Johnson Can Still Whip Votes to Kill Kids
The rescissions package the House just passed is an unmitigated disaster.
Last month, secretary of state Marco Rubio told Congress that “no children are dying on my watch.”
He lied.
Nicholas Kristof of the New York Times put together a great article highlighting the names, photos, and stories of just two of the many, many children who have died as a direct result of the Trump administration’s cuts to foreign aid. If for some reason you still doubt children left without the antiretrovirals they need have died and will continue to die, read Kristof’s piece now.
We will not know the total death toll of the DOGE-led gutting of USAID and PEPFAR for years, maybe decades, but we already know children are dying painful, preventable deaths. When Rubio first paused PEPFAR, mere days after he was confirmed as secretary of state, he did so fully aware that many thousands, maybe millions, of men, women, and children would likely die in the coming months and years.
As I detailed at the time, since President George W. Bush created the program, PEPFAR had already saved tens of millions of lives, prevented millions of children from being born already infected with HIV, and greatly reduced the number of orphans in the world. UNAIDS projected last year that going forward PEPFAR would prevent “an additional 5.2 million AIDS-related deaths and 6.4 million new HIV infections” just between 2024 and 2030.
Achim Steiner, the outgoing head of the United Nations Development Programme, told the Financial Times last week that “literally overnight, clinics are closing, supply chains are disrupted and people are not receiving antiretroviral treatments.”
In May, Nuha Ceesay, the UNAIDS country director for Eswatini, said that “HIV testing services, the gateway to treatment, are now limited.” He explained that “stockouts of antiretroviral, lab test kits, and condoms are expected within months, and health worker layoffs are affecting service delivery and quality data collection.”
One UNAIDS report states that children born after their mother’s antiretroviral treatment was interrupted during the third trimester are 14 times as likely to be born with HIV. The agency is also worried about the horrifying possibility of a drug-resistant HIV mutating, which is more likely when people are missing doses or only receiving fractions of what they should be.
Here’s an exemplary excerpt from the latest report on the global anti-AIDS effort prepared by the secretary-general of the United Nations:
“Direct contributions from [the Government of the United States] amount to 33 per cent of HIV funding in countries supported by the President’s Emergency Plan for AIDS Relief, and the potential withdrawal of the Plan poses a major risk. Many of those nations face high disease and debt burdens, which limits their ability to replace lost resources. While domestic contributions in countries supported by the Plan have risen by 38 per cent since 2010, they remain insufficient to fully cover the support provided under the Plan in a short amount of time.”
As even those somewhat sympathetic to America reducing its role in global health admit, like Hannah Johnson of the George W. Bush Institute, the countries the Trump admin cut off simply cannot afford to pay for the life-saving medications and preventative care we supported. That’s why Bush began PEPFAR in the first place.
Until recently though, those who don’t want to see millions dying in order to save the American taxpayer pennies a day still had a glimmer of hope.
The Trump admin’s first assault on PEPFAR and USAID was almost certainly illegal, a blatant violation of both the Impoundment Control Act of 1974 and Congress’ establishment of USAID as an independent agency. It was fueled by ridiculous conspiracy theories that USAID, one of the most Congressionally supervised and audited agencies in the federal government, had somehow been propping up the Democratic party for decades. It was justified by clear falsehoods, like JD Vance’s recent claim that only 12 percent of foreign aid actually went abroad.
So even after USAID employees were placed on indefinite leave, and food meant for famine relief began to rot in American ports, people could still hope that Congress might step in and get the flow of medicine and stars-and-stripes branded manna going again. Surely senators and members of the House would say something. After all, some of them had been working to define and defend America’s foreign aid programs for decades.
Instead, speaker of the House Mike Johnson just pushed a rescissions package through the House: H.R. 4. If it’s rubber stamped by a simple majority of the Senate, the evisceration of America’s foreign aid programs overseen by Musk et al. will largely remain in place.
Shortly after ramming a budget that will increase the 2025-2034 deficit by $3.0 trillion through the House, Johnson says we just have to let people abroad die easily preventable deaths so that “your taxpayer dollars are no longer being wasted. Instead, they are being directed toward priorities that truly benefit the American people.” So what would H.R. 4 actually cut?
First, H.R. 4 would claw back $500 million of funding for USAID meant to help reduce child mortality; support immunization and oral rehydration; help necessary health and sanitation projects; assist orphans; control HIV/AIDS, tuberculosis, polio, malaria, and other diseases; and prepare for future global health threats. I guess money spent to save a child’s life is wasted.
It would officially cut US funding for the Global Fund, under the auspices of PEPFAR, by $400 million. Health news outlet KFF explains that America’s funding for the Global Fund essentially takes the form of a 1:2 match, so the cut appears likely to reduce total funding for global efforts to fight HIV/AIDS, tuberculosis, and malaria by over a billion dollars.
As I mentioned in my first Substack post on the fast, then slow, death of PEPFAR in January, the average “landed cost of first-line ARVs” is just $58.97 per patient per year according to a 2022 State department report. Taking those numbers as a given, and assuming foreign assistance will decrease by $2 for every $1 the U.S. cuts, H.R. 4 would effectively reduce the Global Fund’s ability to help those with HIV/AIDS by over 20 million patient-years according to some back of the napkin math.
USAID’s operating expenses would also be formally cut by $125 million, reflecting the Trump administration’s illegal and unilateral effort to put the agency underneath the state department and Rubio’s official remit.
Other spending categories like international disaster assistance, which includes funding for the World Food Programme, and refugee assistance would face hundreds of millions in cuts as well. And, while less important than America turning its back on the world’s sick, hungry, and poor, H.R. 4 would totally kill federal funding for the Corporation for Public Broadcasting.1
And in order to kill kids across the globe, to dry up the flow of life-saving food and drugs that costs the average American taxpayer virtually nothing but means everything to countless families abroad, Mike Johnson set to work herding cats. He managed to get Representative Don Bacon, R-Nebraska, who told the Times just last week that he wouldn’t vote for cuts to AIDS relief to vote for the package.
CNN reported yesterday that Johnson even engaged in some last minute haggling over SALT deductions in order to push the package over the finish line. Congressman Nick LaLota, R-New York, explained to the outlet that he “had some conversations with the speaker that raised my level of confidence that will put this and future issues in the right trajectory.”
Johnson proved able to convince 214 Republican members of Congress to vote to kill kids yesterday. Thankfully, there is still a slim but essential chance that the rescissions package might fail in the Senate.
If you live in a state with a Republican senator, call them now. Tell them you won’t vote for a murderer. Tell them children deserve to become adults, no matter where they’re born. Tell them what Jesus told his disciples: “whoever welcomes one such child in my name welcomes me.”
If you don’t have a Republican senator, consider giving to one of the charitable organizations trying desperately to fill in the gaping chasm left by the Trump administration. The charity evaluator/aggregator GiveWell has begun directing grants in response to US aid cuts. I donated $450 to them today and ask that you also give if you are able.
In January, I wrote that “Trump could choose to not make the United States a world historic monster, a creator of orphans sans parallel.” He did not so choose.
But Republican senators still have the chance to deny Trump’s wanton destruction of American foreign aid the imprimatur of Congressional approval. I pray that they do so.
Here are a couple articles I’ve written recently for the Alabama Political Reporter:
An exposé of candidate for lieutenant governor Nicole Wadsworth lying about receiving a PhD from the University of Alabama
And a breakdown of Tuberville’s first major campaign finance reports as he runs for governor
As well as a few odds and ends from elsewhere you should read:
T. Christian Miller and Sebastian Rotella on Bukele’s deal with MS-13 for ProPublica
Ezra Klein’s interview of former Israeli prime minister Ehud Olmert on his New York Times podcast
And Anisha Steephen’s first piece on the IRS for Notes on the Crises
A depressing but neccessary read.