Congress questions global health impact of proposed budget cuts
Secretary of State Rex Tillerson testified before the House and Senate this week on the State Department’s 2018 fiscal year budget request of $37.6 billion, a cut of nearly 30%. Senators and representatives from both parties weighed in on the impact on world health initiatives.
Both Republicans and Democrats have dismissed the budget request as a non-starter, and throughout Tillerson’s testimony committee members expressed concern about the negative impacts these cuts would have on global health initiatives, among other national security issues.
Tillerson said the requested cuts are part of an effort to streamline the State Department and the United States Agency for International Development (USAID), following a 60% increase in its budget from fiscal year 2007, and an all-time high of $55.6 billion in fiscal year 2017. Despite these significant reductions in funding, he argued the U.S. will continue to be a leader in global health, international development and humanitarian efforts.
“Throughout my career I have never believed nor have I experienced that the level of funding devoted to a goal is the most important factor in achieving it,” Tillerson said on Tuesday. “Our budget will never determine our ability to be effective. Our people will.”
Senator Lindsey Graham (R-SC), said he welcomed efforts to reform the State Department, but described the budget request as “radical and reckless when it comes to soft power,” which is essential for national security yet represents only 1.4% of the federal budget. He particularly challenged Tillerson on the request to cut $1 billion from the President’s Emergency Plan for AIDS Relief (PEPFAR) created by the George W. Bush administration.
“Millions of young Africans are alive today because of the PEPFAR program [and] mother-to-child AIDS transmission has gone down by 75%” Graham said. Cutting funding for this program, just as five countries involved are becoming self-sufficient, would result in loss of treatment for hundreds of thousands of people, he added.
Tillerson agreed PEPFAR is “a model health program for the world to follow,” and said the new budget would “sustain the HIV/AIDS treatments in 11 countries, to continue to take those to conclusion as patients roll off of those rolls, then new treatments can be made available.”
However, Graham described the plan as “pennywise and pound-foolish” and said it would negatively impact those countries that have not yet become self-sufficient.
Impact of budget cuts, Global Gag Rule on reproductive health
In addition to the budget’s proposed elimination of funding for family planning, Senator Jeanne Shaheen (D-NH) took issue with the State Department's implementation of the Mexico City Policy in all global health assistance programs. Also known as the Global Gag Rule, this policy blocks federal funding for non-governmental organizations that provide or advocate for abortion services.
“Study after study has shown that integrating reproductive health and HIV treatment and prevention services into basic primary care services leads to better health outcomes and significant cost savings of foreign dollars, and yet the State Department in this budget proposes eliminating all funds for family planning,” Shaheen said. “So how will the State Department continue to move towards integrating HIV and reproductive health and family planning in light of the drastic cuts that are being proposed to reproductive health funding and the restrictions that you are imposing by the Global Gag Rule?”
Tillerson answered that this policy was directed under an executive order made by President Trump, and that the State Department believes the impact on affected reproductive health service providers will be minimal.
“We’re obligated to implement the presidential executive order, and we think we’ve found a way to ... achieve his directive, but do it in a way that has minimal impact on our ability to deliver funding to PEPFAR" and other related programs, he said, adding that the Department will re-evaluate those impacts after 6 months.
Shaheen challenged his assertion that the impacts would be minimal.
“Based on information that I’ve seen from other international sources, losing access to family planning services will result in 2 million more unsafe abortions, 12,000 maternal deaths and 6 million more unintended pregnancies,” she said, and asked if Tillerson would be comfortable with these impacts to women’s health.
“We will carry it out consistent with the president’s executive order, so if certain activities and programs are excluded because of the order, we have to exclude those,” he responded.
On Wednesday, Congressman Ami Bera, MD (D-CA), a physician with a public health and global health background, echoed Senator Shaheen’s concerns about the budget’s impacts on women’s health, particularly a 15% cut to maternal and child health programs. He also further challenged Tillerson on whether he would seek to reverse the Global Gag Rule if adverse impacts were identified at the 6-month re-evaluation.
Tillerson said he could not commit to seeking a reversal of the policy, but noted that if the policy had unintended negative impacts, he has the authority to issue waivers in consultation with the Secretary of Health and Human Services to allow funding to continue.
Also on Wednesday, Congresswoman Lois Frankel (D-FL), described the proposed budget as “inhumane and dangerous,” and argued that U.S. global health initiatives — like The Global Fund, which controls the spread of malaria, tuberculosis and HIV, which the proposed budget would cut by $225 million — are essential for the security of foreign nations as well as our own.
“Diseases do not recognize international borders. [In 2016] almost 80 million people from other countries visit[ed] the U.S, Americans took more than 77 million international trips, we have hundreds of thousands of military living overseas, so U.S. global assistance helps not only to protect people in other countries, but it protects the U.S.,” she said. These health initiatives also mitigate the destabilizing effects of famine, disease, and inhumane conditions which contribute to refugee crises and environments for terrorism, she added, and posed the question to Tillerson, “Why should we care about disease in other countries?”
He said he agreed with her explanation, and emphasized that despite the difficult choices the State Department made in cutting its budget, it remains committed to ongoing global health programs.
“We do believe we can attract others and other funding and enable continuation of these programs and there is no stepping back from our commitment on PEPFAR [and other programs],” he said. “We don’t intend in any way to abandon our efforts or to abandon our view on how important these issues are.”
Some committee members were less critical. Congressman Ted Yoho (R-FL), for example, expressed support for the State Department’s plan to cut costs and identify inefficiencies in foreign aid programs.
“Some of my colleagues here aren’t accepting the fact that we’re $20 trillion in debt and that austerity measures are coming,” he said. Referencing Puerto Rico and Greece, he said, “we’ve got reports of where we’re going to be in 5 to 6 years ... so we do have to reform some of these programs, and that leads to the current budget. [We should] continue the programs that work and ... get rid of the programs that aren’t working.” In addition, we should put pressure on countries that are too reliant on U.S. aid, such as the Democratic Republic of Congo, he said.
Ultimately, the committee members indicated that the final version of the budget will be revised and increased. According to Senator Bob Corker (R-TN), Chairman of the Foreign Relations Committee, the budget presented “is not going to be the budget we deal with. It’s just not.” – by Adam Leitenberger