, 12/17).