June 20, 2019

Federal Appropriations Process Even Rockier than Usual

The federal Appropriations season is underway. The Administration continues its vow to invest in a “moonshot” of federal funding to End the HIV Epidemic (casually known as EtE) over the next 10 years, but this unilateral commitment is resulting in making federal budget negotiations even more precarious this year than usual. The President announced in March that he will support his EtE project allocating $291 million over the next decade to support HIV-related work at the Centers for Disease Control (CDC), the Health Resources and Services Administration (HRSA) and the Indian Health Services.

To pay for this, the President proposed a budget that makes deep cuts elsewhere, particularly in Medicaid, NIH and PEPFAR (the US-led global response to HIV). This is achievable by simultaneously slowing down Medicaid spending, breaking down the Affordable Care Act and discouraging Medicaid Expansion in states considering it – all interventions that will inevitably diminish access to HIV treatment and prevention in 2020.

The House of Representatives has started its debate on the floor about its first package of FY 2020 budget proposals, which includes funding for Labor-Health and Human Services. The House Committee on Appropriations, in sharp contrast to the President, is recommending $3.2 billion for HIV/AIDS research. Their proposal for HRSA overall is $1.5 billion above the President’s budget request. It includes a $116 million for the Ryan White HIV/AIDS program budget in FY2020, as well as a $148 million increase HRSA’s Bureau of Health Professions programs to support the medical workforce. It even adds an increase of $114 million for the Title X Family Planning program.

When the FY2020 budget finally appears in the Senate, it will likely be another turn-about. In this political atmosphere, it seems very unlikely that both chambers will agree on a budget by the October deadline.

Absent that, our federal expenses will have to be paid with short-term Continuing Resolutions while the two chambers hammer out a budget that the President is willing to sign. With enough of those, we may burn through the $291 million that the President promised to implement EtE.