The NPR Politics Podcast - This GOP Fight Could Devastate George W. Bush's Global Health Win

Episode Date: October 4, 2023

Concern from some Republicans over abortion — and resurgent skepticism of foreign aid — could severely curb the effectiveness of the AIDS prevention program PEPFAR. Also known as the President's Emergency Plan for AIDS Relief, PEPFAR is credited with saving more than 25 million lives since it began in 2003.We want to hear from you about the show: npr.org/politicssurveyThis episode: White House reporter Deepa Shivaram, global health correspondent Nurith Aizenman, and senior political editor and correspondent Ron Elving.The podcast is produced by Casey Morell and Elena Moore. Our editor is Eric McDaniel. Our executive producer is Muthoni Muturi.Unlock access to this and other bonus content by supporting The NPR Politics Podcast+. Sign up via Apple Podcasts or at plus.npr.org. Connect:Email the show at [e-mail] the NPR Politics Podcast Facebook Group.Subscribe to the NPR Politics Newsletter.Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

Hi, this is Jill from the Chicago suburbs, and I just got cleared by my doctor to start talking again after two weeks of complete vocal rest following surgery. This podcast was recorded at 109 p.m. on Wednesday, October 4th, 2023. Things may have changed by the time you hear this, but hopefully my friends and family are relieved that they no longer have to guess what I'm trying to say as I acted things out. And hopefully, my voice is getting stronger and stronger. Okay, here's the show. Oh, my gosh. Speedy recovery to you. Stronger and stronger.

That's wild. I can't imagine anyone on radio not talking for two weeks. Hey, there. It's the NPR Politics Podcast. I'm Deepa Shivaram. I cover the White House. And I'm Ron Elving, Editor-Correspondent. And Nareet Eisenman, NPR's Global Health Correspondent, is here with us today. Hey, Nareet. Hello. So after last night, I don't think it's going to be a giant shock to anyone when I say that the legislative branch of the U.S. government isn't exactly working right now.

Republicans in the House can't unite on their own leadership or policy, for that matter. And in addition to ousting a speaker, failing to pass a budget, this also means that things that have long been matters of political consensus, where people magically agree, they aren't really getting passed either. One of the things that's sort of getting into the fray of all of this is PEPFAR. Noreen, for folks who might not be familiar, let's start with the basics. What is PEPFAR? Okay. It was started in 2003 by then President George W. Bush during a truly epic global AIDS crisis globally. In Africa in particular, they were seeing just record high number of deaths, about 3 million deaths per year.

And over the last two decades since it was founded, the U.S. has spent about $110 billion directed to PEPFAR for prevention and AIDS treatments. And so what kinds of initiatives does PEPFAR fund in terms of medication distribution, things like education? What are we looking at here? It's a huge program and it's the gamut know, it's all kinds of efforts to look at prevention, you know, all the steps that people can take to have, you know, safe sex, to avoid encounters that are unsafe, to empower women, and then medication, get people on AIDS drugs. You know, back when PEPFAR was started, AIDS drugs were available

in wealthy countries, but basically out of reach beyond wealthy countries. And there's just been a huge revolution in access and just literally life-saving medications for people to stay alive on. Okay. So major program here. What kind of impact has PEPFAR had? It's widely seen as one of the most successful U.S. assistance programs in history. It reports saving 25 million lives globally. And it's also a rare example of a program that all sides of the political spectrum had seemed to love. Evangelicals, global health advocates, Republicans, Democrats. That's until now. So, Ron, this is in part a disagreement between Republicans in the House and Republicans in the Senate over what abortion rules to tie into this PEPFAR program. But it's also true that there are

some big ideological disagreements going on right now in the Republican Party about how much the U.S. should be entangled with the rest of the world. To begin with the entanglement issue, the United States is and has been the linchpin of many international agreements, and certainly it has been the bedrock for the support of Ukraine since its invasion by Russia. That money does not continue to flow under the budget arrangement that was just enacted by the House this past weekend. Now, we expect that to change. We expect the House to take up that issue separately. We expect the Senate to take up that issue separately.

But the two chambers left it out of the big compromise that kept the government open this past weekend. That was quite notable that Ukraine, of all things, which you would think would be on that list of consensus points for the two parties, at least for most members of both parties, Ukraine was an important element that could keep the entire government shut. That's surprising to a lot of folks, but that is the nature of, as you say, the new schism in the Republican Party, which is really kind of an old schism in the party. It goes back before World War II, and it was called isolationism, or at the time, America first. And we've heard that phrase, America first, a great deal lately. It was more or less part of Donald Trump's program when he ran in 2016, and it is part of the Make America Great Again agenda. So it's part of our era. And since obviously Donald Trump is still the more or less leader of the

Republican Party, it shouldn't be too surprising that they are suspicious of foreign entanglements. Yeah. And, you know, with PEPFAR, it's interesting. This whole kind of issue really first arose under President Trump when he came into office. Like previous Republican presidents, he, through executive action, imposed this policy on certain foreign aid spending programs, this anti-abortion language. And he was the first Republican president to actually apply it to PEPFAR. Then when President Biden came into office, he rescinded that policy. And now what this group of Republicans is working to do is to make it a matter of law. And they are, you know, being encouraged by some of the major

anti-abortion groups out there that have, you know, in fact, even said to me, some of them, that they're going to include, you know, in their scoring of lawmakers, anti-abortion bona fides, you know, how they vote on this particular issue when it comes to PEPFAR. Noreen, just to be clear here, are any PEPFAR funds used to fund abortions anywhere in the world? No. And that's because it's illegal for U.S. government funds to go to foreign aid groups that would use it directly to provide abortions. But, Noreet, is this an argument here that, you know, these kinds of America first arguments that some conservatives are making, is that also an argument being used against PEPFAR per se? How is that really playing out here specifically? Yeah. So interestingly, PEPFAR still does remain, you know, a rare example of a program where you're not hearing so much complaints about the funding per se and about the involvement overseas per se,

but rather you are seeing a willingness to, you know, maybe put it kind of in the sights in order to extract concessions on the abortion issue when it comes to PEPFAR. So for PEPFAR, it's more about abortion. And specifically, some Republicans are trying to stop PEPFAR aid from going to partner organizations, foreign aid groups that PEPFAR partners with, that with their own non-U.S. government funding, provide abortions or information about abortions or advocate for pro-abortion policies. I should say U.S. law already prohibits U.S. tax dollars from directly funding any of those activities by foreign aid groups. Noreen, if these anti-abortion Republicans who are trying to kind of mess with PEPFAR here get their state, they say, yeah, but that was pretty short-lived.

And long-term, there just aren't enough partners on the ground for PEPFAR to work with, foreign aid groups that PEPFAR partners with, in order for it to continue to deliver all the services, the prevention work, the drugs, just all of the on-the-ground work that PEPFAR funds, if it had to essentially sever ties with too many of these partners that may, again, with their own funding, their own non-U.S. sources of funding, do activities around abortion that would be barred, they think that it would, you know, ultimately really impact PEPFAR's effectiveness.

All right, we're going to take a quick break, and we'll be back in a second. And we're back. Ron, I want to bring you in here because this program, PEPFAR, is one of the things that people see as part of President George W. Bush's legacy, something that they really do remember him for and applauded him for at the time, right? That's right. And perhaps he's better known for Iraq and the 2008 Wall Street meltdown and mortgage crisis and so forth. But he is well remembered across the aisle by many because of his willingness to essentially relax some of his usual loyalty to the anti-abortion movement and proceed with this program and try to keep this funding going and make an exception for it. Now, this was in its day part of what he featured in his first term in particular as compassionate conservatism. Now, that's a phrase you don't hear very much

anymore. Obviously, the styles have changed. Donald Trump's style is quite different. But George W. Bush reached out for Democratic votes in 2000, to some degree later elections as well, as a compassionate conservative. And this was an opportunity for him to actually put some policy behind that claim. What's interesting is that both sides are presenting letters from religious groups, faith-based groups. And you're seeing some faith-based groups that are still in that George W. Bush mold, still coming out strongly for leaving PEPFAR untouched, and then others that are really focusing on the anti-abortion angle of this. It's hard to argue with a figure like 25 million lives saved. And it's also hard to judge what you do for people in other countries who may never realize where the good is coming from,

that is to say where the funding is coming from for these drugs, against the very real and present convictions of people in the anti-abortion movement who feel that this and many other programs of outreach have been gamed by people who want to fund abortion as well as AIDS drugs and that they have figured out waysance in their own minds about that having happened. And so some of the animosity from other parts of the conflict between abortion rights advocates and the opposite spills over into this controversy as well. And someone's going to have to try to clean that up. Someone's going to have to try to resolve that if PEPFAR is going to go forward fully funded. It's really striking when I talk to the anti-abortion groups, just the level of distrust of the Biden administration on this issue that they voice. Just a sense that like, okay, even if they don't use abortion language in their documents,

you know, words like sexual and reproductive health, that's got to be code for abortion. They're promoting abortion. And it's also raised a really interesting discussion around fungibility. Basically, they voice a concern that, look, sure, technically U.S. taxpayer dollars do not go towards funding abortion by foreign aid groups. That's illegal. But they say if you give money to them, you know, for another purpose, those groups, that frees up money for them. Money is fungible. That frees up their money, you know, to be used for abortion provision, their non-U.S. money. But then those who are opposed to these changes say, well, that's a slippery slope argument because, you know, there's plenty of groups that PEPFAR partners with and other U.S. government programs partner with that are faith-based,

that do activities like promoting their faith, that U.S. law does not allow U.S. dollars to be used for funding directly. And so you could argue that the money's fungible there too. So, you know, that argument can sort of cut both ways and it might open a whole can of worms of discussion around this fungibility question. Yeah, just the more you kind of open that can, it just keeps getting a little bit more complicated. And it speaks to how, you know, this anti-abortion narrative in the United States and argument that a lot of folks are making isn't really just isolated to that one issue, right? It really, really can go beyond that. Narit, just looking ahead here, what are some of the long-term consequences if the U.S. does step away from its role here with PEPFAR? I really want to stress

that this is, you know, not something that seems to be imminent, you know, when I talk to people who are really counting the votes, right? The support still seems to be pretty strong for PEPFAR funding across Congress overall. And there isn't necessarily an expectation that this is going to result in a defunding anytime soon. But just the mere fact that this program that had been seen as effectively bulletproof, from Washington's political wars, is being ensared, even temporarily, potentially, in this kind of fight, makes people wonder whether their support will begin to erode long term. And, and sure, you know,

if the US turned away from this, it would be a massive departure from a program that, again, is just seen as one of the biggest successes in US foreign policy and aid. Yeah, and can't emphasize enough something that really everyone agreed on at a time and came together on too. Yeah, yeah, really one more bellwether for the fractious times that we seem to find ourselves in. Truly. All right, Narit Eisenman, thank you so much for joining us. My pleasure. I'm Deepa Shivaram. I cover the White House. I'm Ron Elving, interview correspondent. And thank you for listening to the NPR Politics Podcast.