The global pandemic of Coronavirus Disease 2019 (COVID-19) is affecting communities around the world and throughout the United States, with case counts growing daily. Containment and mitigation efforts by federal, state, and local governments have been undertaken to flatten the curve âthat is, to curb widespread transmission that could overwhelm the nation's health care system. Federal response efforts have included the enactment of laws to provide authorities and supplemental funding to prevent, prepare for, and respond to the pandemic. This report focuses on supplemental FY2020 discretionary appropriations provided to programs and activities traditionally funded by the Departments of Labor, Health and Human Services, and Education, and Related Agencies (LHHS) appropriations bill. As of the date of this report, LHHS supplemental appropriations for COVID-19 response have been provided in four separate supplemental appropriations measures: Title III, Division A, of the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 ( P.L. 116-123 ), enacted on March 6, 2020. Title V, Division A, of the Families First Coronavirus Response Act (FFCRA, P.L. 116-127 ), enacted on March 18, 2020. Title VIII, Division B, of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act, P.L. 116-136 ), enacted on March 27, 2020. Title I, Division B, of the Paycheck Protection Program and Health Care Enhancement Act (PPPHCEA, P.L. 116-139 ), enacted on April 24, 2020. In total, LHHS has received roughly $280 billion in supplemental discretionary appropriations from these COVID-19 response measures. These funds are in addition to roughly $195 billion in regular FY2020 LHHS discretionary appropriations provided in Division A of P.L. 116-94 , the FY2020 LHHS omnibus appropriations act that was enacted on December 20, 2019. Unlike the annual discretionary appropriations, however, these additional funds were designated as an "emergency requirement" and thus were effectively exempted from otherwise applicable budget enforcement requirements (such as the statutory discretionary spending limits). Overall, the COVID-19 supplemental funds have increased FY2020 LHHS discretionary appropriations by approximately 143%. The relevant legislative history of each of the four enacted laws containing LHHS supplemental appropriations is detailed below. In the weeks leading up to the supplemental appropriations action in Congress, Alex Azar, the Secretary of the U.S. Department of Health and Human Services (HHS), took administrative steps to allocate existing funding to COVID-19 response efforts. These included issuing a determination on January 25, 2020, allowing the allotment of $105 million from the Infectious Diseases Rapid Response Reserve Fund (IDRRRF). He also reportedly informed Congress on February 2 that he would potentially exercise his authority to transfer $136 million in existing funds within HHS to increase the budgetary resources of several operating divisions and offices that were tasked with COVID-19 response. In response, the Chair of the House Appropriations Committee, Representative Nita Lowey, and the Chair of the LHHS Subcommittee, Representative Rosa DeLauro, sent the Secretary a letter expressing concern that budgetary resources available to HHS at that time would not be sufficient. On February 24, 2020, the Trump Administration sent Congress a request for supplemental appropriations of $1.25 billion for the Public Health and Social Services Emergency Fund (PHSSEF) at HHS. The request letter included a number of other proposals, largely but not exclusively related to re-purposing existing funds toward response efforts. All told, the Administration estimated needing to allocate approximately $2.5 billion toward COVID-19 response efforts. (For the most part, amounts for other LHHS aspects of the request generally were unspecified in the publicly released request letter.) Several days after the Administration's request, the Chair of the House Appropriations Committee introduced H.R. 6074 on March 4, 2020. The measure passed the House that same day by a vote of 415-2, passed the Senate on March 5 by a vote of 96-1, and was signed into law ( P.L. 116-123 ) on March 6. According to the Congressional Budget Office (CBO), P.L. 116-123 provided a total of $7.8 billion in supplemental appropriations in Division A, of which roughly $6.4 billion (about 83%) was for LHHS accounts and activities. (Division B contained authorization provisions related to certain LHHS programs and activitiesâproviding the HHS Secretary authority to temporarily waive or modify the application of certain Medicare requirements with respect to telehealth services. The mandatory spending budgetary effects of these provisions are outside the scope of this report.) A second COVID-19 response measure was developed by Congress and the Administration soon after the first was enacted. Initially, H.R. 6201 was introduced by the Chair of the House Appropriations Committee on March 11, 2020. The House amended and passed the measure by a vote of 363-40 on March 14, but further alterations to the final legislative package were negotiated over the next two days. On March 16, the House (by unanimous consent) considered and agreed to a resolution ( H.Res. 904 ) that directed the Clerk to make changes to the legislation when preparing the final, official version of the House-passed bill ( engrossment ). The engrossed version was sent to the Senate and ultimately passed without amendment by a vote of 90-8 on March 18. The President signed the bill into law ( P.L. 116-127 ) the same day. Division A of P.L. 116-127 was estimated by CBO to provide a total of $2.5 billion in supplemental appropriations, of which $1.25 billion (approximately 51%) was for LHHS accounts and activities. (Other divisions of the act contained authorization provisions that in some cases relate to LHHS programs and activitiesâfor instance, provisions providing a 6.2% increase to the federal matching assistance percentage for Medicaid and certain other programs. The mandatory spending budgetary effects of such provisions are outside scope of this report.) On March 17, 2020, the Administration released a second request for FY2020 supplemental appropriations of $45.8 billion for COVID-19 response, of which $11.1 billion was for LHHS accounts and activities. Over the next several days, Congress and the Administration negotiated the scope and scale of this legislative response, which was expected to involve authorities and additional funding for numerous programs across the federal government. The legislative vehicle that was ultimately chosen for this package was H.R. 748 , an unrelated measure that had been passed previously by the House. Prior to when a deal was reached between Congress and the Administration, the Senate voted on March 22 (47-47) and March 23 (49-46) not to invoke cloture on the motion to proceed to H.R. 748 . The measure was ultimately laid before the Senate by unanimous consent and passed with a substitute amendment by a vote of 96-0 on March 25. The House subsequently took up the Senate amendment on March 27, and agreed to it by a voice vote. The bill was signed into law ( P.L. 116-136 ) by the President that same day. According to CBO, P.L. 116-136 provided about $330 billion in supplemental appropriations in Division B, of which $172.1 billion (approximately 57%) was for LHHS accounts and activities. (Division A contained authorization provisions that in some cases relate to LHHS programs and activitiesâfor instance, $1.320 billion in mandatory funds for the HRSA health centers program. The mandatory spending budgetary effects of such provisions are outside the scope of this report.) About three weeks after the enactment of the CARES Act, Congress and the President came to an agreement that, among other provisions, provided additional supplemental appropriations to HHS for the Provider Relief Fund and to support COVID-19 testing. The legislative vehicle that was used for the agreement was H.R. 266 , an unrelated appropriations bill that had been passed previously by the House. On April 21, 2020, the measure was laid before the Senate by unanimous consent and passed with a substitute amendment by voice vote. The House adopted the Senate version of the proposal on April 23 by a vote of 388-5. The President signed the bill into law ( P.L. 116-139 ) the following day. According to CBO, P.L. 116-139 provided $162.1 billion in supplemental appropriations in Division B, of which $100 billion (approximately 62%) was for LHHS. (Division A contained no provisions related to LHHS programs and activities. The mandatory spending budgetary effects of the authorization provisions in Division A are outside the scope of this report.) As previously mentioned, LHHS has received in total roughly $280 billion in supplemental discretionary appropriations from the COVID-19 response measures ( Table 1 ). HHS received funding in all four supplemental appropriations acts, whereas the Department of Labor (DOL), the Department of Education (ED), and entities funded under the Related Agencies (RA) heading received funding in the third supplemental only. HHS received the vast majority of all LHHS COVID-19 supplemental fundsâ$248 billion, or 89%. ED received the second-largest shareâ$31 billion, or 11%. DOL and RA received approximately 0.1% and 0.2%, respectively. The remainder of this report provides highlights for HHS, DOL, ED, and RA, and includes a detailed table ( Table 2 ) organized by department or agency and by account, program, or activity. The majority of DOL funds ($345 million) in the third measure are for dislocated worker assistance through activities authorized by the Workforce Innovation and Opportunity Act (WIOA). Specifically, the DOL funds are for the WIOA National Reserve, which provides National Dislocated Worker Grants (NDWGs) to states and localities to assist with worker dislocation resulting from natural disasters and mass layoffs. These funds are generally expected to address workforce-related effects of the COVID-19 pandemic. The majority of HHS funds (93%) in the supplemental appropriations measures have been appropriated to the Public Health and Social Services Emergency Fund (PHSSEF). The PHSSEF account is used by the HHS Secretary for one-time or short-term funding, such as emergency supplemental appropriations, and for some ongoing public health preparedness activities in the Office of the HHS Assistant Secretary for Preparedness and Response (ASPR). Accounts at the Centers for Disease Control and Prevention (CDC) received approximately 3% of the supplemental HHS appropriations provided in the COVID-19 response measures. Accounts at the Administration for Children and Families (ACF) received a similar amount. Remaining funds were provided in smaller amounts to the National Institutes of Health (NIH), the Administration for Community Living (ACL), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Centers for Medicare and Medicaid Services (CMS). While amounts shown in Table 2 are displayed as appropriated, readers should note that the first, third, and fourth COVID-19 supplemental appropriations acts authorized HHS to transfer funds made available in these acts, provided the transfers are made to prevent, prepare for, and respond to the pandemic. (This broad authority giving HHS discretion over certain transfers is in addition to provisions in these three measures that direct HHS to make specific transfers.) The first measure broadly allowed for HHS to transfer funds among accounts at CDC, NIH, and PHSSEF. The third measure allowed for transfers among amounts at CDC, PHSSEF, ACF, ACL, and NIH. The fourth measure allowed for transfers among accounts at CDC, NIH, PHSSEF, and the Food and Drug Administration, but limited the amounts available for such transfers (e.g., it excluded from this authority $75 billion provided to the PHSSEF for the "Provider Relief Fund"). The acts require HHS to notify the House and the Senate appropriations committees 10 days in advance of such transfers. The PHSSEF received about $232 billion in funding across the four measures. This accounts for 83% of all LHHS funds provided in the acts (and 93% of the HHS funds in the LHHS titles of the bills). These PHSSEF funds may support various activities, including health care surge capacity and the development and purchase of medical countermeasures, including vaccines. In general, PHSSEF supplemental funding has been provided for four main sets of activities. Medical Countermeasures and Surge Capacity: The first and third measures each provided funding to support the development, and in some cases federal purchase, of COVID-19 medical countermeasures, such as diagnostic tests, treatments, vaccines, and medical supplies, as well as for healthcare workforce and other surge capacity activities. In total, approximately $30.4 billion has been provided for these activities. Note that the bills also specify that some of these funds are to be transferred elsewhere (e.g., to other federal agencies for the care of persons under federal quarantine) or reserved for specific purposes or activities (e.g., deposits to the Strategic National Stockpile). These activities may be carried out by various ASPR components, especially the Biomedical Advanced Research and Development Authority (BARDA) for countermeasure development and procurement. COVID-19 Testing for the Uninsured : The second supplemental measure included $1 billion to provide reimbursements for COVID-19 testing and related services for persons who are uninsured. In addition, the fourth measure specified that up to $1 billion out of the amounts appropriated for broader COVID-19 testing purposes (discussed below) may be used to cover the costs of testing for the uninsured. Both measures provide for these payments to be made according to the National Disaster Medical System (NDMS) definitive care reimbursement mechanism. However, the program is administered by HRSA. Provider Relief Fund: The third and fourth supplemental measures each provided funding for a "Provider Relief Fund" to assist health care providers and facilities affected by the COVID-19 pandemic. These funds are intended to reimburse eligible health care providers for health care-related expenses or lost revenues that are attributable to COVID-19. The measures define eligible providers broadly as any that provide "diagnoses, testing, or care for individuals with possible or actual cases of COVID-19." In total, $175 billion has been appropriated for the Provider Relief Fund. COVID-19 Testing , Surveillance, and Contact Tracing : The fourth supplemental measure provided $25 billion to augment national capacity for COVID-19 containment, including expanded testing capacity, and workforce and technical capacity for disease surveillance and contact tracing. The bill directed HHS to reserve some of these funds for specific purposes (e.g., not less than $11 billion is for states, localities, territories, tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes). In addition, the bill specified that certain funds are to be transferred to other agencies and accounts (e.g., $600 million is to be transferred to the FDA for diagnostic, serological, antigen, and other tests). In addition to the activities specified above, PHSSEF appropriations in the first, third, and fourth supplemental measures called for some portion of the funds to be transferred to other agencies or accounts for particular activities. For instance, some PHSSEF funds are required to be transferred to the HRSA for health centers, rural health, the Ryan White HIV/AIDS program, and health care systems. Further public health-related funding for preparedness and response was appropriated to the CDC ($6.5 billion) and NIH ($1.8 billion) in the first and third supplemental measures. In addition, the fourth supplemental explicitly directed certain PHSSEF appropriations to be transferred to CDC and NIH for COVID-19 response activities. When accounting for these transfers, total funding directed to the CDC would come to not less than $7.5 billion and total funding directed to NIH would come to not less than $3.6 billion. The CDC funding was intended, among other things, to support grants, or cooperative agreements with grants to states, localities, tribes and other entities, for public health activities (e.g., surveillance, infection control, diagnostics, laboratory support, and epidemiology), as well as for global disease detection and modernization of public health data collection. The funds may also be used to support public outreach campaigns, and provide guidance to physicians, health care workers, and others. Most of the NIH funding was provided to several institutes to support basic scientific research as well as research on potential vaccines, therapeutics, and diagnostics related to COVID-19. ACL received a total of $1.2 billion in the second and third response measures. The majority of this funding ($750 million) was spread across a variety of activities that the agency undertakes to help provide meals to low-income seniors. SAMHSA received $425 million in the third measure, with $250 million for Certified Community Behavioral Health Clinics, $50 million for suicide prevention programs, and not less than $15 million for Indian Tribes. The measure specified that not less than $100 million be made available as emergency response grants for state governments for crisis intervention services, mental health and substance use disorder treatment, and recovery supports for individuals affected by the pandemic. CMS received $200 million in the third measure. At least half of this appropriation was to be spent on additional infection control surveys for federally certified facilities with populations vulnerable to severe illness from COVID-19. ACF received $6.3 billion in the third measure. These funds were directed to a number of human services programs. For instance, the Child Care and Development Block Grant received $3.5 billion to provide continued assistance to child care providers in the event of decreased enrollment or program closures. These funds may also be used to support child care facilities that are open and operating, including those providing care for the children of essential workers. Several other ACF programs received funding, including the Community Services Block Grant ($1 billion), Head Start ($750 million), and the Low Income Home Energy Assistance Program ($225 million). Almost all of the $30.925 billion in supplemental ED appropriations provided in the third measure are for the Education Stabilization Fund (ESF). The ESF is composed of three emergency relief funds: (1) a Governor's Emergency Education Relief (GEER) Fund (Â§18002), (2) an Elementary and Secondary School Emergency Relief Fund (ESSERF; Â§18003), and (3) a Higher Education Emergency Relief (HEER) Fund (Â§18004). The third measure provided a total of $30.750 billion for the ESF and specified that these funds are to remain available through September 30, 2021. The GEER Fund may be used to provide emergency support through grants to local educational agencies (LEAs) that the state educational agency (SEA) or governor determines to have been the most significantly impacted by COVID-19. Emergency support may also be provided through grants to institutions of higher education (IHEs) serving students within the state that the governor determines to have been the most significantly impacted by COVID-19. A governor may also choose to provide emergency support to any other IHE, LEA, or education-related entity within the state that he or she deems "essential for carrying out emergency educational services" to students for a broad array of purposes ranging from any activity authorized under various federal education laws to the provision of child care and early childhood education, social and emotional support, and the protection of education-related jobs. Funds from the ESSERF are to be awarded to states based on their relative shares of grants awarded under Title I-A of the Elementary and Secondary Education Act (ESEA), as amended. SEAs are required to provide at least 90% of the funds to LEAs to be used for myriad purposes such as any activity authorized under various federal education laws (e.g., ESEA), coordination of preparedness and response to the COVID-19 pandemic, technology acquisition, mental health, and activities related to summer learning. Funds retained by the SEA must be used for emergency needs, as determined by the SEA, to address issues in response to the COVID-19 pandemic and for administration. The HEER Fund is to distribute funds to IHEs to address needs directly related to the COVID-19 pandemic, including, but not limited to, transitioning courses to distance education and grant aid to students for their educational costs such as food, housing, course materials, health care, and child care. The Social Security Administration (SSA) received the largest amount ($300 million) among the related agencies. These funds were provided to the SSA Limitation on Administrative Expenses account to support the salaries and benefits of all SSA employees affected as a result of office closures. The funds are also to be used for costs associated with telework, phone, and communication services for employees; for overtime costs and supplies; and for processing disability and retirement benefit workloads and backlogs. Table 2 displays funding directed to LHHS programs and activities, as enacted, across the four COVID-19 supplemental appropriations acts. It is organized by department or agency and by account, program, or activity. The table also indicates a number of cases in which appropriations language reserved funds within a particular account for specific programs or activities, or directed that funds be transferred to other accounts. It makes note of instances in which these reservations are for not less than (NLT) or not more than (NMT) a certain dollar amount. In cases where the bill text calls for transfers, funds are shown in the account to which they were appropriated, not in the account to which they are to be transferred.
The legislative response to the global pandemic of Coronavirus Disease 2019 (COVID-19) has included the enactment of laws to provide authorities and supplemental funding to prevent, prepare for, and respond to the pandemic. This report focuses on supplemental FY2020 discretionary appropriations provided to programs and activities traditionally funded by the Departments of Labor, Health and Human Services, and Education, and Related Agencies (LHHS) appropriations bill. As of the date of this report, LHHS supplemental appropriations for COVID-19 response have been provided in four separate supplemental appropriations measures: Title III, Division A, of the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 ( P.L. 116-123 ), enacted on March 6, 2020, provided approximately $6.4 billion in supplemental LHHS funds. Title V, Division A, of the Families First Coronavirus Response Act (FFCRA, P.L. 116-127 ), enacted on March 18, 2020, provided $1.25 billion in supplemental LHHS funds. Title VIII, Division B, of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act, P.L. 116-136 ), enacted on March 27, 2020, provided $172.1 billion in supplemental LHHS funds. Title I, Division B, of the Paycheck Protection Program and Health Care Enhancement Act (PPPHCEA, P.L. 116-139 ), enacted on April 24, 2020, provided $100 billion in supplemental LHHS funds. In total, LHHS has received roughly $280 billion in supplemental discretionary appropriations from these COVID-19 response measures. These supplemental funds are in addition to roughly $195 billion in regular FY2020 LHHS discretionary appropriations provided in Division A of P.L. 116-94 , the FY2020 omnibus appropriations act containing full-year LHHS appropriations that was enacted on December 20, 2019. Unlike the annual discretionary appropriations, however, these additional funds were designated as an "emergency requirement" and thus were effectively exempted from otherwise applicable budget enforcement requirements (such as the statutory discretionary spending limits). Overall, the COVID-19 supplemental funds have increased FY2020 LHHS discretionary appropriations by approximately 143%. The Department of Health and Human Services (HHS) received funding in all four COVID-19 supplemental appropriations acts, whereas the Department of Labor (DOL), Department of Education (ED), and entities funded under the "Related Agencies" heading received funding in the third supplemental only. In total, HHS received $248 billion, or 89% of all COVID-19 LHHS supplemental appropriations. ED received the second-largest share at $31 billion, or 11%. DOL and the Related Agencies received approximately 0.1% and 0.2% of the LHHS COVID-19 supplemental funds, respectively.