WASHINGTON – In a year that combines federal belt-tightening and election year politics, President Barack Obama’s administration released a budget proposal that asked every department to “tighten their belts to free up more resources for areas critical to economic growth.”

A major international relations program — the Global Health Initiative – would receive its lowest funding level since its creation in 2009. The proposed $8.5 billion represents a decrease of just over $300 million from 2012.  The six-year plan acts as an umbrella for most U.S. international health projects as part of an effort to develop a comprehensive U.S. global health strategy.

A panel of policy experts examined how Obama’s budget plan would affect U.S. global health outreach in a live, interactive webcast Tuesday afternoon, hosted by the Kaiser Family Foundation.

“We’re in austere times and choices have to be made,” said Mark Dybul, co-director of the Global Health Program at Georgetown University.  “To the extent that [lawmakers] believe we are on the right path and they are comfortable with that path, I will defer to them because they know 90 times more than any of us on the outside.”

Where were the decreases?

Many key components of the Global Health Initiative would receive less funding if the spending plan is eventually approved by Congress. Funding for HIV/AIDS treatment, which comprises the largest portion of the global health budget, would decrease by 11 percent, in addition to cuts to programs for tuberculosis, malaria, and nutrition.

However, the Global Fund, a set of public-private partnerships that raises money and funds international health programs, would receive a significant increase in funding to $1.65 billion — up 27 percent from 2012.

“The increases really are to meet pledges that the administration made to (the partnerships),” said Dybul. “[The U.S.] won’t make pledges unless we intend to meet them, which runs counter to a lot of our global colleagues who don’t quite have that rigidity.”

The Global Health Initiative cuts come as the administration pushes its own priorities, such as the Affordable Care Act – the federal health care law.  Although that law and other federal programs such as Medicare and Medicaid take center stage in the budget debate, the administration says it is also invested in supporting global initiatives through research.

Coping with less

The Obama administration needs to be open with  Congress and the advocacy community to get allies for the budget plan, according to Beth Tritter, managing director at the Glover Park Group, a Democratic-leaning lobbying firm.

“When you see a number drop like that, it looks like it’s being de-emphasized, or it looks like it’s being de-prioritized,” Tritter said. “I don’t know that we’ve heard enough at this point to understand if that’s the case.”

Even if the cuts become law, Kaiser’s panelists agreed that they wouldn’t mean an end to programs – perhaps simply a change in the way policymakers allocate resources.

“This is possibly an opportunity of doing more with less,” said Larry Nowels, consultant for the U.S. Global Leadership Coalition.

“The moment we’re in in global health right now is an extraordinary moment,” said Dybul. “Scientific advance has given us the ability to really put together packages of resources that will allow us to really begin to end the AIDS epidemic. Same in malaria…same in child health.”

The House Budget Committee’s budget resolution, which panelists said could be approved as early as next month, will determine whether the cuts stay in the budget or are modified.

“Global health was not the controversy that kept Congress and the administration at [odds] last year,” said Tritter.  “I don’t think that’s where the controversy is this year either.”

But she cautioned that the Obama administration needs to clearly make its case to Congress on the need for global health funding to keep it at the proposed levels.