Nancy Pelosi, the Democratic former House speaker, and George W. Bush, the Republican former president, don’t agree on a lot. But earlier this yr, they joined a high-powered gathering in Washington — with the Irish rock star Bono on video from Dublin — to mark the 20th anniversary of America’s greatest and, arguably, most profitable overseas support program.
Mr. Bush created that program, the President’s Emergency Program for AIDS Relief, in 2003. In the 20 years since, PEPFAR, as it’s recognized, has saved 25 million lives and served as a strong software for smooth diplomacy, an emblem of America’s ethical management on the earth. It has had extraordinary assist from a bipartisan coalition of liberals and Christian conservatives.
But now PEPFAR is in peril of changing into a sufferer of abortion politics — simply as the State Department is reorganizing to make this system everlasting.
The program is about to run out on the finish of September. But House Republicans will not be transferring ahead with a invoice to reauthorize it for one more 5 years, as a result of abortion opponents — led by a G.O.P. congressman who has lengthy been a supporter of PEPFAR — are insisting on including abortion-related restrictions.
The stalemate is the newest instance of how Republicans are utilizing their majority within the House of Representatives to impose their conservative views on social coverage all through the federal authorities. They have centered specifically on abortion, a yr after the Supreme Court overturned Roe v. Wade and, with it, the best to authorized abortion. Earlier this summer season, House Republicans loaded up the annual navy coverage invoice that has lengthy been bipartisan with provisions to restrict abortion entry and transgender care.
The battle over PEPFAR, a $7 billion-a-year program that operates in additional than 50 international locations, is analogous, as a result of it’s a broadly bipartisan program that now seems liable to being sucked right into a partisan battle over cultural and social points.
PEPFAR continues to have large assist, together with from Representative Michael McCaul of Texas, the Republican chairman of the Foreign Affairs Committee, which oversees this system and approve the reauthorization laws. But up to now, Mr. McCaul has not superior it due to the objections of abortion foes, together with his Republican colleague, Representative Christopher H. Smith of New Jersey, one of many main anti-abortion voices in Congress who additionally helped draft the laws creating PEPFAR.
Mr. Smith now says he won’t comply with renew this system except it’s topic to the so-called Mexico City coverage — enacted by Republican presidents however lifted by Democrats, together with President Biden — that may bar this system from partnering with any group that gives abortion providers, irrespective of the supply of the funding.
That is a non-starter for Democrats, who’re demanding a “clean” five-year reauthorization — one with no added coverage restrictions.
“We’ve done clean reauthorizations for 20 years,” stated Representative Barbara Lee, Democratic of California and a chief sponsor of PEPFAR.
But there’s a substantial stumbling block: Three influential exterior teams that oppose abortion — the Family Research Council, the Heritage Foundation’s political motion arm and Susan B. Anthony Pro-Life America — have sided with Mr. Smith and intend to “score” the vote after they compile their annual scores of members of Congress. A vote for renewing PEPFAR with out the anti-abortion language could be counted as a demerit, making it politically poisonous for many Republicans.
The scenario has alarmed champions of this system. In an e mail, Bono referred to as the deadlock “madness,” and referred to as on Congress to “protect the bipartisan commitment to keeping politics out of PEPFAR.”
Mr. McCaul stated he’s “talking to supporters both inside and outside the government, and working with my colleagues on both sides of the aisle in the House and the Senate” to resolve the dispute. He has additionally been texting with Bono, who in flip has been in contact with congressional leaders on the matter.
A senior White House official, talking on the situation of anonymity to explain the negotiations, stated on Thursday that the White House was “engaging closely with Congress at senior levels” in pursuit of a straight five-year reauthorization.
The program is a crucial legacy for Mr. Bush and different Republicans of his period, together with Bill Frist, the previous Senate majority chief, and Rick Santorum, a former senator from Pennsylvania.
“I look back on the things I did as a member of Congress, and feel like I was able, as the pro-life warrior in the United States Senate, to forge a compromise to get conservatives to support this,” Mr. Santorum stated in an interview. “It’s been a great thing for our country, and it’s been a great thing for humanity.”
Last week, Mr. Santorum publicly pleaded for a “five-year, clean extension” in an opinion essay within the conservative outlet Newsmax. He stated he supposed to make use of Congress’s upcoming August recess to attempt to forge a compromise.
But in latest months, Mr. Smith, the New Jersey Republican, and right-wing teams have begun accusing the Biden administration of injecting progressive politics into this system.
In late May, a Heritage Foundation scholar revealed an essay in The Hill arguing that PEPFAR had change into “increasingly politicized” and wanted an overhaul. Mr. Smith adopted in early June with “Dear Colleague” letter asserting that Mr. Biden had “hijacked PEPFAR.”
In an interview, he pointed to new language in a PEPFAR country and regional operational plan calling for this system to associate with organizations that advocate for “institutional reforms in law and policy regarding sexual, reproductive and economic rights of women.” He argued that was code for a plan to “integrate abortion with H.I.V./AIDS work.”
The doc additionally says PEPFAR applications ought to “advance human rights and decriminalization for lesbian, gay, bisexual, transgender, queer, and intersex (L.G.B.T.Q.I.+) communities.” That didn’t sit properly with the Family Research Council, whose chief lobbyist, Travis Weber, recently called PEPFAR “a massive slush fund for abortion and L.G.B.T. advocacy.” In an interview, he stated he stood by these phrases.
The senior White House official stated that the “intentional focus on health equity is new” and that it got here in response to requests from native communities for PEPFAR to “address barriers to health for children, adolescent girls and young women, and key populations.” The point out of women’s rights refers to making sure that adolescent girls have entry to varsities, the official stated.
The Biden administration has added a footnote to the doc clarifying that PEPFAR doesn’t fund abortions, an assertion that Mr. Smith referred to as “meaningless.”
There isn’t any proof that PEPFAR or its overseas companions have used federal tax {dollars} to advertise or carry out abortions; U.S. regulation doesn’t permit it. But some PEPFAR grantees, such as Population Services International, a worldwide health nonprofit based mostly in Washington, do present abortion-related providers with cash from different sources.
“The assertion is made by critics is that organizations like P.S.I. are working with U.S. money and involved in abortion — and shouldn’t that be illegal?” stated Karl Hofmann, the group’s president and chief government. “I guess my answer is, those two facts are true, and it’s not illegal.”
Ms. Lee, the California Democrat, stated she is working to “clarify this misrepresentation” being made by Mr. Smith.
But the prospects for a five-year extension appear bleak.
“We are in a very precarious place,” stated Shepherd Smith, an evangelical Christian and a co-founder of Childrens AIDS Fund International, a nonprofit. He has organized different faith-based teams to subject a letter in assist of reauthorization.
Christopher H. Smith, the New Jersey congressman, has proposed another: He persuaded fellow Republicans to insert language right into a State Department spending invoice that may permit PEPFAR to maintain working for a yr and not using a new authorization, however topic to the anti-abortion restrictions. That measure, nonetheless, like lots of the spending payments making their approach by means of the Republican-led House, is unlikely to be acceptable to the Democratic-controlled Senate.
And the symbolism of such a transfer could be devastating, PEPFAR’s backers say — a sign to different nations that the United States is abandoning its bipartisan dedication to finish the AIDS epidemic by 2030, and that Washington is really damaged. It would even be a setback for world health; PEPFAR has created an infrastructure of clinics in poor nations that present different providers, together with Covid-19 testing and vaccines.
“This is not an issue that at all involves abortion — it’s about having health care facilities in countries to deal with pandemic type of challenges,” stated Senator Benjamin L. Cardin, Democrat of Maryland. He referred to as PEPFAR’s creation “one of the great moments in American foreign policy.”
As the talk performs out on Capitol Hill, the State Department official who oversees PEPFAR, Dr. John N. Nkengasong, is about to get a giant promotion. On Tuesday, Secretary of State Antony J. Blinken is anticipated to announce the institution of a brand new Bureau of Global Health Security and Diplomacy, to be led by Dr. Nkengasong. The thought is to combine PEPFAR into the division’s broader world health work and to transition it out of emergency standing.
Since its inception, this system has invested greater than $100 billion in preventing the worldwide AIDS disaster. Independent analyses by Ok.F.F., previously the Kaiser Family Foundation, have discovered that PEPFAR has helped improve maternal and child health and is “related to large, significant declines in mortality” in international locations the place it has operated.
Backers of this system are hoping that Mr. Bush will weigh in. Earlier this yr, Emily Bass, an writer and activist, despatched the previous president a signed copy of her e book, “To End a Plague: America’s Fight to Defeat AIDS in Africa,” which chronicles the PEPFAR story.
Just a few weeks in the past, Ms. Bass stated, Mr. Bush despatched a letter thanking her.
“Laura and I will remain invested in this mission for the rest of our lives,” he wrote.
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