# Labor, Health and Human Services, and Education: FY2021 Appropriations > Briefs, arguments, decisions, and more. URL: https://www.frixlaw.com/law-library/documents/crs%3AR46859 ## Record - **Collection:** Congressional research report - **Document type:** CRS Report - **Published:** January 10, 2022 - **Citation:** R46859 ## Text Labor, Health and Human Services, and Education: FY2021 Appropriations Updated January 10, 2022 Congressional Research Service https://crsreports.congress.gov R46859 SUMMARY Labor, Health and Human Services, and Education: FY2021 Appropriations This report offers an overview of actions taken by Congress and the President to provide FY2021 appropriations for accounts funded by the Departments of Labor, Health and Human Services, and Education, and Related Agencies (LHHS) appropriations bill. This bill includes all accounts funded through the annual appropriations process at the Department of Labor (DOL) and Department of Education (ED). It also provides annual appropriations for most agencies within the Department of Health and Human Services (HHS), with certain exceptions (e.g., the Food and Drug Administration is funded via the Agriculture bill). The LHHS bill also provides funds for more than a dozen related agencies, including the Social Security Administration (SSA). This report primarily focuses on regular FY2021 LHHS discretionary funding enacted during the annual appropriations process. The emergency-designated discretionary funding that was subsequently enacted for FY2021 is generally not included in the budgetary figures discussed in the main body of the report. (The FY2021 emergency supplemental discretionary appropriations enacted for COVID-19 pandemic response are addressed in the context of the FY2021 annual cycle in Appendix C.) Regular Appropriations FY2021 LHHS Omnibus: On December 27, 2020, the Consolidated Appropriations Act, 2021 (FY2021 LHHS omnibus; H.R. 133) was signed into law by President Trump as P.L. 116-260. The FY2021 LHHS omnibus provided full-year appropriations for all 12 annual appropriations acts in Divisions A-L. Annual discretionary LHHS appropriations totaled $198.5 billion. This amount is 1.6% more than FY2020 enacted and 11.0% more than the FY2021 President’s budget request. The omnibus also provided $980.0 billion in mandatory funding, for a combined LHHS total of $1.178 trillion. The distribution of discretionary funding was as follows:     R46859 January 10, 2022 Karen E. Lynch, Coordinator Specialist in Social Policy Jessica Tollestrup, Coordinator Specialist in Social Policy Kyle D. Shohfi Analyst in Education Policy David H. Bradley Specialist in Labor Economics Angela Napili Senior Research Librarian William R. Morton Analyst in Income Security DOL: $12.5 billion, 1.0% more than FY2020. HHS: $97.0 billion, 2.2% more than FY2020. ED: $73.54 billion, 1.1% more than FY2020. Related Agencies: $15.5 billion, 0.6% more than FY2020. FY2021 LHHS Senate Action: The FY2021 LHHS bill did not receive subcommittee, full committee, or initial floor action in the Senate prior to its enactment. The chair of the Senate Committee on Appropriations, Senator Richard Shelby, released drafts of all 12 annual appropriations bills along with draft accompanying committee reports on November 10, 2020, which was intended to further negotiations on annual appropriations between the House and the Senate. These draft numbers are not presented in this report. FY2021 LHHS House Action: On July 13, 2020, the House Appropriations Committee voted to report the FY2021 LHHS appropriations bill, 30-22; the measure was subsequently reported to the House on July 15 (H.R. 7614; H.Rept. 116-450). This was preceded by subcommittee approval of the draft bill on July 7, by a vote of 9-6. As reported by the full committee, the bill would have provided $198.1 billion in discretionary LHHS funds, a 1.3% increase from FY2020 enacted levels. This amount would have been 10.8% more than the FY2021 President’s request. In addition, the House committee bill would have provided an estimated $980.0 billion in mandatory funding, for a combined total of $1.178 trillion for LHHS as a whole. The distribution of discretionary funding was as follows:     DOL: $12.7 billion, 2.0% more than FY2020. HHS: $96.4 billion, 1.5% more than FY2020. ED: $73.47 billion, 1.0% more than FY2020. Related Agencies: $15.6 billion, 1.4% more than FY2020. Congressional Research Service Labor, Health and Human Services, and Education: FY2021 Appropriations The House version of LHHS appropriations was initially considered on the floor as part of a consolidated appropriations package and passed the House (217-197), as amended, on July 31, 2020 (Division E of H.R. 7617). Of the amendments offered, 84 were adopted and 8 were rejected. Because there is no publicly available source that estimates the account-level budgetary effects of the amendments adopted to Division E, this report provides analysis of the House Committee-reported version of the LHHS bill. For information on the LHHS amendments offered during floor consideration, see Appendix B. FY2021 President’s Budget Request: The President’s FY2021 budget request was submitted to Congress on February 10, 2020. On March 17, 2020, President Trump submitted a letter to Congress about FY2021 budget amendments (along with a supplemental appropriations request for FY2020) related to the response to the COVID-19 pandemic. These budget amendments affected the FY2021 President’s requested levels for Centers for Disease Control and Prevention (CDC) and National Institutes of Health (NIH) accounts at HHS. Amounts shown for the President’s request in the source materials consulted for this report generally appear to reflect these budget amendments. The President requested $178.8 billion in discretionary funding for accounts funded by the LHHS bill, which would have been a decrease of 8.5% from FY2020 levels. In addition, the President requested $978.3 billion in annually appropriated mandatory funding, for a total of $1.157 trillion for LHHS as a whole. The distribution of discretionary funding was as follows:     DOL: $11.1 billion, 10.5% less than FY2020. HHS: $87.0 billion, 8.3% less than FY2020. ED: $66.6 billion, 8.5% less than FY2020. Related Agencies: $14.1 billion, 8.2% less than FY2020. Supplemental Appropriations Several acts have been signed into law providing FY2020 and FY2021 supplemental discretionary appropriations for LHHS programs and activities related to the COVID-19 pandemic. For FY2021, the same law that provided “regular” annual LHHS appropriations for FY2021 in Division H also provided supplemental discretionary appropriations in a separate division (Coronavirus Response and Relief Supplemental Appropriations Act, 2021; CRRSA). This law, which was enacted on December 27, 2020, provided a total of $154.9 billion in supplemental LHHS funds (Title III, Division M, of P.L. 116-260). In addition, prior to the end of FY2021, a second supplemental appropriations act containing LHHS appropriations was enacted (P.L. 117-31) on July 30, 2021. This law provided $25 million in supplemental appropriations for the Refugee and Entrant Assistance account at HHS for specified purposes related to Afghan special immigrants. In total, FY2021 supplemental appropriations increased regular discretionary FY2021 LHHS enacted funding by about 78.1%. This funding was split roughly equally between HHS (48.1%) and ED (52.9%). (None was enacted for DOL or RA.) The ED budgetary increase due to its supplemental funding was 111.5% (+82.0 billion) more than its FY2021 regular discretionary appropriations. HHS regular discretionary appropriations were increased by 75.2% (+$72.9 billion). See Appendix C of this report for an analysis of the supplemental discretionary LHHS appropriations provided in these acts. For a detailed discussion of the LHHS COVID-19 pandemic response funding, see CRS Report R46775, Overview of COVID-19 LHHS Supplemental Appropriations: FY2020 and FY2021. Congressional Research Service Labor, Health and Human Services, and Education: FY2021 Appropriations Contents Introduction ..................................................................................................................................... 1 Report Roadmap and Useful Terminology ...................................................................................... 1 Scope of the Report ................................................................................................................... 2 Important Budget Concepts....................................................................................................... 3 Mandatory vs. Discretionary Budget Authority .................................................................. 3 Total Budget Authority Provided in the Bill vs. Total Budget Authority Available in the Fiscal Year.............................................................................................................. 4 Status of FY2021 LHHS Appropriations ........................................................................................ 4 FY2021 Supplemental Appropriations ...................................................................................... 4 Emergency Security Supplemental Appropriations Act, 2021 (H.R. 3237; P.L. 117-31) ............................................................................................................................. 5 The Coronavirus Response and Relief Supplemental Appropriations (CRRSA) Act, 2021 (Division M of H.R. 133; P.L. 116-260, “5th COVID”) .................................. 5 FY2021 Annual LHHS Appropriations ..................................................................................... 6 FY2021 LHHS Omnibus (Division H, Consolidated Appropriations Act, 2021, H.R. 133; P.L. 116-260) ................................................................................................... 6 FY2021 Continuing Resolutions (Division A of H.R. 8337; P.L. 116-159) ....................... 8 Earlier Congressional Action on an LHHS Bill .................................................................. 8 FY2021 President’s Budget Request......................................................................................... 9 Conclusion of the FY2020 Appropriations Process and FY2020 Supplemental Appropriations ..................................................................................................................... 10 Summary of FY2021 LHHS Appropriations ................................................................................. 12 Department of Labor (DOL) ......................................................................................................... 15 About DOL ............................................................................................................................. 16 FY2021 DOL Appropriations Overview ................................................................................. 16 Selected DOL Highlights ........................................................................................................ 17 Employment and Training Administration (ETA)............................................................. 17 Office of Foreign Labor Certification (OFLC) ................................................................. 18 Bureau of Labor Statistics (BLS) ...................................................................................... 19 Bureau of International Labor Affairs (ILAB) .................................................................. 19 Labor-Related General Provisions .................................................................................... 19 Department of Health and Human Services (HHS)....................................................................... 22 About HHS .............................................................................................................................. 23 FY2021 HHS Appropriations Overview ................................................................................. 24 Special Public Health Funding Mechanisms ........................................................................... 26 Public Health Service Evaluation Tap............................................................................... 26 Prevention and Public Health Fund .................................................................................. 28 Selected HHS Highlights by Agency ...................................................................................... 28 HRSA ................................................................................................................................ 29 CDC .................................................................................................................................. 29 NIH ................................................................................................................................... 31 SAMHSA .......................................................................................................................... 32 AHRQ ............................................................................................................................... 32 CMS .................................................................................................................................. 33 ACF ................................................................................................................................... 33 ACL .................................................................................................................................. 34 Congressional Research Service Labor, Health and Human Services, and Education: FY2021 Appropriations Restrictions Related to Certain Controversial Issues .............................................................. 35 Department of Education (ED) ...................................................................................................... 42 About ED ................................................................................................................................ 42 FY2021 ED Appropriations Overview .................................................................................... 43 Selected ED Highlights ........................................................................................................... 44 Education for the Disadvantaged ...................................................................................... 44 Student Financial Assistance............................................................................................. 45 Related Agencies ........................................................................................................................... 47 FY2021 Related Agencies Appropriations Overview ............................................................. 48 Selected Related Agencies Highlights..................................................................................... 49 SSA Limitation on Administrative Expenses (LAE) ........................................................ 49 Corporation for National and Community Service ........................................................... 50 National Labor Relations Board (NLRB) ......................................................................... 50 Figures Figure 1. FY2021 Enacted LHHS Appropriations .......................................................................... 7 Figure 2. FY2021 Enacted LHHS Appropriations by Title ........................................................... 15 Figure 3. FY2021 Enacted HHS Appropriations by Agency......................................................... 26 Tables Table 1. Status of Full-Year LHHS Appropriations Legislation, FY2021 ....................................... 6 Table 2. LHHS Appropriations Overview by Bill Title, FY2020-FY2021 ................................... 13 Table 3. DOL Appropriations Overview ....................................................................................... 17 Table 4. Detailed DOL Appropriations .......................................................................................... 20 Table 5. HHS Appropriations Overview........................................................................................ 24 Table 6. HHS Appropriations Totals by Agency ........................................................................... 36 Table 7. HHS Discretionary Appropriations for Selected Programs or Activities, by Agency .................................................................................................................................. 39 Table 8. ED Appropriations Overview .......................................................................................... 43 Table 9. Detailed ED Appropriations ............................................................................................ 46 Table 10. Related Agencies Appropriations Overview .................................................................. 48 Table 11. Detailed Related Agencies Appropriations .................................................................... 50 Table A-1. LHHS Discretionary FY2020 Enacted Levels, FY2021 House 302(b) Suballocations, and FY2021 Enacted Levels ............................................................................. 57 Table A-2. LHHS Appropriations Overview, by Bill Title: FY2020-FY2021............................... 58 Table B-1. LHHS House Floor Amendments Offered to H.R. 7617 ............................................. 60 Table C-1. Summary of Enacted FY2021 Discretionary Regular and Supplemental Appropriations............................................................................................................................ 70 Congressional Research Service Labor, Health and Human Services, and Education: FY2021 Appropriations Appendixes Appendix A. Budget Enforcement Activities ................................................................................ 53 Appendix B. House Floor Amendments Offered to H.R. 7617 ..................................................... 60 Appendix C. Enacted FY2021 LHHS Supplemental Appropriations ........................................... 69 Contacts Author Information........................................................................................................................ 71 Congressional Research Service Labor, Health and Human Services, and Education: FY2021 Appropriations Introduction This report provides an overview of FY2021 appropriations actions for accounts traditionally funded in the appropriations bill for the Departments of Labor, Health and Human Services, and Education, and Related Agencies (LHHS). This bill provides discretionary and mandatory appropriations to three federal departments: the Department of Labor (DOL), the Department of Health and Human Services (HHS), and the Department of Education (ED). In addition, the bill provides annual appropriations for more than a dozen related agencies, including the Social Security Administration (SSA). Discretionary funds represent less than one-fifth of the total funds appropriated in the annual LHHS bill. Nevertheless, the LHHS bill is typically the largest single source of discretionary funds for domestic nondefense federal programs among the various appropriations bills. (The Department of Defense bill is the largest source of discretionary funds among all federal programs.) Because the appropriations process both provides and controls discretionary funding (concepts discussed further in “Mandatory vs. Discretionary Budget Authority”), the bulk of this report is focused on these funds. Scope of the Report: Emergency and Mandatory Funding Related to COVID-19 This report primarily focuses on regular FY2021 LHHS discretionary funding enacted during the annual appropriations process. The emergency discretionary funding that was enacted for FY2020, or proposed and enacted for FY2021, is generally not included in the budgetary figures discussed or table totals presented in the main body of the report. (Note that while emergency-designated spending, including that proposed and enacted in the context of annual LHHS appropriations, is presented below the table totals, it is not included in them. Also, the FY2021 emergency supplemental appropriations enacted for COVID-19 pandemic response and other purposes are addressed in the context of the FY2021 annual cycle in Appendix C.) In addition, during FY2020 and FY2021, mandatory appropriations were enacted to certain LHHS-related accounts for COVID-19 pandemic response, including in the American Rescue Plan Act of 2021 (P.L. 117-2). These mandatory funds are beyond the scope of this report. The LHHS bill typically is one of the more controversial of the regular appropriations bills because of the size of its funding and the scope of its programs, as well as various related social policy issues addressed in the bill, such as restrictions on the use of federal funds for abortion and for research on human embryos, stem cells, and gun violence. Congressional clients may consult the LHHS experts list in CRS Report R42638, Appropriations: CRS Experts, for information on which analysts to contact at the Congressional Research Service (CRS) with questions on specific agencies and programs funded in the LHHS bill. Report Roadmap and Useful Terminology This report is divided into several sections. The opening section provides an explanation of the scope of the LHHS bill (and hence, the scope of this report) and an introduction to important terminology and concepts that carry throughout the report. Next is a series of sections describing major congressional actions on FY2021 appropriations and (for context) a review of the conclusion of the FY2020 appropriations process. This is followed by a high-level summary and analysis of enacted and proposed appropriations for FY2021, compared to FY2020 funding levels. The body of the report concludes with overview sections for each of the major titles of the bill: DOL, HHS, ED, and Related Agencies (RA). These sections provide selected highlights from FY2021 enacted and proposed funding levels compared to FY2020. (Note that the Congressional Research Service 1 Labor, Health and Human Services, and Education: FY2021 Appropriations distribution of funds is sometimes illustrated by figures, which in all cases are based on the FY2021 enacted version of the LHHS bill.1) Appendix A provides a summary of budget enforcement activities for FY2021. This includes information on the Budget Control Act of 2011 (BCA; P.L. 112-25) and sequestration, budget enforcement in the absence of an FY2021 budget resolution, the House LHHS subcommittee spending allocation, and current-year spending levels. This is followed by Appendix B, which provides an overview of the LHHS-related floor amendments that were offered in the House during its consideration of H.R. 7617. Appendix C provides an analysis of the supplemental discretionary LHHS appropriations enacted for FY2021. For a detailed discussion of the FY2021 supplemental LHHS COVID-19 pandemic response funding, see CRS Report R46775, Overview of COVID-19 LHHS Supplemental Appropriations: FY2020 and FY2021. Scope of the Report This report focuses on appropriations to agencies and accounts that are subject to the jurisdiction of the Labor, Health and Human Services, Education, and Related Agencies subcommittees of the House and Senate appropriations committees (i.e., accounts traditionally funded via the LHHS bill). Department “totals” provided in this report do not include funding for accounts or agencies that are traditionally funded by appropriations bills under the jurisdiction of other subcommittees. The LHHS bill provides appropriations for the following federal departments and agencies:     the Department of Labor; most agencies at the Department of Health and Human Services, except for the Food and Drug Administration (funded through the Agriculture appropriations bill), the Indian Health Service (funded through the Interior-Environment appropriations bill), and the Agency for Toxic Substances and Disease Registry (also funded through the Interior-Environment appropriations bill); the Department of Education; and more than a dozen related agencies, including the Social Security Administration, the Corporation for National and Community Service, the Corporation for Public Broadcasting, the Institute of Museum and Library Services, the National Labor Relations Board, and the Railroad Retirement Board. Note also that funding totals displayed in this report do not reflect amounts provided outside of the annual appropriations process. Certain direct spending programs, such as Social Security and parts of Medicare, receive funding directly from their authorizing statutes; such funds are not reflected in the totals provided in this report because they are not provided through the annual appropriations process (see related discussion in the “Important Budget Concepts” section). 1 The dollars and percentages in each figure also are generally illustrative, except as noted, of the parallel distribution of funds enacted in FY2020 and proposed by the FY2021 President’s budget and the House committee bill. Congressional Research Service 2 Labor, Health and Human Services, and Education: FY2021 Appropriations Important Budget Concepts Mandatory vs. Discretionary Budget Authority2 The LHHS bill includes both discretionary and mandatory budget authority. While all discretionary spending is subject to the annual appropriations process, only a portion of mandatory spending is provided in appropriations measures. Mandatory programs funded through the annual appropriations process are commonly referred to as appropriated entitlements. In general, appropriators have little control over the amounts provided for appropriated entitlements; rather, the authorizing statute controls the program parameters (e.g., eligibility rules, benefit levels) that entitle certain recipients to payments. If Congress does not appropriate the money necessary to meet these commitments, entitled recipients (e.g., individuals, states, or other entities) may have legal recourse.3 Most mandatory spending is not provided through the annual appropriations process, but rather through budget authority provided by the program’s authorizing statute (e.g., Social Security benefits payments). The funding amounts in this report do not include budget authority provided outside of the appropriations process. Instead, the amounts reflect only those funds, discretionary and mandatory, that are provided through appropriations acts. As displayed in this report, mandatory amounts for the FY2021 President’s budget submission reflect current-law (or current services) estimates; they generally do not include the President’s proposed changes to a mandatory spending program’s authorizing statute that might affect total spending. (In general, such proposals are excluded from this report, as they typically would be enacted in authorizing legislation.) The report focuses most closely on discretionary funding because discretionary funding receives the bulk of attention during the appropriations process. (While the LHHS bill includes more mandatory funding than discretionary funding, the appropriators generally have less flexibility in adjusting mandatory funding levels than discretionary funding levels.) Mandatory and discretionary spending is subject to budget enforcement processes that include sequestration. In general, sequestration involves largely across-the-board reductions that are made to certain categories of discretionary or mandatory spending. However, the conditions that trigger sequestration, and how it is carried out, differ for each type of spending. This is discussed further in Appendix A. 2 For definitions of these and other budget terms, see U.S. Government Accountability Office (GAO), A Glossary of Terms Used in the Federal Budget Process, GAO-05-734SP, September 1, 2005, http://www.gao.gov/products/GAO05-734SP. (Terms of interest may include appropriated entitlement, direct spending, discretionary, entitlement authority, and mandatory.) 3 Sometimes appropriations measures include amendments to laws authorizing mandatory spending programs and thereby change the amount of mandatory appropriations needed. Because such amendments are legislative in nature, they may violate parliamentary rules separating authorizations and appropriations. For more information, see CRS Report R42388, The Congressional Appropriations Process: An Introduction. Congressional Research Service 3 Labor, Health and Human Services, and Education: FY2021 Appropriations Total Budget Authority Provided in the Bill vs. Total Budget Authority Available in the Fiscal Year Budget authority is the amount of money a federal agency is legally authorized to commit or spend. Appropriations bills may include budget authority that becomes available in the current fiscal year, in future fiscal years, or some combination. Amounts that become available in future fiscal years are typically referred to as advance appropriations. Unless otherwise specified, appropriations levels displayed in this report refer to the total amount of budget authority provided in an appropriations bill (i.e., “total in the bill”), regardless of the year in which the funding becomes available.4 In some cases, the report breaks out current-year appropriations (i.e., the amount of budget authority available for obligation in a given fiscal year, regardless of the year in which it was first appropriated).5 As the annual appropriations process unfolds, the amount of current-year budget authority is measured against 302(b) allocation ceilings (budget enforcement caps for appropriations subcommittees that traditionally emerge following the budget resolution process). The process of measuring appropriations against these spending ceilings takes into account scorekeeping adjustments, which are made by the Congressional Budget Office (CBO) to reflect conventions and special instructions of Congress.6 Unless otherwise specified, appropriations levels displayed in this report do not reflect additional scorekeeping adjustments. (Those scorekeeping adjustments are displayed at the bottom of Table 2.) Status of FY2021 LHHS Appropriations FY2021 Supplemental Appropriations The legislative response to the global COVID-19 pandemic has included the enactment of laws to provide authorities and supplemental funding to prevent, prepare for, and respond to the pandemic. LHHS supplemental appropriations for COVID-19 pandemic response were enacted in four FY2020 measures, and one FY2021 measure. All five of these supplementals are discussed in detail in CRS Report R46775, Overview of COVID-19 LHHS Supplemental Appropriations: FY2020 and FY2021. In addition, prior to the end of FY2021, a second supplemental appropriations act containing LHHS appropriations was enacted (P.L. 117-31) on July 30, 2021. This law provided $25 million in supplemental appropriations for the Refugee and Entrant Assistance account at HHS for specified purposes related to Afghan special immigrants. See Appendix C for an analysis of the regular and supplemental discretionary LHHS appropriations enacted for FY2021. 4 Such figures include advance appropriations provided in the bill for future fiscal years, but do not include advance appropriations provided in prior years’ appropriations bills that become available in the current year. 5 Such figures exclude advance appropriations for future years, but include advance appropriations from prior years that become available in the given fiscal year. 6 For more information on scorekeeping, see CRS Report 98-560, Baselines and Scorekeeping in the Federal Budget Process. See also a discussion of key scorekeeping guidelines included in the joint explanatory statement accompanying the conference report to the Balanced Budget Act of 1997 (H.Rept. 105-217, pp. 1007-1014). Congressional Research Service 4 Labor, Health and Human Services, and Education: FY2021 Appropriations Emergency Security Supplemental Appropriations Act, 2021 (H.R. 3237; P.L. 117-31) H.R. 3237 was introduced as a supplemental appropriations bill by the chair of the House Appropriations Committee, Representative DeLauro, on May 14, 2021. Both as introduced and as passed by the House (213-212, 3 present) on May 20, 2021, the bill did not contain LHHS funding. Subsequently, the Senate added $25 million in supplemental appropriations for the Refugee and Entrant Assistance account at HHS for specified purposes related to Afghan special immigrants, among other changes. The bill passed the Senate, as amended (98-0), on July 29, 2021. The House agreed to the Senate-passed version (416-11) on July 30, 2021, and the bill was signed into law (P.L. 117-31) by President Biden that same day. According to CBO, the $25 million in supplemental LHHS appropriations provided by P.L. 11731 was about 1% of the $2.1 billion in FY2021 discretionary appropriations provided by the law. 7 The Coronavirus Response and Relief Supplemental Appropriations (CRRSA) Act, 2021 (Division M of H.R. 133; P.L. 116-260, “5th COVID”) While annual appropriations for FY2021 were under discussion during the summer and fall of 2020, Congress and President Trump considered whether any additional COVID-19 pandemic response funding should be enacted in separate supplemental appropriations measures or packaged with the FY2021 annual funding. (Four COVID-19 pandemic response FY2020 supplemental appropriations acts had previously been enacted; see discussion in “Conclusion of the FY2020 Appropriations Process and FY2020 Supplemental Appropriations”.) In addition, policymakers had the option of making further COVID-19 pandemic response funding subject to the limit on FY2021 nondefense discretionary spending, or providing that funding instead as emergency appropriations (effectively exempt from that limit).8 Ultimately, additional FY2021 appropriations for COVID-19 pandemic relief were enacted as part of H.R. 133. (Regular FY2021 LHHS annual appropriations were provided in Division H, referred to in this report as “the FY2021 LHHS omnibus”; emergency supplemental funding for COVID-19 pandemic response was provided in Division M.) On December 21, 2020, the final version of H.R. 133 was approved by the House. (The vote to approve the portion that contained Division M was 359-53.9) The measure was approved by the Senate (92-6) later that same day, and signed into law (P.L. 116-260) by President Trump on December 27. 7 CBO, Discretionary Spending: Senate Amendment 2123, July 29, 2021, https://www.cbo.gov/system/files/2021-07/ EmergencySecuritySupplementalAppropriationsAct2021.pdf. 8 Prior to the enactment of full year FY2021 LHHS funding, COVID-19 pandemic-related LHHS provisions were proposed in several different appropriations measures for FY2021, including the House-passed full-year LHHS bill (Division E, H.R. 7617), a supplemental appropriations package (Division A, H.R. 925), and the FY2021 continuing resolution (Division A, P.L. 116-159). While in some cases, the budgetary effects of the COVID-19 pandemic-related provisions were designated as an emergency requirement, that was not the case universally. 9 The special rule, H.Res. 1271, provided for the consideration of an amendment consisting of the final text for enactment (as contained in House Rules Committee Print 116-68) to the Senate amendment to H.R. 133. H.Res. 1271 also provided for the House to adopt the amendment in two votes: the first on Divisions B, C, E, and F, and the second on the remaining divisions. The House adopted Divisions B, C, E, and F by a vote of 327-85, and adopted the remaining divisions by a vote of 359-53. The subsequent motion that the House agree to the Senate amendment with an amendment was agreed to without objection. Congressional Research Service 5 Labor, Health and Human Services, and Education: FY2021 Appropriations According to CBO, P.L. 116-260 provided about $184.3 billion in supplemental appropriations in Division M, of which $155 billion (approximately 84%) was for LHHS accounts and activities.10 Funding was provided for various programs and activities at HHS and ED. FY2021 Annual LHHS Appropriations Table 1 provides a timeline of major legislative actions for full-year LHHS proposals, which are discussed in greater detail below. Table 1. Status of Full-Year LHHS Appropriations Legislation, FY2021 Subcommittee Approval House Senate 7/7/2020 9-6 Resolution of House and Senate Differences Full Committee Approval House H.R. 7614 H.Rept. 116-450 7/13/20 30-22 Senate House Initial Passage H.R. 7617, Division E 7/31/20 217-197 Senate Initial Passage Conf. Report House Final Passage Senate Final Passage H.R. 133, Division H 12/21/20 359-53 H.R. 133, Division H 12/21/20 96-2 Public Law P.L. 116260 12/27/20 Source: CRS Appropriations Status Table. FY2021 LHHS Omnibus (Division H, Consolidated Appropriations Act, 2021, H.R. 133; P.L. 116-260) On December 27, 2020, the Consolidated Appropriations Act, 2021 was signed into law by the President (H.R. 133, P.L. 116-260). P.L. 116-260 provided full-year appropriations for all 12 annual appropriations acts in Divisions A-L, and supplemental appropriations for COVID-19 pandemic relief in Division M.11 (Full-year LHHS appropriations were enacted in Division H, referred to as “the FY2021 LHHS omnibus.”) Prior to its enactment, the final version of the measure was approved by the House on December 21. (The vote to approve the portion that contained LHHS appropriations was 359-53.12) It was approved by the Senate (92-6) later that same day. 10 The total amount of supplemental appropriations in Division M is from CBO, Discretionary Spending Under Division M, the Coronavirus Response and Relief Supplemental Appropriations Act, 2021, December 22, 2020, p. 1, https://www.cbo.gov/publication/56916. The total amount of LHHS supplemental appropriations in Title III of Division M was calculated by CRS (see Table 2 of this report), and does not include funding appropriated in Title III to the Food and Drug Administration (FDA) Salaries and Expenses account, as this funding is generally not under the purview of the LHHS Appropriations Act. 11 P.L. 116-260 also contained additional COVID-19 pandemic response provisions in Division N, but this division is considered authorizing legislation, rather than appropriations legislation, and is thus beyond the scope of this report. For further discussion, see the Congressional Budget Office cost estimate for Division N, released on January 14, 2021, https://www.cbo.gov/system/files/2021-01/PL_116-260_div_N.pdf. In addition, Divisions O-FF of P.L. 116-260 contained miscellaneous authorizing provisions that are also beyond the scope of this report. 12 The special rule, H.Res. 1271, provided for the consideration of an amendment consisting of the final text for enactment (as contained in House Rules Committee Print 116-68) to the Senate amendment to H.R. 133. H.Res. 1271 also provided for the House to adopt the amendment in two votes: the first on Divisions B, C, E, and F, and the second on the remaining divisions. The House adopted Divisions B, C, E, and F by a vote of 327-85, and adopted the remaining divisions by a vote of 359-53. The subsequent motion that the House agree to the Senate amendment with an Congressional Research Service 6 Labor, Health and Human Services, and Education: FY2021 Appropriations LHHS discretionary appropriations in the FY2021 LHHS omnibus totaled $198.5 billion. This amount is 1.6% more than FY2020 enacted and 11.0% more than the FY2021 President’s budget request. The omnibus also provided $980.0 billion in mandatory funding, for a combined LHHS total of $1.178 trillion. (Note that these totals are based only on amounts of non-emergency appropriations provided by the FY2021 LHHS omnibus and do not include emergencydesignated or supplemental funds, which were provided in addition to the annual appropriations. Division H also enacted $1.6 billion in emergency-designated budget authority, of which $925 million was for DOL in Title I, and $638 million was for HHS in Title II, which is not reflected in the above figures.) See Figure 1 for a breakdown of FY2021 discretionary and mandatory LHHS appropriations.13 Figure 1. FY2021 Enacted LHHS Appropriations Source: Amounts in this figure are generally drawn from or calculated based on data contained in the explanatory statement accompanying the FY2021 LHHS omnibus (P.L. 116-260), available in the Congressional Record, vol. 166, no. 218, book IV, December 21, 2020, pp. H8619-H8711. Enacted totals (“Total BA in the Bill”) for FY2021 do not include emergency-designated appropriations provided in Division H or M of P.L. 116-260, or P.L. 117-31. For consistency with source materials, amounts in this figure generally do not reflect mandatory spending sequestration. CRS calculations do, however, include LHHS funding provided to HHS pursuant to the 21st Century Cures Act (P.L. 114-255), as amended. Notes: Details may not add to totals due to rounding. Amounts in this figure (1) reflect all budget authority appropriated in the bill, regardless of the year in which funds become available (i.e., totals do not include advances from prior-year appropriations, but do include advances for subsequent years provided in this bill); (2) have generally not been adjusted to reflect scorekeeping; (3) comprise only those funds provided for agencies and accounts subject to the jurisdiction of the LHHS subcommittees of the House and Senate appropriations committees; and (4) do not include appropriations that occur outside of appropriations bills. amendment was agreed to without objection. 13 While the percentages in this figure were calculated based on amounts in the FY2021 LHHS omnibus, they are generally also illustrative—within a few percentage points—of the share of mandatory and discretionary funds in FY2020 and under the various FY2021 proposals (e.g., President’s budget and the House-committee bill). Congressional Research Service 7 Labor, Health and Human Services, and Education: FY2021 Appropriations FY2021 Continuing Resolutions (Division A of H.R. 8337; P.L. 116-159) Between the start of the fiscal year on October 1, 2020, and the enactment of the annual LHHS appropriations on December 27, 2020, LHHS programs and activities were provided temporary FY2021 funding via a series of continuing resolutions (CRs). The first CR providing temporary funding for LHHS programs and activities was signed into law on October 1 (Division A of H.R. 8337; P.L. 116-159). The measure had previously been introduced by the House Appropriations Committee chair, Representative Lowey, on September 22, and had passed the House that same day, 359-57.14 The Senate subsequently took up and passed the measure without amendment, 84-10, on September 30. The CR provided continuing appropriations for all 12 annual appropriations acts (including LHHS) through December 11, 2020. In general, the CR funded discretionary programs at the same rate and under the same conditions as in FY2020 (§101) and annually appropriated entitlements at their current law levels (§111).15 It also included several anomalies that are specific to LHHS accounts or related activities (§§149-156). This first CR was extended by four subsequent CRs:     P.L. 116-215 (Division A), which extended LHHS funding through December 18; P.L. 116-225, which extended LHHS funding through December 20; P.L. 116-226, which extended LHHS funding through December 21; and P.L. 116-246, which extended LHHS funding through December 28. Earlier Congressional Action on an LHHS Bill FY2021 LHHS Action in the Senate Senate Appropriations Committee action on the FY2021 LHHS bill did not occur during the FY2021 cycle. The chair of the Senate Committee on Appropriations, Senator Richard Shelby, released drafts of all 12 annual appropriations bills along with draft accompanying committee reports on November 10, 2020, which was intended to further negotiations on annual appropriations between the House and the Senate.16 These draft numbers are not presented in this report. 14 For further information about the continuing appropriations in H.R. 8337, see House Appropriations Committee, “House Democrats File Bipartisan Continuing Resolution,” press release, September 22, 2020, https://appropriations.house.gov/news/press-releases/house-democrats-file-bipartisan-continuing-resolution. Previously, the chairwoman had introduced H.R. 8319, which included a similar CR in Division A, but that measure did not receive House floor consideration. For further information about the continuing appropriations in H.R. 8319, see House Appropriations Committee, “House Democrats Introduce Continuing Resolution,” press release, September 21, 2020, https://appropriations.house.gov/news/press-releases/house-democrats-introduce-continuing-resolution-1. 15 For an estimate of the discretionary appropriations contained in Division A of H.R. 8337, see CBO, “CBO’s Estimate for H.R. 8337, the Continuing Appropriations Act, 2021 and Other Extensions Act, as Passed by the House of Representatives on September 22, 2020,” September 23, 2020, https://www.cbo.gov/system/files/2020-09/hr8337.pdf. 16 See linked draft bill and report language text in the Senate Appropriations Committee majority press release, “Committee Releases FY21 Bills in Effort to Advance Process, Produce Bipartisan Results,” November 10, 2020, https://www.appropriations.senate.gov/news/committee-releases-fy21-bills-in-effort-to-advance-process-producebipartisan-results. See also the statement from the Senate Appropriations Committee Vice Chair, Senator Patrick Leahy, at https://www.appropriations.senate.gov/news/minority/senate-approps-vice-chair-leahy-statement-on-therelease-of-the-fy-2021-senate-appropriations-bills-. Congressional Research Service 8 Labor, Health and Human Services, and Education: FY2021 Appropriations FY2021 LHHS Action in the House (Division A, H.R. 2740) The House LHHS subcommittee approved the draft LHHS bill on July 7, by a vote of 9-6. On July 13, 2020, the House Appropriations Committee voted to report the FY2021 LHHS appropriations bill, 30-22; the measure was subsequently reported to the House on July 15 (H.R. 7614; H.Rept. 116-450). As reported by the full committee, the bill would have provided $198.1 billion in discretionary LHHS funds, a 1.3% increase from FY2020 enacted levels. This amount would have been 10.8% more than the FY2021 President’s request. In addition, the House committee bill would have provided an estimated $980.0 billion in mandatory funding, for a combined total of $1.178 trillion for LHHS as a whole. (Note that these totals are based only on amounts of non-emergency appropriations that would have been provided by the House committee bill and do not include emergency-designated or supplemental funds, which were provided in addition to the annual appropriations. The House committee bill included a total of $19.4 billion in emergencydesignated budget authority in Title VI, of which $925 million was for DOL and $18.5 billion was for HHS, which is not reflected in the above figures.) Later in July, LHHS appropriations were initially considered on the House floor as part of a consolidated appropriations package and passed the House (217-197), as amended, on July 31, 2020 (Division E of H.R. 7617). This package would have provided appropriations for five other appropriations acts in addition to LHHS: Department of Defense; Commerce, Justice, Science; Energy and Water Development; Financial Services and General Government; and Transportation, Housing, and Urban Development.17 Floor action on H.R. 7617 was regulated by the terms of a special rule (H.Res. 1067) that made in order 92 amendments to the LHHS title of the bill.18 That rule also provided the authority for the chair of the Appropriations Committee or her designee to offer any of the amendments made in order en bloc (i.e., in groups of amendments to be disposed of together). All but three LHHS amendments were considered in this manner.19 When counted as 92 separate amendments, 84 were adopted and 8 were rejected. Because there is no publicly available source that estimates the account-level budgetary effects of the amendments adopted to Division E, this report provides analysis of the House Committeereported version of the LHHS bill. For information on the LHHS amendments offered during floor consideration, see Appendix B. FY2021 President’s Budget Request The President’s FY2021 budget request was submitted to Congress on February 10, 2020.20 On March 17, 2020, President Trump submitted a letter to Congress about FY2021 budget 17 H.R. 7617 was initially expected to provide appropriations for the act funding the Department of Homeland Security, but that division was ultimately omitted under the terms of the special rule that regulated floor consideration (H.Res. 1067). 18 For a list of these LHHS amendments (numbered 218-309) and the text of each that was made in order, see H.Rept. 116-461, pp. 23-32 and 89-108. Readers should note that LHHS amendments were keyed to Division F of what was to be the base text for amendment (Rules Committee Print 116–60). The LHHS division was redesignated as Division E after House passage due to the omission of the Department of Homeland Security division from the bill. 19 For the en bloc amendments proposing changes to the LHHS division of the bill, see consideration of amendments en bloc nos. 3, 4, and 5 in Congressional Record, daily edition, Vol. 166, No. 135 (July 30, 2020), pp. H4134-H4139, H4143-H4169. 20 For further information on the HHS budget request, see CRS Report R46321, Department of Health and Human Services: FY2021 Budget Request. Note that the report covers the FY2021 President’s request for HHS in its entirety, Congressional Research Service 9 Labor, Health and Human Services, and Education: FY2021 Appropriations amendments (along with a supplemental appropriations request for FY2020) related to the response to the COVID-19 pandemic.21 These budget amendments affected the FY2021 President’s requested levels for CDC and NIH accounts at HHS.22 The President requested $178.8 billion in discretionary funding for accounts funded by the LHHS bill, which would have been a decrease of 8.5% from FY2020 levels. In addition, the President requested $978.3 billion in annually appropriated mandatory funding, for a total of $1.157 trillion for LHHS as a whole. Conclusion of the FY2020 Appropriations Process and FY2020 Supplemental Appropriations FY2020 regular appropriations for LHHS were enacted as part of the Further Consolidated Appropriations Act, 2020, on December 20, 2019 (FY2020 LHHS omnibus; P.L. 116-94). The FY2020 LHHS omnibus was agreed to by the House (297-120) on December 17, 2019, and by the Senate (71-23) on December 19. The bill was signed into law on December 20 (P.L. 116-94). LHHS discretionary appropriations in the FY2020 LHHS omnibus totaled $195.4 billion. This amount is 3.2% more than FY2019 enacted and 17.4% more than the FY2020 President’s budget request. The omnibus also provided $902.3 billion in mandatory funding, for a combined LHHS total of $1.098 trillion.23 On January 29, 2020, supplemental appropriations of $210 million in additional funding to DOL to carry out the United States-Mexico-Canada Agreement (USMCA) were enacted (P.L. 116113).24 Subsequent to the enactment of annual FY2020 LHHS discretionary appropriations and the submission of the President’s budget, the effects of the COVID-19 global pandemic on communities across the world and throughout the United States elicited a legislative response from Congress and the President during the remainder of FY2020. Four FY2020 supplemental appropriations were part of this legislative response:25 not just the components of the agency funded through the annual LHHS bill. 21 Executive Office of the President, Office of Management and Budget, Letter from Acting Director Russell T. Vought to The Honorable Michael R. Pence, March 17, 2020, https://www.whitehouse.gov/wp-content/uploads/2020/03/Letterregarding-additional-funding-to-support-the-United-States-response-to-COVID-19-3.17.2020.pdf. 22 Amounts shown for the President’s request in the source materials consulted for this report generally appear to reflect these budget amendments. The source materials used for the President’s request are drawn from or calculated based on the explanatory statement accompanying the FY2021 LHHS omnibus (P.L. 116-260), available in the Congressional Record, vol. 166, no. 218, book IV, December 21, 2020, pp. H8619-H8711. 23 For further information, see CRS Report R46492, Labor, Health and Human Services, and Education: FY2020 Appropriations. 24 Title IX of the United States-Mexico-Canada Agreement Supplemental Appropriations Act, 2019, (USMCA, P.L. 116-113). The USMCA supplemental appropriations of $210 million for DOL were for the Bureau of International Labor Affairs (ILAB) to support the implementation and enforcement of the USMCA. The labor-related provisions in the USMCA, which are associated with ILAB’s role, are discussed in CRS Report R44981, The United States-MexicoCanada Agreement (USMCA), pp. 32-33. 25 Other divisions of the acts that provided supplemental LHHS appropriations contained authorization provisions that in some cases relate to LHHS programs and activities—for instance, provisions providing a 6.2% increase to the federal matching assistance percentage for Medicaid and certain other programs in FFCRA, and provisions modifying student loan subsidy costs in the CARES Act. The mandatory spending budgetary effects of such provisions are outside the scope of this report. For further information on the LHHS appropriations provided by these COVID-19 pandemic response supplementals, see CRS Report R46353, COVID-19: Overview of FY2020 LHHS Supplemental Congressional Research Service 10 Labor, Health and Human Services, and Education: FY2021 Appropriations     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 funds26 (“1st COVID”); 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 (“2nd COVID”); 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 (“3rd COVID”); and 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 (“4th COVID”). In total, FY2020 supplemental appropriations increased regular FY2020 LHHS enacted funding by about 143%. The bulk of the supplemental funding (89%) was directed at HHS. The $248 billion in supplemental HHS funds represented a 261% increase over the agency’s FY2020 regular appropriations funding level. ED received the next largest increase via supplemental funds (43%), whereas DOL and RA received the smallest increases relative to their initial FY2020 enacted levels (5% and 3%, respectively). Appropriations. 26 Of the amount shown for P.L. 116-123, $300 million (appropriated to the Public Health and Social Services Emergency Fund at HHS) was contingent upon future HHS actions. Congressional Research Service 11 Labor, Health and Human Services, and Education: FY2021 Appropriations Summary of FY2021 LHHS Appropriations Dollars and Percentages in this Report Amounts displayed in this report are typically rounded to the nearest million or billion (as labeled). Dollar and percentage changes discussed in the text are based on unrounded amounts. Unless otherwise specified, appropriations levels displayed in this report refer to the total amount of budget authority provided in an appropriations bill (i.e., “total in the bill”), regardless of the year in which the funding becomes available. Amounts for the FY2020 Enacted, FY2021 Request, and FY2021 Enacted are generally drawn from or calculated based on data contained in the explanatory statement accompanying the FY2021 LHHS omnibus (P.L. 116-260), available in the Congressional Record, vol. 166, no. 218, book IV, December 21, 2020, pp. H8619-H8711. (The amount for P.L. 117-31 is from CBO, Discretionary Spending: Senate Amendment 2123, July 29, 2021, https://www.cbo.gov/system/files/2021-07/EmergencySecuritySupplementalAppropriationsAct2021.pdf.) Amounts for the FY2021 House Committee-reported bill are generally drawn from or calculated based on data contained in the committee report (H.Rept. 116-450) accompanying H.R. 7614. Throughout this report, the FY2021 House Appropriations Committee-reported LHHS bill is commonly referred to as the House “committee bill.” (This report does not contain estimates of the House-passed version of H.R. 7617, as there is no publicly available source that estimates the account-level budgetary effects of the adopted amendments. However, information on the LHHS amendments offered during floor consideration can be found in Appendix B.) Enacted totals (“Total BA in the Bill”) for FY2020 do not include emergency-designated appropriations provided in P.L. 116-113, P.L. 116-123, P.L. 116-127, P.L. 116-136, or P.L. 116-139. House committee bill totals (“Total BA in the Bill”) for FY2021 do not include emergency-designated appropriations proposed in Title VI of H.R. 7614. Enacted totals (“Total BA in the Bill”) for FY2021 do not include emergency-designated appropriations provided in Division H or M of P.L. 116-260, or P.L. 117-31. For informational purposes, FY2020 enacted, and FY2021 proposed and enacted, emergency-designated amounts are displayed separately at the bottom of tables throughout the report and not summed. One exception is made in Table A-1, which includes FY2020 and FY2021 enacted emergency-designated funds in the “Adjusted Appropriations” totals, as scored by the Congressional Budget Office. In addition, further details on the FY2021 supplemental appropriations can be found in Appendix C. For consistency with source materials, the FY2020 and FY2021 numbers in this report generally do not reflect actual or anticipated post-enactment budgetary adjustments, except as noted.27 CRS calculations do, however, include LHHS funding provided to HHS pursuant to the 21st Century Cures Act (P.L. 114-255). Table 2 displays FY2021 discretionary and mandatory LHHS budget authority provided or proposed, by bill title, along with FY2020 enacted levels. The amounts shown in this table reflect total budget authority provided in the annual LHHS bill (i.e., all funds appropriated in the bill, regardless of the fiscal year in which the funds become available), not total budget authority available for the current fiscal year. (For a comparable table showing current-year budget authority, see Table A-2. Note that the totals in this table do not include emergency-designated appropriations; those amounts are displayed separately at the bottom of the table and are in 27 The general practice for CRS reports on the LHHS bill has been to reflect conventions used in source materials. These conventions have varied over the years. For instance, CRS reports on LHHS appropriations for FY2012-FY2015 generally relied on source materials that adjusted appropriations amounts in the prior-year column to reflect sequestration, reestimates of mandatory spending, transfers, reprogramming, and other adjustments for comparability. However, the FY2016 version of this report broke from that practice due to differing display conventions in source documents, and did not reflect any such adjustments (except sequestration for the Prevention and Public Health Fund (PPHF)). The FY2017 version of this report differed from both of these prior practices, in that it reflected a smaller subset of transfers (generally concentrated at the National Institutes of Health) and other adjustments for comparability (e.g., program moves from one account to another), but not reprogramming of funds or mandatory sequestration (except sequestration of the PPHF). The FY2018, FY2019, and FY2020 versions of this report, however, relied on source materials that generally did not reflect any transfers or other budgetary adjustments pursuant to administrative authorities except PPHF sequestration. The source materials used for the FY2021 report version, and thus the numbers in this report, continue this most recent approach. Congressional Research Service 12 Labor, Health and Human Services, and Education: FY2021 Appropriations addition to regular appropriations. For a discussion of the FY2021 supplemental appropriations displayed below the bill totals in Table 2, see Appendix C.) Table 2. LHHS Appropriations Overview by Bill Title, FY2020-FY2021 (Total budget authority provided in the bill, in billions of dollars) FY2020 Enacted FY2021 Request FY2021 House Cmte. (H.R. 7614) 13.8 12.5 14.0 13.9 Discretionary 12.4 11.1 12.7 12.5 Mandatory 1.4 1.4 1.4 1.4 Title II: HHS 934.8 1,005.0 1,016.0 1016.6 Discretionary 94.9 87.0 96.4 97.0 Mandatory 839.9 917.9 919.6 919.6 Title III: Education 76.4 70.2 77.1 77.2 Discretionary 72.8 66.6 73.5 73.5 Mandatory 3.6 3.7 3.7 3.7 72.7 69.4 70.9 70.8 Discretionary 15.4 14.1 15.6 15.5 Mandatory 57.3 55.3 55.3 55.3 Total BA in the Bill 1,097.7 1,157.1 1,178.0 1,178.5 Discretionary 195.4 178.8 198.1 198.5 Mandatory 902.3 978.3 980.0 980.0 USMCA (P.L. 116-113) 0.2 - - - 1st COVID (P.L. 116-123) 6.4 - - - 2nd COVID (P.L. 116-127) 1.3 - - - 3rd COVID (P.L. 116-136) 172.1 - - - 4th COVID (P.L. 116-139) 100.0 - - - Emergency Funding in Annual LHHSa - - 19.4 1.6 5th COVID (Division M, P.L. 116-260) - - - 154.9 Afghan special immigrants (P.L. 117-31) - - - 0.0b Advances for Future Years (provided in current bill)c 189.1 197.1 197.6 197.6 Advances from Prior Years (for use in current year)c 186.7 188.6 189.0 189.0 Additional Scorekeeping Adjustmentsd -10.5 -9.9 -13.2 -22.5 Bill Title Title I: Labor Title IV: Related Agencies FY2021 Enacted (P.L. 116260) Emergency Funding (not included in above totals) Memoranda (non-emergency funds only): Source: Amounts in this table for the FY2020 Enacted, FY2021 Request, and FY2021 Enacted columns are generally drawn from or calculated based on data contained in the explanatory statement accompanying the Congressional Research Service 13 Labor, Health and Human Services, and Education: FY2021 Appropriations FY2021 LHHS omnibus (P.L. 116-260), available in the Congressional Record, vol. 166, no. 218, book IV, December 21, 2020, pp. H8619-H8711. (The amount for P.L. 117-31 is from CBO, Discretionary Spending: Senate Amendment 2123, July 29, 2021, https://www.cbo.gov/system/files/2021-07/ EmergencySecuritySupplementalAppropriationsAct2021.pdf.) Amounts in the FY2021 House Committee column are generally drawn from or calculated based on data contained in the committee report (H.Rept. 116-450) accompanying H.R. 7614. Enacted totals (“Total BA in the Bill”) for FY2020 do not include emergency-designated appropriations provided in P.L. 116-113, P.L. 116-123, P.L. 116-127, P.L. 116-136, or P.L. 116-139. House committee bill totals (“Total BA in the Bill”) for FY2021 do not include emergency-designated appropriations proposed in Title VI of H.R. 7614. Enacted totals (“Total BA in the Bill”) for FY2021 do not include emergencydesignated appropriations provided in Division H or M of P.L. 116-260, or P.L. 117-31. For consistency with source materials, amounts in this figure generally do not reflect mandatory spending sequestration, where applicable, nor do they reflect any transfers or reprogramming of funds pursuant to executive authorities. CRS calculations do, however, include LHHS funding provided to HHS pursuant to the 21st Century Cures Act (P.L. 114-255), as amended. Notes: BA = Budget Authority. Details may not add to totals due to rounding. Amounts in this table (1) reflect all BA appropriated in the bill, regardless of the year in which funds become available (i.e., totals do not include advances from prior-year appropriations, but do include advances for subsequent years provided in this bill); (2) have generally not been adjusted to reflect scorekeeping; (3) comprise only those funds provided (or requested) for agencies and accounts subject to the jurisdiction of the LHHS subcommittees of the House and Senate appropriations committees; and (4) do not include appropriations that occur outside of appropriations bills. No amounts are shown for Title V, because this title consists solely of general provisions. a. The FY2021 House committee bill included a total of $19.4 billion in emergency-designated budget authority in Title VI, of which $925 million was for DOL and $18.5 billion was for HHS. Subsequently, Division H of P.L. 116-260 enacted $1.6 billion in emergency-designated budget authority, of which $925 million was for DOL in Title I, and $638 million was for HHS in Title II. b. P.L. 117-31 provided $25 million in supplemental appropriations for the Refugee and Entrant Assistance account at HHS for specified purposes related to Afghan special immigrants, which rounds to $0.0 in billions (the unit of measure used in this table). c. Totals in this table are based on budget authority provided in the bill (i.e., they exclude advance appropriations from prior bills and include advance appropriations from this bill made available in future years). The calculation for total budget authority available in the current year is as follows: Total BA in the Bill, minus Advances for Future Years, plus Advances from Prior Years. d. Totals in this table have generally not been adjusted for further scorekeeping. (To adjust for scorekeeping, add this line to the total budget authority.) Figure 2 displays the FY2021 enacted discretionary and mandatory LHHS funding levels, by bill title. (While the dollars and percentages discussed in this section were calculated based on the FY2021 enacted amounts, they are generally also illustrative—within several percentage points— of the share of funds directed to each bill title in FY2020 and under the other FY2021 proposals.) As this figure demonstrates, HHS accounts for the largest share of total FY2021 LHHS appropriations: $1,017 billion, or 86.3%. This is due to the large amount of mandatory funding included in the HHS appropriation, the majority of which is for Medicaid grants to states and payments to health care trust funds. After HHS, ED and the Related Agencies represent the nextlargest shares of total LHHS funding, accounting for 6.6% and 6.0%, respectively. (The majority of the ED appropriations each year are discretionary, while the bulk of funding for the Related Agencies goes toward mandatory payments and administrative costs of the Supplemental Security Income program at the Social Security Administration.) DOL accounts for the smallest share of total LHHS funds, 1.2%. The overall composition of LHHS funding is noticeably different when comparing only discretionary appropriations. HHS accounts for a comparatively smaller share of total discretionary appropriations (48.8%), while ED accounts for a relatively larger share (37.0%). Together, these two departments represent the majority (85.9%) of discretionary LHHS appropriations. DOL and the Related Agencies account for a roughly even split of the remaining 14.1% of discretionary LHHS funds. Congressional Research Service 14 Labor, Health and Human Services, and Education: FY2021 Appropriations Figure 2. FY2021 Enacted LHHS Appropriations by Title (Budget authority in billions of dollars [unless otherwise indicated]) Source: Amounts in this figure are generally drawn from or calculated based on data contained in the explanatory statement accompanying the FY2021 LHHS omnibus (P.L. 116-260), available in the Congressional Record, vol. 166, no. 218, book IV, December 21, 2020, pp. H8619-H8711. Enacted totals (“Total BA in the Bill”) for FY2021 do not include emergency-designated appropriations provided in Division H or M of P.L. 116-260, or P.L. 117-31. For consistency with source materials, amounts in this figure generally do not reflect mandatory spending sequestration, where applicable, nor do they reflect any transfers or reprogramming of funds pursuant to executive authorities. CRS calculations do, however, include LHHS funding provided to HHS pursuant to the 21st Century Cures Act (P.L. 114-255), as amended. Notes: Details may not add to totals due to rounding. Amounts in this figure (1) reflect all BA appropriated in the bill, regardless of the year in which funds become available (i.e., totals do not include advances from prioryear appropriations, but do include advances for subsequent years provided in this bill); (2) have generally not been adjusted to reflect scorekeeping; (3) comprise only those funds provided for agencies and accounts subject to the jurisdiction of the LHHS subcommittees of the House and Senate appropriations committees; and (4) do not include appropriations that occur outside of appropriations bills. Department of Labor (DOL) Note that all amounts in this section are based on regular LHHS appropriations only. Amounts in this section do not include mandatory funds provided outside of the annual appropriations process (e.g., direct appropriations for Unemployment Insurance benefits payments). All amounts in this section are rounded to the nearest million or billion (as labeled). The dollar changes and percentage changes discussed in the text are based on unrounded amounts. For consistency with source materials, amounts do not reflect sequestration or reestimates of mandatory spending programs, where applicable. Congressional Research Service 15 Labor, Health and Human Services, and Education: FY2021 Appropriations About DOL DOL is a federal department comprised of multiple entities that provide services related to employment and training, worker protection, income security, and contract enforcement. Annual LHHS appropriations laws direct funding to all DOL entities (see the text box).29 The DOL entities fall primarily into two main functional areas—workforce development and worker protection. First, there are several DOL entities that administer workforce employment DOL Entities Funded via the and training programs—such as the Workforce LHHS Appropriations Process Innovation and Opportunity Act (WIOA) state Employment and Training Administration (ETA) formula grant programs, Job Corps, and the Employee Benefits Security Administration (EBSA) Employment Service—that provide direct Wage and Hour Division (WHD) funding for employment activities or Office of Federal Contract Compliance Programs administration of income security programs (OFCCP) (e.g., for the Unemployment Insurance Office of Labor-Management Standards (OLMS) benefits program). Also included in this area is Office of Workers’ Compensation Programs (OWCP) the Veterans’ Employment and Training Occupational Safety and Health Administration (OSHA) Service (VETS), which provides employment Mine Safety and Health Administration (MSHA) services specifically for the veteran Bureau of Labor Statistics (BLS) population. Second, there are several agencies Office of Disability Employment Policy (ODEP) that provide various worker protection Departmental Management (DM)28 services. For example, the Occupational Safety and Health Administration (OSHA), the Mine Safety and Health Administration (MSHA), and the Wage and Hour Division (WHD) provide different types of regulation and oversight of working conditions. DOL entities focused on worker protection provide services to ensure worker safety, adherence to wage and overtime laws, and contract compliance, among other duties. In addition to these two main functional areas, DOL’s Bureau of Labor Statistics (BLS) collects data and provides analysis on the labor market and related labor issues. FY2021 DOL Appropriations Overview Table 3 generally displays FY2021 discretionary and mandatory DOL budget authority provided or proposed, along with FY2020 enacted levels. The totals in this table do not include emergency supplemental appropriations; amounts provided in supplemental appropriations are displayed separately at the bottom of the table and are in addition to regular appropriations. (Although not technically supplemental appropriations, the bottom of the table also includes emergencydesignated discretionary funding proposed or enacted in annual LHHS measures.) The FY2021 LHHS omnibus increased discretionary appropriations for DOL by $122 million (+1.0%) compared to the FY2020 enacted levels. Discretionary DOL appropriations would have increased by $254 million (+2.0%) under the FY2021 House committee bill, compared to FY2020 enacted, but would have decreased under the FY2021 President’s budget request by $1.3 billion (-10.5%). Of the total funding provided in the bill for DOL, roughly 90% is discretionary. 28 Departmental Management includes the DOL salaries and expenses, Veterans Employment and Training Service (VETS), IT Modernization, and the Office of the Inspector General. 29 The Pension Benefit Guaranty Corporation (PBGC) is funded primarily through insurance premiums and related fees from companies covered by the PBGC. For further information, see CRS In Focus IF10492, An Overview of the Pension Benefit Guaranty Corporation (PBGC). Congressional Research Service 16 Labor, Health and Human Services, and Education: FY2021 Appropriations Table 3. DOL Appropriations Overview (In billions of dollars) FY2020 Enacted FY2021 Request FY2021 House Cmte. (H.R. 7614) Discretionary 12.4 11.1 12.7 12.5 Mandatory 1.4 1.4 1.4 1.4 13.8 12.5 14.0 13.9 USMCA (P.L. 116-113) 0.2 — — — 3rd COVID (P.L. 116-136) 0.4 — — — Emergency Funding in Annual LHHSa — — 0.9 0.9 Funding Total BA in the Bill FY2021 Enacted (P.L. 116260) Emergency Funding (not included in above totals) Source: Amounts in this table for the FY2020 Enacted, FY2021 Request, and FY2021 Enacted columns are generally drawn from or calculated based on data contained in the explanatory statement accompanying the FY2021 LHHS omnibus (P.L. 116-260), available in the Congressional Record, vol. 166, no. 218, book IV, December 21, 2020, pp. H8619-H8711. Amounts in the FY2021 House Committee column are generally drawn from or calculated based on data contained in the committee report (H.Rept. 116-450) accompanying H.R. 7614. Enacted totals (“Total BA in the Bill”) for FY2020 do not include emergency-designated appropriations provided in P.L. 116-113, P.L. 116-123, P.L. 116-127, P.L. 116-136, or P.L. 116-139. House committee bill totals (“Total BA in the Bill”) for FY2021 do not include emergency-designated appropriations proposed in Title VI of H.R. 7614. Enacted totals (“Total BA in the Bill”) for FY2021 do not include emergency-designated appropriations provided in Division H or M of P.L. 116-260, or P.L. 117-31. For consistency with source materials, amounts in this figure generally do not reflect mandatory spending sequestration, where applicable, nor do they reflect any transfers or reprogramming of funds pursuant to executive authorities. Notes: BA = Budget Authority. Details may not add to totals due to rounding. Amounts in this table (1) reflect all BA appropriated in the bill, regardless of the year in which funds become available (i.e., totals do not include advances from prior-year appropriations, but do include advances for subsequent years provided in this bill); (2) have generally not been adjusted to reflect scorekeeping; (3) comprise only those funds provided (or requested) for agencies and accounts subject to the jurisdiction of the LHHS subcommittees of the House and Senate appropriations committees; and (4) do not include appropriations that occur outside of appropriations bills. a. The FY2021 House committee bill included a total of $19.4 billion in emergency-designated budget authority in Title VI, of which $925 million was for DOL. Subsequently, Division H of P.L. 116-260 enacted $1.6 billion in emergency-designated budget authority, of which $925 million was for DOL. Selected DOL Highlights The following sections present highlights from FY2021 enacted and proposed appropriations compared to FY2020 enacted appropriations for selected DOL accounts and programs. 30 Table 4 displays funding for DOL programs and activities discussed in this section. Employment and Training Administration (ETA) ETA administers the primary federal workforce development statute, the Workforce Innovation and Opportunity Act (WIOA, P.L. 113-128). The WIOA, which replaced the Workforce 30 DOL budget materials can be found at https://www.dol.gov/general/aboutdol#budget. Congressional Research Service 17 Labor, Health and Human Services, and Education: FY2021 Appropriations Investment Act, was enacted in July 2014 and authorized appropriations for its programs and activities from FY2015 through FY2020. Authorization of appropriations for WIOA programs and activities expired at the end of FY2020 but was extended through FY2021 by the FY2021 LHHS omnibus (P.L. 116-260, Division H, Title I). Title I of WIOA, which authorizes more than half of all funding for the programs authorized by the four titles of WIOA, includes three state formula grant programs serving Adults, Youth, and Dislocated Workers. While the FY2021 LHHS omnibus provided a $26 million increase (+0.9%) for the three WIOA state formula grant programs compared to FY2020, the FY2021 President’s budget would have provided level funding and the House committee bill would have increased funding by $50 million (+1.8%), compared to FY2020 enacted levels. The FY2021 LHHS omnibus provided $281 million for the Dislocated Workers Activities National Reserve (DWA National Reserve), which was an increase of $10 million (+3.7%) compared to the FY2020 enacted level. This was the same amount that was proposed by the House committee bill, whereas the FY2021 President’s budget would have reduced funding for the DWA National Reserve by $110 million (-40.6%). In addition, the FY2021 LHHS omnibus maintained a provision in that account (which originated in the FY2018 omnibus and has been included since then) directing $35 million from the DWA National Reserve toward training and employment assistance for workers dislocated in both the Appalachian and lower Mississippi regions. Finally, the FY2021 LHHS omnibus maintained a provision that originated in the FY2020 omnibus directing $45 million from the DWA National Reserve to be used in developing, offering, or improving career training programs at community colleges. The FY2021 LHHS omnibus provided $185 million for the Apprenticeship Grant program, which was $10 million (+5.7%) more than the level enacted in FY2020 and the same that the House committee bill would have provided. The FY2021 President’s budget would have increased the level of funding for the Apprenticeship Grant program by $25 million (+14.3%) compared to the FY2020 enacted level. Four ETA programs for which the FY2021 President’s budget proposed no funding—the Native Americans program, the Migrant and Seasonal Farmworkers program, the Community Service Employment for Older Americans (CSEOA) program, and the Workforce Data Quality Initiative—received FY2021 appropriations at roughly the same level as FY2020. Office of Foreign Labor Certification (OFLC) The FY2021 LHHS omnibus provided $78 million for OFLC, which was an increase of $9 million (+13.1%) compared to the FY2020 enacted level and the same amount that was proposed by the House committee bill. This FY2021 enacted level was $2 million less (-2.6%) than the amount requested in the FY2021 President’s budget. The OFLC, which is part of ETA, is responsible for labor certification applications for employment-based and immigration and guest worker programs. Of the $9 million increase, $3 million was for national administration and $6 million was for grants to states. As noted in the FY2021 House committee report, the $6 million increase in OFLC grants to states was proposed partly in response to an increase in the number of H-2A applications that resulted in requests from states for additional resources for reviewing, processing, recruitment of potential domestic agricultural workers, and contract oversight.31 31 H.Rept. 116-450, pp. 20-21. Congressional Research Service 18 Labor, Health and Human Services, and Education: FY2021 Appropriations Bureau of Labor Statistics (BLS) The FY2021 LHHS omnibus provided $655 million for BLS, the same level as FY2020 enacted The House committee bill had previously proposed level funding, whereas the FY2021 President’s budget had proposed a $3 million increase (+0.5%) relative to FY2020. As noted in the explanatory statement accompanying the FY2021 LHHS omnibus, $13 million of the FY2021 appropriation was for necessary costs associated with the physical relocation of BLS headquarters to the Suitland Federal Complex, which was initiated in FY2020.32 Similarly, the FY2021 House committee report indicated continued support for BLS to continue implementation of several data projects started in FY2020, including work to implement an annual supplement to the Current Population Survey (CPS) to collect data on contingent workers every two years and other topics in the alternate years, to restore the production of labor market data in the Local Area Unemployment Statistics (LAUS) program for New England Minor Civil Divisions with populations less than 1,000, and to plan and develop a new National Longitudinal Survey of Youth (NLSY) cohort.33 Bureau of International Labor Affairs (ILAB) The FY2021 LHHS omnibus provided $96 million for ILAB, which was the same as the FY2020 enacted level and the same amount that the House committee bill would have provided. The FY2021 President’s budget would have decreased funding by $77 million (-80.6%) for ILAB, which provides research, advocacy, technical assistance, and grants to promote workers’ rights in different parts of the world. Language in the FY2021 President’s budget indicated that the proposed reduction reflected a $67.3 million decrease to eliminate new grants and a $10.3 million decrease to reduce staff levels, with the remaining $19 million to be used on “efforts to make U.S. trade agreements fair for U.S. workers by monitoring and enforcing the labor provisions of free trade agreements (FTAs) and trade preference programs to ensure a fair global playing field for U.S. workers and businesses.”34 Labor-Related General Provisions Annual LHHS appropriations acts regularly contain general provisions related to certain labor issues. This section highlights selected DOL general provisions in the FY2021 LHHS omnibus. The FY2021 LHHS omnibus continued several provisions that have been included in at least one previous LHHS appropriations act, including provisions that   exempt certain insurance claims adjusters from overtime protection for two years following a “major disaster” (included since FY2016);35 direct the Secretary of Labor to accept private wage surveys as part of the process of determining prevailing wages in the H-2B program, even in instances in which relevant wage data are available from the Bureau of Labor Statistics (included since FY2016);36 32 Congressional Record, December 21, 2020, Vol. 166, No. 218, Book IV, p. H8619. 33 H.Rept. 116-450, pp. 31-32. 34 See DOL, FY2021 Congressional Budget Justification, Departmental Management, p. DM-41, https://www.dol.gov/ sites/dolgov/files/general/budget/2021/CBJ-2021-V3-02.pdf. 35 See Division H, Title I, §108 of P.L. 116-260. 36 See Division H, Title I, §110 of P.L. 116-260. The H-2B program allows for the temporary employment of foreign Congressional Research Service 19 Labor, Health and Human Services, and Education: FY2021 Appropriations  authorize the Secretary of Labor to provide up to $2 million in “excess personal property” to apprenticeship programs to assist training apprentices (included since FY2018);37  authorize the Secretary of Labor to employ law enforcement officers or special agents to provide protection to the Secretary of Labor and certain other employees and family members at public events and in situations in which there is a “unique and articulable” threat of physical harm (included since FY2018);38 authorize the Secretary of Labor to dispose of or divest “by any means the Secretary determines appropriate” all or part of the real property on which the Treasure Island Job Corps Center is located (included since FY2018);39 and   prohibit any funds from the FY2021 omnibus from being used to alter the Interagency Agreement between DOL and USDA or to close any Civilian Conservation Centers unless certain conditions are met (included since FY2020).40 Table 4. Detailed DOL Appropriations (In millions of dollars) Agency or Selected Program FY2020 Enacted FY2021 Request FY2021 House Cmte. (H.R. 7614) FY2021 Enacted (P.L. 116260) ETA—Mandatorya 680 634 634 634 ETA—Discretionary 9,293 8,043 9,527 9,392 Training and Employment Services: 3,611 3,358 3,697 3,663 State Formula Grants: 2,820 2,820 2,870 2,845 Adult Activities Grants to States 855 855 865 863 Youth Activities Grants to States 913 913 925 921 1,052 1,052 1,080 1,062 791 538 827 818 DWA National Reserve 271 161 281 281 Native Americans 55 0 56 56 Migrant and Seasonal Farmworkers 92 0 96 94 YouthBuild 95 85 101 97 Reintegration of Ex-Offenders 98 93 103 100 Discretionary ETA Programs: Dislocated Worker Activities (DWA) Grants to States National Activities: workers in nonagricultural sectors and requires these workers to be paid the “prevailing wage” (i.e., the average wage paid to similar workers in the local area). Under DOL regulations, private employer surveys may be considered only if the employer meets certain conditions. 37 See Division H, Title I, §112 of P.L. 116-260. 38 See Division H, Title I, §113 of P.L. 116-260. 39 See Division H, Title I, §114 of P.L. 116-260. 40 See Division H, Title I, §116 of P.L. 116-260. Congressional Research Service 20 Labor, Health and Human Services, and Education: FY2021 Appropriations FY2021 Request FY2021 House Cmte. (H.R. 7614) FY2021 Enacted (P.L. 116260) 6 0 6 6 175 200 185 185 1,744 1,016 1,756 1,749 405 0 410 405 3,375 3,497 3,506 3,417 2,553 2,665 2,668 2,584 Employment Service 690 688 698 692 Foreign Labor Certification 69 80 78 78 One-Stop Career Centers 63 65 63 63 ETA Program Administration 159 172 159 159 Employee Benefits Security Administration 181 193 181 181 Pension Benefit Guaranty Corp, (PBGC) program level (non-add)b (453) (465) (465) (465) Wage and Hour Division 242 244 246 246 Office of Labor-Management Standards 43 50 42 44 Office of Federal Contract Compliance Programs 106 106 106 106 Office of Workers’ Compensation Programs— Mandatoryc 695 739 739 739 Office of Workers’ Compensation Programs— Discretionary 118 119 118 118 Occupational Safety & Health Administration 582 577 594 592 Mine Safety & Health Administration 380 382 380 380 Bureau of Labor Statistics 655 658 655 655 Office of Disability Employment Policy 39 27 39 39 Departmental Management 776 714 780 784 Salaries and Expenses 348 272 349 349 96 19 96 96 Veterans Employment and Training 311 312 314 316 IT Modernization 25 37 25 27 Office of the Inspector General 91 93 92 91 Total, DOL BA in the Bill 13,789 12,488 14,041 13,909 Subtotal, Mandatory 1,375 1,373 1,373 1,373 Subtotal, Discretionary 12,414 11,114 12,668 12,536 Agency or Selected Program Workforce Data Quality Initiative Apprenticeship Grants Job Corps Community Service Employment for Older Americans State Unemployment Insurance and Employment Service Operations (SUI/ESO): Unemployment Compensation International Labor Affairs (non-addd) Congressional Research Service FY2020 Enacted 21 Labor, Health and Human Services, and Education: FY2021 Appropriations Agency or Selected Program FY2020 Enacted FY2021 Request FY2021 House Cmte. (H.R. 7614) FY2021 Enacted (P.L. 116260) Emergency Funding (not included in above totals) USMCA (P.L. 116-113) 210 — — — 3rd COVID (P.L. 116-136) 360 — — — Emergency Funding in Annual LHHSe — — 925 925 Total, BA Available in Fiscal Year (current year from any bill) 13,789 12,548 14,041 13,909 Total, BA Advances for Future Years (provided in current bill) 1,786 1,726 1,786 1,786 Total, BA Advances from Prior Years (for use in current year) 1,786 1,786 1,786 1,786 Memoranda (non-emergency funds only) Source: Amounts in this table for the FY2020 Enacted, FY2021 Request, and FY2021 Enacted columns are generally drawn from or calculated based on data contained in the explanatory statement accompanying the FY2021 LHHS omnibus (P.L. 116-260), available in the Congressional Record, vol. 166, no. 218, book IV, December 21, 2020, pp. H8619-H8711. Amounts in the FY2021 House Committee column are generally drawn from or calculated based on data contained in the committee report (H.Rept. 116-450) accompanying H.R. 7614. Enacted totals (“Total BA in the Bill”) for FY2020 do not include emergency-designated appropriations provided in P.L. 116-113, P.L. 116-123, P.L. 116-127, P.L. 116-136, or P.L. 116-139. House committee bill totals (“Total BA in the Bill”) for FY2021 do not include emergency-designated appropriations proposed in Title VI of H.R. 7614. Enacted totals (“Total BA in the Bill”) for FY2021 do not include emergency-designated appropriations provided in Division H or M of P.L. 116-260, or P.L. 117-31. For consistency with source materials, amounts in this figure generally do not reflect mandatory spending sequestration, where applicable, nor do they reflect any transfers or reprogramming of funds pursuant to executive authorities. Notes: BA = Budget Authority. Details may not add to totals due to rounding. Amounts in this table (1) reflect all BA appropriated in the bill, regardless of the year in which funds become available (i.e., totals do not include advances from prior-year appropriations, but do include advances for subsequent years provided in this bill); (2) have generally not been adjusted to reflect scorekeeping; (3) comprise only those funds provided (or requested) for agencies and accounts subject to the jurisdiction of the LHHS subcommittees of the House and Senate appropriations committees; and (4) do not include appropriations that occur outside of appropriations bills. a. Mandatory funding within ETA goes to Federal Unemployment Benefits and Allowances (FUBA) and Advances to the Unemployment Trust Fund (UTF), if any. FUBA funds Trade Adjustment Assistance for Workers (TAA). b. PBGC funding is provided outside the LHHS Appropriations Act. c. Mandatory programs in the Office of Workers’ Compensation Programs include Special Benefits (comprising the Federal Employees’ Compensation Benefits and the Longshore and Harbor Workers’ Benefits), Special Benefits for Disabled Coal Miners, Energy Employees Occupational Illness Compensation (Administrative Expenses), and the Black Lung Disability Trust Fund. d. The funding for International Labor Affairs is included in the Salaries and Expenses total. e. The FY2021 House committee bill included a total of $19.4 billion in emergency-designated budget authority in Title VI, of which $925 million was for DOL. Subsequently, Division H of P.L. 116-260 enacted $1.6 billion in emergency-designated budget authority, of which $925 million was for DOL. Department of Health and Human Services (HHS) Note that all amounts in this section are based on regular LHHS appropriations only; they do not include funds for HHS agencies provided through other appropriations bills (e.g., funding for the Congressional Research Service 22 Labor, Health and Human Services, and Education: FY2021 Appropriations Food and Drug Administration) or outside of the annual appropriations process (e.g., direct appropriations for Medicare or mandatory funds provided by authorizing laws, such as the Patient Protection and Affordable Care Act [ACA, P.L. 111-148]). All amounts in this section are rounded to the nearest million or billion (as labeled). The dollar changes and percentage changes discussed in the text are based on unrounded amounts. For consistency with source materials, amounts do not reflect sequestration or re-estimates of mandatory spending programs, where applicable. About HHS HHS Agencies Funded via the HHS is a large federal department composed LHHS Appropriations Process of multiple agencies working to enhance the Health Resources and Services Administration (HRSA) health and well-being of Americans. Annual Centers for Disease Control and Prevention (CDC) LHHS appropriations laws direct funding to National Institutes of Health (NIH) most (but not all) HHS agencies (see text box Substance Abuse and Mental Health Services for HHS agencies supported by the LHHS Administration (SAMHSA) bill).41 For instance, the LHHS bill directs Agency for Healthcare Research and Quality (AHRQ) funding to five Public Health Service (PHS) Centers for Medicare & Medicaid Services (CMS) agencies: the Health Resources and Services Administration for Children and Families (ACF) Administration (HRSA), Centers for Disease Administration for Community Living (ACL) Control and Prevention (CDC), National Office of the Secretary (OS) Institutes of Health (NIH), Substance Abuse and Mental Health Services Administration (SAMHSA), and Agency for Healthcare Research and Quality (AHRQ).42 These public health agencies support diverse missions, ranging from the provision of health care services and supports (e.g., HRSA, SAMHSA), to the advancement of health care quality and medical research (e.g., AHRQ, NIH), to the prevention and control of infectious and chronic diseases (e.g., CDC). In addition, the LHHS bill provides funding for annually appropriated components of CMS,43 which is the HHS agency responsible for the administration of Medicare, Medicaid, the State Children’s Health Insurance Program (CHIP), and consumer protections and private health insurance provisions of the ACA. The LHHS bill also provides funding for two HHS agencies focused primarily on the provision of social services: the Administration for Children and Families (ACF) and the Administration for Community Living (ACL). ACF’s mission is to promote the economic and social well-being of vulnerable children, youth, families, and communities. ACL was formed with a goal of increasing access to community supports for older Americans and people with disabilities. The LHHS bill also provides funding for the HHS Office of the Secretary (OS), which encompasses a broad array of management, research, oversight, and emergency preparedness functions in support of the entire department. 41 Three HHS public health agencies receive annual funding from appropriations bills other than the LHHS bill: the Food and Drug Administration (funded through the Agriculture appropriations bill), the Indian Health Service (funded through the Interior-Environment appropriations bill), and the Agency for Toxic Substances and Disease Registry (funded through the Interior-Environment appropriations bill). In addition, while the National Institutes of Health (NIH) receive the majority of their appropriations from the LHHS bill, one NIH institute (the National Institute of Environmental Health Sciences) receives appropriations from two bills: LHHS and the Interior-Environment bill. 42 For more information on HHS PHS agencies, see CRS Report R44916, Public Health Service Agencies: Overview and Funding (FY2016-FY2018). 43 Much of the funding for CMS activities is provided through mandatory appropriations in authorizing legislation, and thus is not subject to the annual appropriations process. Congressional Research Service 23 Labor, Health and Human Services, and Education: FY2021 Appropriations FY2021 HHS Appropriations Overview Table 5 displays enacted and proposed FY2021 funding levels for HHS, along with FY2020 levels. Note that the totals in this table do not include emergency supplemental appropriations; amounts provided in supplementals are displayed separately at the bottom of the table and are in addition to regular appropriations. (Although not technically supplemental appropriations, the bottom of the table also includes emergency-designated discretionary funding proposed or enacted in annual LHHS measures.) For a discussion of the FY2021 supplemental appropriations in Division M of P.L. 116-260 and P.L. 117-31, see Appendix C. In general, discretionary funds account for about 10% of HHS appropriations in the LHHS bill. Compared to the FY2020 funding levels, the FY2021 LHHS omnibus increased HHS discretionary appropriations by 2.2%. The House committee bill would have increased HHS discretionary appropriations to a lesser degree, by 1.5%, while the President requested an 8.3% decrease in discretionary HHS funding. Table 5. HHS Appropriations Overview (In billions of dollars) FY2020 Enacted FY2021 Request FY2021 House Cmte. (H.R. 7614) Discretionary 94.9 87.0 96.4 97.0 Mandatory 839.9 917.9 919.6 919.6 Total BA in the Bill 934.8 1,005.0 1,016.0 1,016.6 1st COVID (P.L. 116-123) 6.4 — — — 2nd COVID (P.L. 116-127) 1.3 — — — 3rd COVID (P.L. 116-136) 140.4 — — — 4th COVID (P.L. 116-139) 100.0 — — — Emergency Funding in Annual LHHSa — — 18.5 0.6 5th COVID (Division M, P.L. 116-260) — — — 72.9 Afghan special immigrants (P.L. 117-31) - - - 0.0b Funding FY2021 Enacted (P.L. 116-260) Emergency Funding (not included in above totals) Sources: Amounts in this table for the FY2020 Enacted, FY2021 Request, and FY2021 Enacted columns are generally drawn from or calculated based on data contained in the explanatory statement accompanying the FY2021 LHHS omnibus (P.L. 116-260), available in the Congressional Record, vol. 166, no. 218, book IV, December 21, 2020, pp. H8619-H8711. (The amount for P.L. 117-31 is from CBO, Discretionary Spending: Senate Amendment 2123, July 29, 2021, https://www.cbo.gov/system/files/2021-07/ EmergencySecuritySupplementalAppropriationsAct2021.pdf.) Amounts in the FY2021 House Committee column are generally drawn from or calculated based on data contained in the committee report (H.Rept. 116-450) accompanying H.R. 7614. Enacted totals (“Total BA in the Bill”) for FY2020 do not include emergency-designated appropriations provided in P.L. 116-113, P.L. 116-123, P.L. 116-127, P.L. 116-136, or P.L. 116-139. House committee bill totals (“Total BA in the Bill”) for FY2021 do not include emergency-designated appropriations proposed in Title VI of H.R. 7614. Enacted totals (“Total BA in the Bill”) for FY2021 do not include emergencydesignated appropriations provided in Division H or M of P.L. 116-260, or P.L. 117-31. For consistency with source materials, amounts in this figure generally do not reflect mandatory spending sequestration, where Congressional Research Service 24 Labor, Health and Human Services, and Education: FY2021 Appropriations applicable, nor do they reflect any transfers or reprogramming of funds pursuant to executive authorities. CRS calculations do, however, include LHHS funding provided to HHS pursuant to the 21 st Century Cures Act (P.L. 114-255), as amended. Notes: BA = Budget Authority. Details may not add to totals due to rounding. Amounts in this table (1) reflect all BA appropriated in the bill, regardless of the year in which funds become available (i.e., totals do not include advances from prior-year appropriations, but do include advances for subsequent years provided in this bill); (2) have generally not been adjusted to reflect scorekeeping; (3) comprise only those funds provided (or requested) for agencies and accounts subject to the jurisdiction of the LHHS subcommittees of the House and Senate appropriations committees; and (4) do not include appropriations that occur outside of appropriations bills. a. The FY2021 House committee bill included a total of $19.4 billion in emergency-designated budget authority in Title VI, of $18.5 billion was for HHS. Subsequently, Division H of P.L. 116-260 enacted $1.6 billion in emergency-designated budget authority, of which $638 million was for HHS in Title II. b. P.L. 117-31 provided $25 million in supplemental appropriations for the Refugee and Entrant Assistance account at HHS for specified purposes related to Afghan special immigrants, which rounds to $0.0 in billions (the unit of measure used in this table). Figure 3 provides an HHS agency-level breakdown of FY2021 enacted appropriations. As this figure demonstrates, annual HHS appropriations are dominated by mandatory funding, the majority of which goes to CMS to provide Medicaid benefits and payments to health care trust funds. When taking into account both mandatory and discretionary funding, CMS accounts for $906.6 billion, which is 89.2% of all enacted appropriations for HHS. NIH and ACF account for the next-largest shares of total HHS appropriations, receiving about 4.1% apiece. By contrast, when looking exclusively at discretionary appropriations, funding for CMS constitutes about 4.6% of FY2021 enacted HHS appropriations. Instead, the bulk of discretionary appropriations went to the PHS agencies, which combined to account for 63.8% of discretionary appropriations provided for HHS.44 NIH typically receives the largest share of all discretionary funding among HHS agencies (42.7% in FY2021), with ACF accounting for the second-largest share (25.5% in FY2021). 44 For further information about PHS agency funding, see CRS Report R44916, Public Health Service Agencies: Overview and Funding (FY2016-FY2018). Congressional Research Service 25 Labor, Health and Human Services, and Education: FY2021 Appropriations Figure 3. FY2021 Enacted HHS Appropriations by Agency (Budget authority in billions of dollars) Source: Amounts in this figure are generally drawn from or calculated based on data contained in the explanatory statement accompanying the FY2021 LHHS omnibus (P.L. 116-260), available in the Congressional Record, vol. 166, no. 218, book IV, December 21, 2020, pp. H8619-H8711. Enacted totals (“Total BA in the Bill”) for FY2021 do not include emergency-designated appropriations provided in Division H or M of P.L. 116-260, or P.L. 117-31. For consistency with source materials, amounts in this figure generally do not reflect mandatory spending sequestration, where applicable, nor do they reflect any transfers or reprogramming of funds pursuant to executive authorities. CRS calculations do, however, include LHHS funding provided to HHS pursuant to the 21st Century Cures Act (P.L. 114-255), as amended. Notes: Details may not add to totals due to rounding. The bar representing the combined mandatory and discretionary total for CMS has been abbreviated due to space constraints. When taking into account both mandatory and discretionary funding, CMS receives over 20 times the funding appropriated to either ACF or NIH in the FY2021 LHHS omnibus. Amounts in this table (1) reflect all BA appropriated in the bill, regardless of the year in which funds become available (i.e., totals do not include advances from prior-year appropriations, but do include advances for subsequent years provided in this bill); (2) have generally not been adjusted to reflect scorekeeping; (3) comprise only those funds provided (or requested) for agencies and accounts subject to the jurisdiction of the LHHS subcommittees of the House and Senate appropriations committees; and (4) do not include appropriations that occur outside of appropriations bills. Special Public Health Funding Mechanisms Annual appropriations for HHS public health service agencies are best understood in the context of certain HHS-specific funding mechanisms: the Public Health Service Evaluation Set-Aside, and the Prevention and Public Health Fund (PPHF). In recent years, LHHS appropriations have used these funding mechanisms to direct additional support to certain programs and activities. Public Health Service Evaluation Tap The PHS Evaluation Set-Aside, also known as the PHS Evaluation Tap, is a unique feature of HHS appropriations. It is authorized by Section 241 of the Public Health Service Act (PHSA), and allows the Secretary of HHS, with the approval of appropriators, to redistribute a portion of eligible PHS agency appropriations across HHS for program evaluation purposes. The PHSA limits the set-aside to not less than 0.2% and not more than 1% of eligible program appropriations. However, LHHS appropriations acts have commonly established a higher Congressional Research Service 26 Labor, Health and Human Services, and Education: FY2021 Appropriations maximum percentage for the set-aside and have distributed specific amounts of “tap” funding to selected HHS programs. Since FY2010, and including in FY2021, this higher maximum set-aside level has been 2.5% of eligible appropriations.45 (The President’s budget proposed to increase the set-aside to 2.9%, while the House committee bill would have increased it to 3.0%.) Display of Evaluation Tap Transfers Before FY2015, the PHS tap traditionally provided more than a dozen HHS programs By convention, tables in this report show only the amount of PHS Evaluation Tap funds received by an with funding beyond their annual agency (i.e., tables do not subtract the amount of the appropriations and, in some cases, was the evaluation tap from donor agencies’ appropriations). sole source of funding for a program or That is to say, tap amounts shown in the following activity. However, since FY2015 and tables are in addition to amounts shown for budget including in FY2020, LHHS appropriations authority, but the amounts shown for budget authority have not been adjusted to reflect potential “transferlaws have directed tap funds to a smaller out” of funds to the tap. number of programs or activities within three HHS agencies (NIH, SAMHSA, and OS) and have not provided any tap transfers to AHRQ, CDC, and HRSA. This has been particularly notable for AHRQ, which had been funded primarily through tap transfers from FY2003 to FY2014, but has received discretionary appropriations since then.46 The House committee bill generally would have maintained the current distributional practice for FY2021, except that it would have also provided tap funding to AHRQ. The President’s budget proposed to expand the activities and agencies funded by the PHS tap to include the Public Health Scientific Services at the CDC and to supplemental funding for organ transplantation activities at HRSA, while simultaneously proposing to reduce tap transfers to the NIH. Since FY2015, LHHS appropriations laws have directed the largest share of tap transfers to NIH.47 The FY2021 LHHS omnibus provided $1.3 billion in tap transfers to NIH, a $41 million (+3.3%) increase over the FY2020 level. The FY2021 House committee bill proposed that the NIH transfers be increased by $110 million (+9.0%), whereas the President’s request proposed that the transfers be reduced by $490 million (-39.8%). 45 See Section 204, Division H, P.L. 116-260 for the FY2021 maximum set-aside level. The last time that an appropriations act set the PHS tap percentage at a level other than 2.5% was in FY2009, when it was 2.4% (see P.L. 111-8). The FY2021 omnibus also retained a change to this provision, first included in the FY2014 omnibus, allowing tap transfers to be used for the “evaluation and the implementation” of programs funded in the HHS title of the LHHS appropriations act. Prior to FY2014, such provisions had restricted tap funds to the “evaluation of the implementation” of programs authorized under the Public Health Service Act. 46 Until FY2015, AHRQ had not received a discretionary appropriation in an annual appropriations act in more than a decade. FY2009 was the exception to this general pattern, as AHRQ received a supplemental appropriation from the American Recovery and Reinvestment Act that year. In recent years, AHRQ has also received some transfers from the Prevention and Public Health Fund and the Patient-Centered Outcomes Research Trust Fund, though these transfers were generally much smaller than the transfers AHRQ received from the tap. For more information, see CRS Report R44136, The Agency for Healthcare Research and Quality (AHRQ) Budget: Fact Sheet. 47 Prior to FY2015, NIH had traditionally been by far the largest net donor of tap funds, rather than a net recipient. The joint explanatory statement accompanying the FY2015 omnibus explained this shift as being intended to ensure that tap transfers are a “net benefit to NIH rather than a liability” and noted that this change was in response to a growing concern at the loss of NIH funds to the tap. Joint Explanatory Statement, Proceedings and Debates of the 113 th Congress, Second Session, Congressional Record, vol. 160, no. 151, Book II, December 11, 2014, p. H9832. Congressional Research Service 27 Labor, Health and Human Services, and Education: FY2021 Appropriations Prevention and Public Health Fund Display of PPHF Transfers PPHF transfer amounts displayed in the HHS tables in this report are in addition to amounts shown for budget authority provided in the bill. For consistency with source materials, the amounts shown for PPHF transfers in these tables reflect the estimated effects of mandatory spending sequestration; this is not the case for other mandatory spending shown in this report (also for consistency with source materials). The ACA both authorized and appropriated mandatory funding to three funds to support programs and activities within the PHS agencies.48 One of these, the Prevention and Public Health Fund (PPHF, ACA §4002, as amended), was given a permanent, annual appropriation that was intended to provide support each year to prevention, wellness, and related public health programs funded through HHS accounts. The ACA had appropriated $2 billion in mandatory funds to the PPHF for FY2021, but this amount was reduced by subsequent laws that decreased PPHF funding for FY2021 and other fiscal years. Under current law, the FY2021 appropriation was $950 million.49 In addition, this appropriation was subject to a 5.7% reduction due to sequestration of nonexempt mandatory spending.50 (For more information on sequestration, see the budget enforcement discussion in Appendix A.) After sequestration, the total PPHF appropriation available for FY2021 was $896 million, an increase of $2 million relative to FY2020. Of this amount, the LHHS omnibus allocated $856 million to CDC, $12 million to SAMHSA, and $28 million to ACL.51 PPHF funds are intended to supplement (sometimes quite substantially) the funding that selected programs receive through regular appropriations. Although the PPHF authority instructs the HHS Secretary to transfer amounts from the fund to HHS agencies, since FY2014 provisions in annual appropriations acts and accompanying reports have explicitly directed the distribution of PPHF funds and prohibited the Secretary from making further transfers for those years.52 CDC commonly receives the largest share of annual PPHF funds. The amount provided to CDC for FY2021 and proposed by the House committee bill, $854 million, was a $2 million (+0.2%) increase relative to FY2020. The President’s request proposed increasing the PPHF funding transferred to CDC to $894 million (+4.6%), and providing no mandated transfers to SAMHSA or ACL. Selected HHS Highlights by Agency This section begins with a limited selection of FY2021 discretionary funding highlights by HHS agency. The discussion is largely based on the enacted and proposed appropriations levels for FY2021, compared to FY2020 enacted levels.53 These summaries are followed by a brief overview of significant provisions from annual HHS appropriations laws that restrict spending in certain controversial areas, such as abortion and stem cell research. The section concludes with 48 For more information, see CRS Report R41301, Appropriations and Fund Transfers in the Affordable Care Act (ACA). 49 42 U.S.C. §300u-11. 50 OMB Report to the Congress on the Joint Committee Reductions for Fiscal Year 2021, February 10, 2020, p. 7 of 17, https://www.whitehouse.gov/wp-content/uploads/2020/02/JC-sequestration_report_FY21_2-10-20.pdf. 51 See explanatory statement accompanying the FY2021 LHHS omnibus (P.L. 116-260), available in the Congressional Record, December 21, 2020, Vol. 166, No. 218, Book IV, p. H8634, for allocations to specific agency programs and activities. 52 See Division H, §222, P.L. 116-260. 53 HHS budget materials can be found at http://www.hhs.gov/budget/. Congressional Research Service 28 Labor, Health and Human Services, and Education: FY2021 Appropriations two tables (Table 6 and Table 7) presenting more detailed information on FY2020 enacted and FY2021 proposed and enacted funding levels for HHS. HRSA The FY2021 LHHS omnibus provided $7.2 billion in discretionary budget authority for HRSA. This was $171 million (+2.4%) more than HRSA’s FY2020 discretionary funding level and $913 million (+14.5%) more than the FY2021 President’s budget request. Under the Primary Health Care account, the Community Health Centers program received $1.683 billion, an increase of $57 million (+3.5%) relative to FY2020.54 The explanatory statement also recommended $102.5 million under that same account for the second year of the Ending the HIV Epidemic Initiative, which is focused on reducing HIV transmission via increased use of preexposure prophylaxis (PrEP) among high risk groups.55 Under the Ryan White HIV/AIDS Program appropriation, there is an additional $105 million set aside for this HIV initiative, an increase of $35 million relative to FY2020. The explanatory statement also “encourages the acceleration of the development of oral, ultra-long-acting, sustained-release therapies” as part of this initiative.56 The explanatory statement provided $34 million for telehealth within the Rural Health account, a $5 million (+17.2%) increase relative to FY2020. Within this amount, $6.5 million was provided for the Telehealth Centers of Excellence (COE) and $1 million was provided for an evaluation of nationwide telehealth investments in rural areas and populations.57 It also directed HHS and HRSA to “continue to utilize the expertise of the COEs in the Ending the HIV Epidemic initiative to develop best practices for utilizing telehealth in HIV prevention, care, and treatment.” The Maternal and Child Health (MCH) Block Grant received $713 million, an increase of $25 million (+3.6%) relative to FY2020. Related to maternal health, the explanatory statement set aside $9 million for the Alliance for Maternal Health Safety Bundles, which are “a set of targeted and evidence-based best practices that, when implemented, improve patient outcomes and reduce maternal mortality and severe maternal morbidity,”58 and provided $5 million for State Maternal Health Innovation Grants. Within the Health Workforce account, the explanatory statement designated $2.5 million for midwife training “to address the national shortage of maternity care providers and the lack of diversity in the maternity care workforce.”59 CDC The FY2021 LHHS omnibus provided $7.0 billion in discretionary budget authority for CDC, which was $123 million (+1.8%) more than CDC’s FY2020 funding level. The FY2021 LHHS omnibus did not direct any PHS tap funds to the CDC, continuing the practice started in FY2015. 54 The Health Centers program also received significant additional FY2020 and FY2021 funding related to the COVID- 19 pandemic, totaling roughly $2 billion. For a discussion of this funding, see CRS Report R46711, U.S. Public Health Service: COVID-19 Supplemental Appropriations in the 116th Congress. 55 Congressional Record, December 21, 2020, Vol. 166, No. 218, Book IV, p. H8620. An amount of $50 million was set aside in FY2020 for the first year of this initiative (see Congressional Record, December 17, 2019, Vol. 165, No. 204, Book III, p. H11063). 56 Ibid, p. H8621. 57 Ibid, p. H8620. See H.Rept. 116-450, pp. 58-59, for further information. 58 Ibid, p. H8620. See H.Rept. 116-450, p. 51, for a description of this activity. 59 Ibid, p. H8620. Congressional Research Service 29 Labor, Health and Human Services, and Education: FY2021 Appropriations It also did not direct the transfer of funds from the HHS Nonrecurring Expenses Fund (NEF) to the CDC (unlike FY2020).60 However, the FY2021 LHHS omnibus did supplement discretionary CDC appropriations by directing $856 million in PPHF transfers to the CDC, which was $2 million (+0.2%) more than FY2020. All told, this combination of funding—compared to FY2020 funding from discretionary appropriations and directed transfers from the PPHF and NEF— represented a decrease of $100 million (-1.3%) from FY2020 in budget authority that is inclusive of directed transfers. The President’s budget request would have increased discretionary budget authority by $54 million (+0.8%) relative to FY2020, while also requesting that $542 million in tap funds be directed to the CDC. The President’s budget also requested $894 million in PPHF transfers, which would have been a $40 million (+4.6%) increase. The President’s budget did not request that any transfers from the NEF be directed to the CDC. All told, this combination of funding would have represented an increase of $410 million (+5.1%) from FY2020. All programmatic accounts received increases relative to FY2020 except Public Health Preparedness and Response and CDC-Wide Activities and Program Support. Among these increases: (1) the HIV/AIDS, Viral Hepatitis, STI and TB Prevention account, which was funded at an increased level of $1.3 billion (+3.2% above FY2020) included a $35 million increase for the Ending HIV/AIDS Initiative;61 and (2) the Emerging and Zoonotic Infectious Diseases (EZID) account, which was funded at an increased level of $596 million (+4.5% above FY2020), included $10 million in funding for a new pilot program that would award competitive grants for the development of Social Determinants of Health Accelerator Plans62. Other increases included the Environmental Health account, funded at $206 million (+4.6%)63, and the Public Health Scientific Services account, funded at $592 million (+6.6%). With regard to the Injury Prevention and Control account, which received $683 million (+0.8%), the explanatory statement included funding for several line items that were first included in FY2020, including child sexual abuse prevention ($1.5 million), suicide prevention ($12 million), and adverse childhood experiences (ACEs, $5 million).64 The explanatory statement also included specific funding for Firearm Injury and Mortality Prevention Research program ($12.5 million) and Opioid Overdose Prevention and Surveillance ($476 million).65 60 The NEF was established by the Consolidated Appropriations Act of 2008 to enable the HHS Secretary to repurpose certain unobligated balances [Text truncated at 120,000 characters. The full text is on the page linked above.] --- Source: Frix Law Library, https://www.frixlaw.com/law-library/documents/crs%3AR46859. Public record. Not legal advice.