On Feb. 22, President Barack Obama requested an emergency supplemental appropriations bill to respond to public health concerns of the Zika virus. The request includes a total of $1.885 billion in additional funding in excess of the $518.491 billion in total base nondefense discretionary budget authority already available for fiscal year 2016.
If the president’s request or another supplemental is enacted, it would be the 15th emergency supplemental appropriation enacted since 2006. Cumulatively, Congresses have provided about $190 billion in nondefense emergency supplemental appropriations since 2006.
Interestingly enough, the president’s request for Zika could be paid for with Ebola funds.
In early April, the administration identified $589 million (including $510 million from Ebola resources) that could be reprogrammed towards the Zika funding.
So far, about $427 million has been redirected.
In total, there are about $2.77 billion in unobligated balances from the 2015 fiscal year Ebola emergency supplemental appropriation that could be used towards a Zika response.
That includes $1.461 billion in budget authority for the Department of Health and Human Services, $1.294 billion for the State Department and the U.S. Agency for International Development, and $17.3 million for the Department of Defense.
The HHS funds are mostly likely reprogrammable without congressional action, given that the appropriation was made available for Ebola or other infectious diseases.
Emergency Supplemental Appropriations
Emergency supplemental appropriations are not subject to the pay-as-you-go and spending cap requirements originally prescribed by the Budgetary Enforcement Act of 1990, and now under the authority of the Statutory Pay-As-You-Go Act of 2010.
Specifically, Congress designates the emergency requirement in statute and, for discretionary appropriations, on an account by account basis under section 251(b)(3)(A) of the Balanced Budget and Emergency Deficit Control Act of 1985.
These bills can be initiated by either Congress or the president, and there is virtually no limit on the amount of additional spending that may be passed other than through a point of order that can easily be waived.
Most of the funding included in the president’s emergency supplemental request, $1.509 billion, would go to HHS, with about half of that amount going to the Centers for Disease Control and Prevention.
Why Obama Is Asking for Zika Funds
The president’s Zika request would also include a one-year increase in the Federal Medical Assistance Percentage for Puerto Rico and other U.S. territories. It would include funding for additional clinicians and home visits in Puerto Rico—including Puerto Rico’s Maternal and Child Health Program, about $130 million to National Institutes of Health for the development of vaccines as well as basic research on the history of Zika, and $10 million for Food and Drug Administration vaccine and diagnostics development and review.
Furthermore, the president’s emergency supplemental includes a request to use unobligated resources from USAID and the State Department associated with the Ebola supplemental.
What’s telling about this request is that if you remove the Medicaid FMAP provision, HHS already has more than enough unobligated budget authority to cover the $1.263 billion in additional activities included in the supplemental request.
The president has, of course, wanted an enhanced Medicaid Federal Medical Assistance Percentage for Puerto Rico and other U.S. territories for some time. In fact, a similar policy was included in the president’s 2017 fiscal year budget request.
However, by using the Zika emergency supplemental to move the proposal forward, the president seems to be trying to capitalize on the recent disease outbreak in order to get his proposed policy through while avoiding having to pay for the policy change. Otherwise, the Medicaid Federal Medical Assistance Percentage provision might have to stand on its own.
Potential Congressional Action Needed
Congressional action may be needed to reprogram the State Department and USAID funds as the appropriation was made to “prevent, prepare for, or respond to the Ebola disease outbreak.”
Emergency supplemental appropriations bills are intended to cover emergencies, disaster relief, or other needs that are determined to be too urgent to be postponed until the next enactment of regular appropriations.
If both the Zika and Ebola disease outbreaks are considered to be serious public health concerns needing additional funding, any unobligated balances from the Ebola supplemental appropriations bill spent on Zika could be backfilled through a normal appropriation.