George W. Bush wades into PEPFAR fight as deadline nears

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House and Senate Republicans are working on a last-ditch effort to save a global HIV-AIDS program set to expire Sept. 30 — defying influential anti-abortion and conservative groups that are lobbying against its renewal.

Rep. Michael McCaul (R-Texas), chair of the House Foreign Affairs Committee, which oversees the President’s Emergency Plan for AIDS Relief, told POLITICO that he’s working on a bill to extend the program, though it may fall short of the standard five-year extension and include some new language to mollify anti-abortion groups.

McCaul said he recently had lunch in Kennebunkport, Maine, with former President George W. Bush and their two wives and discussed the law’s fate. Congressional staff and advocates supporting the law known as PEPFAR said it’s part of a push by the 43rd president to defend the program he helped create in 2003 and that’s credited with saving 25 million lives.

“He wants to come in at the right time,” McCaul said Tuesday about Bush’s involvement. “This is one of his biggest legacies.”

On Wednesday, the former president published an op-ed asking Congress to reauthorize PEPFAR for five more years “without delay,” saying that failing to do so would be “a source of national shame.”

Bush’s entry into the fight underscores the growing concern from members in both parties that PEPFAR, which enjoyed two decades of strong bipartisan support, will fall victim to abortion politics.

Reauthorization is currently in jeopardy as some Republicans and conservative advocacy groups allege that part of the program’s nearly $7 billion annual budget flows to abortion providers — a claim Bush, President Joe Biden's administration, program leaders and outside experts deny.

A health advocate familiar with the effort to re-up the law but not authorized to speak on the record said the former president has also reached out to other GOP members “very on the [down-low].”

A senior Senate Democratic aide involved with the negotiations said Bush’s outreach on PEPFAR is a result of “a multitude of former and current members of Congress and faith leaders asking him to get into the game.”

The former president did not respond to a request for comment.

Bush allies and surrogates have also rallied to the cause. David Kramer, the head of the George W. Bush Institute, recently called Rep. Chris Smith (R-N.J.), Congress’ most vocal opponent of reauthorizing PEPFAR.

Smith said that Kramer failed to change his mind and that he responded to Kramer: “Why isn’t Bush calling Biden and asking him to stop hijacking his noble program?”

A spokesperson for the George W. Bush Institute told POLITICO it had nothing to add.

With just two weeks left before PEPFAR’s authorization expires, Sen. Lindsey Graham (R-S.C.) is working with Bob Menendez (D-N.J.), chair of the Senate Foreign Relations Committee, on a three-year reauthorization bill.

“It’s been a program that works,” Graham said Tuesday. “I’m willing to make changes if it makes sense, but I want to get it reauthorized.”

While the program will continue to be funded even if it is not reauthorized by the end of the month, supporters say that without a long-term commitment, groups fighting HIV and AIDS around the world will struggle to hire staff and launch long-term projects.

That fear has sparked a lobbying blitz with several former Republican lawmakers jumping into the fray.

Along with former Senate Majority Leader Bill Frist of Tennessee — an architect of PEPFAR two decades ago — former Pennsylvania Sen. Rick Santorum confirmed that he has also called lawmakers “to help find a path forward which will continue long-term funding for PEPFAR.”

“This [is] one of the few significant bipartisan programs in a policy area that is rife with disagreements and distrust,” he said in a statement.

The push by these former GOP leaders, all of them staunch opponents of abortion while in office, defies the efforts of influential anti-abortion and conservative advocacy groups that have demanded Congress not renew PEPFAR unless restrictions are imposed to block any organization receiving U.S. funds from using other sources of money to provide abortions or discuss them.

Those groups — including Susan B. Anthony Pro-Life America and the Heritage Foundation — have joined with Republicans in Congress, led by Smith, to oppose the standard five-year reauthorization of PEPFAR and to push for a one-year funding patch instead.

Smith added that he, too, has lobbied House and Senate Republicans and plans to fight McCaul’s reauthorization push.

“If we were to support a three- or five-year reauthorization, we would be rubber-stamping and endorsing all of the radical changes that have been made by President Biden,” he said. “We’re ready to fight this.”

Addressing that charge, Bush wrote Wednesday that while some in his party are questioning “whether PEPFAR’s implementation under the current administration is sufficiently pro-life, … there is no program more pro-life.”

Failure to renew PEPFAR would bar Congress from increasing its nearly $7 billion yearly budget and could terminate several legal provisions in the program — including a rule that directs at least half of PEPFAR funds toward patient treatment and care. Presidential administrations could continue abiding by those rules or drop them.

The House Appropriations Committee approved a one-year funding patch this summer for PEPFAR, with new anti-abortion restrictions, as part of the State, Foreign Operations, and Related Programs funding bill for the 2024 fiscal year. But that bill has yet to receive a floor vote and is unlikely to become law because Democrats oppose the PEPFAR language, other anti-abortion provisions, and deep cuts to foreign aid programs.

Rep. Mario Diaz-Balart (R-Fla.), who sponsored the bill, said he considers it a last resort for PEPFAR and prefers a reauthorization.

“I do hope that the authorizers are able to get it done so that we don't have to be doing this every single year,” he said in an interview.

McCaul said he is working toward a compromise with anti-abortion groups to have provisions in PEPFAR legislation that enforce the Helms Amendment, which prohibits the use of any U.S. foreign assistance funds for abortion as a method of family planning.

“If the outside groups are good with that sort of compromise, then I think we’d be in a good place to move forward,” McCaul said. “There’s a lot of momentum on the Republican side. But it’s not gonna be easy.”

It’s unclear what form the reauthorization would take in the House but it could hitch a ride on a continuing resolution with government funding, McCaul said.

As the Sept. 30 deadline nears, HIV activists and PEPFAR supporters are staging protests on Capitol Hill targeting Republican leadership, warning that a failure to re-up the program would signal decreasing interest from the U.S. in the global fight against HIV just as the Covid-19 pandemic reversed progress against HIV and AIDS in some regions, fueling a rise in new infections.