Discretionary Spending
Function 150 - International Affairs
Reduce Appropriations for Global Health to Their Level in 2000
CBO periodically issues a compendium of policy options (called Options for Reducing the Deficit) covering a broad range of issues, as well as separate reports that include options for changing federal tax and spending policies in particular areas. This option appears in one of those publications. The options are derived from many sources and reflect a range of possibilities. For each option, CBO presents an estimate of its effects on the budget but makes no recommendations. Inclusion or exclusion of any particular option does not imply an endorsement or rejection by CBO.
| Billions of Dollars | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 | 2025 | 2026 | 2027 | 2028 | 2019- 2023 |
2019- 2028 |
|
| Change in Spending | |||||||||||||
| Budget authority | 0 | -7.6 | -7.8 | -8.0 | -8.1 | -8.3 | -8.5 | -8.7 | -8.9 | -9.0 | -31.5 | -74.8 | |
| Outlays | 0 | -0.5 | -3.3 | -5.8 | -6.9 | -7.4 | -7.8 | -8.2 | -8.4 | -8.6 | -16.5 | -57.0 | |
This option would take effect in October 2019.
The estimate of savings stems from the difference between the proposed funding and amounts in the Congressional Budget Office's baseline, which are determined by 2018 appropriations and adjusted for inflation.
Background
Between 2000 and 2010, annual appropriations for Global Health increased (in 2018 dollars) from roughly $1 billion to $9 billion. (Some Global Health funding is appropriated to accounts managed by the Department of State, whereas other funding is appropriated to accounts managed by the United States Agency for International Development. The Congressional Budget Office has aggregated the accounts here.) Global Health appropriations are used to combat HIV/AIDS, prevent child and maternal deaths, and reduce the threat of infectious diseases. Most of the funding in recent years has been spent for efforts in African nations.
Option
This option would reduce Global Health appropriations to about $1 billion annually, which was their inflation-adjusted level in 2000.
Effects on the Budget
Implementing this option would save $57 billion over 10 years. CBO expects that 7 percent of the savings resulting from the reduction in funding in 2020 would accrue in that year, 36 percent would accrue the next year, and the remainder would accrue over the following years. That rate of spending is consistent with historical patterns in the Global Health account. Choosing among prospective recipients is a lengthy process, so outlays often do not occur until several years after Global Health funds have been appropriated.
The estimate of savings stems from the difference between the proposed funding and amounts in CBO's baseline, which are determined by 2018 appropriations and adjusted for inflation. Savings under this option would be proportional: Decreasing Global Health appropriations to $3 billion instead (roughly their level in 2003), for instance, would save about $36 billion over 10 years. The option's savings are somewhat uncertain because of the potential for actual appropriations to differ from CBO's baseline projections.
Other Effects
One argument for this option is that the goals for the program may have nearly been met. The U.S. government's strategy has been to control the HIV/AIDS epidemic by 2020 in a selected group of countries with high rates of infection. If the program has been able to largely achieve that goal, further spending in that category might not be as valuable. A second argument is that a reduction in Global Health appropriations could spur other organizations or governments to increase their investments in such initiatives. Those investments could be at least as effective—or even more effective—than those of the State Department and the Agency for International Development.
The main argument against this option is that combating certain diseases could be more difficult if other funding sources did not emerge. That outcome could adversely affect health worldwide.