Status of FY2024 Labor, Health and Human Services, and Education Appropriations: In Brief

Changes from July 10, 2023 to October 26, 2023

This page shows textual changes in the document between the two versions indicated in the dates above. Textual matter removed in the later version is indicated with ~~red strikethrough~~ and textual matter added in the later version is indicated with blue.

Status of FY2024 Labor, Health and Human
~~July 10~~October 26, 2023 , 2023
Services, and Education Appropriations:
Karen E. Lynch
In Brief
Specialist in Social Policy Specialist in Social Policy

This report provides a brief summary of the status of FY2024 Labor, Health and Human This report provides a brief summary of the status of FY2024 Labor, Health and Human
Jessica Tollestrup
Services, and Education (LHHS) appropriations as of the cover date of this report. It also Services, and Education (LHHS) appropriations as of the cover date of this report. It also
Specialist in Social Policy Specialist in Social Policy
provides background on the scope of the LHHS bill generally and the provides background on the scope of the LHHS bill generally and the ~~budgetary~~ context for context for
congressional appropriations decisions
~~congressional decision-making~~, including the submission of the FY2024 President’s budget , including the submission of the FY2024 President’s budget
request and budget enforcement in the absence of a budget resolution. request and budget enforcement in the absence of a budget resolution.

~~On June 15, 2023, the House Appropriations Committee voted to report~~Congress has not yet reached agreement on full-year regular FY2024 LHHS appropriations. In the interim, FY2024 funding has been provided temporarily through a continuing resolution (CR). The CR was signed into law on September 30, 2023 (Division A of H.R. 5860; P.L. 118-15), providing continuing appropriations for all 12 annual appropriations acts (including LHHS) through November 17, 2023. In general, the CR funds discretionary programs at the same rate, and under the same conditions, as in FY2023 and funds annually appropriated entitlements at their current law levels. The CR includes a few provisions that are specific to LHHS accounts or related activities. The FY2024 LHHS bill has not received initial floor consideration in either the House or the Senate as of the cover date of this report. On July 27, 2023, the Senate Appropriations Committee voted to report the FY2024 LHHS bill, 26-2; the measure was subsequently reported to the Senate that same day (S. 2624; S.Rept. 118-84). The Senate committee bill would reduce discretionary appropriations for LHHS by 6% (-$12.1 billion) relative to FY2023 and by 1% (-$1.8 billion) relative to FY2022. The measure was not formally marked up in subcommittee prior to full committee consideration. The Senate Appropriations Committee reported its initial suballocations for all 12 subcommittees, its initial suballocations for all 12 subcommittees,
including LHHSincluding LHHS ~~(33-27). Subsequently, the Senate~~, on June 22, 2023 (15-13). While the House Appropriations Committee Appropriations Committee has not voted to report its version of the LHHS bill, the draft bill was approved in subcommittee on July 14, 2023, by a voice vote. Previously, on June 15, 2023, the House Appropriations Committee approved draft suballocations (33-27), which would reduce regular discretionary appropriations for LHHS by 29% (-$60.3 billion) relative to FY2023 and by 25% (-$49.9 billion) relative to FY2022. Most recently, on October 6, 2023, Representative Aderholt, Chair of the House Appropriations LHHS Subcommittee, introduced an LHHS bill (H.R. 5894). Because H.R. 5894 has not received any congressional action, this report does not discuss this measure~~voted to report its suballocations on June 22,~~
~~2023 (15-13). Neither the House nor the Senate has voted to report its respective version of the LHHS bill~~. .

Congressional Research Service Congressional Research Service

Status of FY2023 LHHS Appropriations: In Brief

~~his report provides a brief summary of the status~~ongress has not yet reached agreement on full-year regular FY2024 appropriations for the Departments of Labor, Health and Human Services, of Labor, Health and Human Services,
~~and Education (LHHS) appropriations during the FY2024 appropriations cycle, including~~
~~T relevant congressional actions and a top-line comparison of discretionary funding enacted~~
~~in FY2023 versus relevant FY2024 legislative proposals as of the cover date of this report. It also~~
~~provides background on the scope of the bill and the budgetary context for congressional~~
~~decisionmaking.~~
~~On June 15, 2023, the House Appropriations Committee voted to report its initial suballocations~~
~~for all 12 subcommittees, including LHHS (33-27).1 Subsequently, the Senate Appropriations~~
~~Committee voted to report its suballocations on June 22, 2023 (15-13).2 As of the cover date of~~
~~this report, neither the House Appropriations Committee nor the Senate Appropriations~~
~~Committee has voted to report its respective version of the LHHS bill~~and Education, and Related Agencies C (LHHS). In the interim, FY2024 funding has been provided temporarily through a continuing resolution (CR). The CR was signed into law on September 30, 2023 (Division A of H.R. 5860; P.L. 118-15), providing continuing appropriations for all 12 annual appropriations acts (including LHHS) through November 17, 2023. Previously, on July 27, 2023, the Senate Appropriations Committee voted to report the FY2024 LHHS bill, 26-2 (S. 2624; S.Rept. 118-84). While the House Appropriations Committee has not yet reported its version of the FY2024 LHHS bill, the draft bill was approved in subcommittee on July 14, 2023, by a voice vote.1 This report provides a brief summary of the status of Labor, Health and Human Services, and Education (LHHS) appropriations during the FY2024 appropriations cycle, including relevant congressional actions and a top-line comparison of discretionary funding enacted in FY2023 versus relevant FY2024 legislative proposals as of the cover date of this report. It also provides background on the scope of the bill and the context for congressional appropriations decisions. .
Congressional clients may consult the LHHS experts list in CRS Report R42638, Congressional clients may consult the LHHS experts list in CRS Report R42638, Appropriations:
CRS Experts, for information on which analysts to contact at the Congressional Research Service , for information on which analysts to contact at the Congressional Research Service
(CRS) with questions on specific agencies and programs funded in the LHHS bill. (CRS) with questions on specific agencies and programs funded in the LHHS bill.
Scope of the LHHS Bill
The LHHS bill is the largest of the 12 annual appropriations bills when accounting for both The LHHS bill is the largest of the 12 annual appropriations bills when accounting for both
mandatory and discretionary funding ($1.4 trillion in FY2023).mandatory and discretionary funding ($1.4 trillion in FY2023).32 It provides annually appropriated It provides annually appropriated
budget authority for the following federal departments and agencies: budget authority for the following federal departments and agencies:
• the Department of Labor (DOL); • the Department of Labor (DOL);
• most agencies at the Department of Health and Human Services (HHS), except • most agencies at the Department of Health and Human Services (HHS), except
for the Food and Drug Administration (funded through the Agriculture for the Food and Drug Administration (funded through the Agriculture
appropriations bill), the Indian Health Service (funded through the Interior-appropriations bill), the Indian Health Service (funded through the Interior-
Environment appropriations bill), and the Agency for Toxic Substances and Environment appropriations bill), and the Agency for Toxic Substances and
Disease Registry (funded through the Interior-Environment appropriations bill); Disease Registry (funded through the Interior-Environment appropriations bill);
• the Department of Education (ED); and • the Department of Education (ED); and
• more than a dozen related agencies (RA), including the Social Security • more than a dozen related agencies (RA), including the Social Security
Administration (SSA), the Corporation for National and Community Service, the Administration (SSA), the Corporation for National and Community Service, the
Corporation for Public Broadcasting, the Institute of Museum and Library Corporation for Public Broadcasting, the Institute of Museum and Library
Services, the National Labor Relations Board, and the Railroad Retirement Services, the National Labor Relations Board, and the Railroad Retirement
Board. Board.
~~In general, mandatory funding represents more than 80% of the total LHHS bill, supporting~~
~~annually appropriated entitlements such as Medicaid and Supplemental Security Income (SSI).~~
~~Discretionary funds, which account for less than 20% of total funds in the bill, tend to be the~~

~~1 The House Appropriations Committee suballocations have not yet been formally reported as of the cover date of this~~
~~report, but they have been published by the committee at https://appropriations.house.gov/sites/~~
~~republicans.appropriations.house.gov/files/documents/~~
~~FY24%20House%20Subcommittee%20Allocations%206.13.23_0.pdf.~~
~~2 S.Rept. 118-45.~~
3 1 See draft text linked to House Appropriations Committee, “Committee Releases FY24 Labor, Health and Human Services, Education, and Related Agencies Appropriations Bill,” July 13, 2023, https://appropriations.house.gov/news/press-releases/committee-releases-fy24-labor-health-and-human-services-education-and-related. Also, on October 6, 2023, Representative Aderholt, Chair of the House Appropriations LHHS Subcommittee, introduced an FY2024 LHHS bill (H.R. 5894). Because H.R. 5894 has not received any congressional action, this report does not discuss this measure. 2 Calculated based on the explanatory statement accompanying the FY2023 LHHS omnibus (P.L. 117-328) available in Calculated based on the explanatory statement accompanying the FY2023 LHHS omnibus (P.L. 117-328) available in
the the Congressional Record, vol. 168, no. 198, book II, December 20, 2022, pp. S8874-S9198. The discretionary funding , vol. 168, no. 198, book II, December 20, 2022, pp. S8874-S9198. The discretionary funding
provided in the LHHS appropriations act is both provided and controlled by that act. The mandatory funding provided provided in the LHHS appropriations act is both provided and controlled by that act. The mandatory funding provided
in the LHHS act is controlled by provisions in authorizing law. For definitions of these and other budget terms, see U.S. in the LHHS act is controlled by provisions in authorizing law. For definitions of these and other budget terms, see U.S.
Government Accountability Office (GAO), A Glossary of Terms Used in the Federal Budget Process, GAO-05-734SP, Government Accountability Office (GAO), A Glossary of Terms Used in the Federal Budget Process, GAO-05-734SP,
September 1, 2005, http://www.gao.gov/products/GAO-05-734SP. (Terms of interest may include September 1, 2005, http://www.gao.gov/products/GAO-05-734SP. (Terms of interest may include budget authority, ,
appropriated entitlement, , direct spending, , discretionary, , entitlement authority, and , and mandatory.) .)
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Status of FY2023 LHHS Appropriations: In Brief

In general, mandatory funding represents more than 80% of the total LHHS bill, supporting annually appropriated entitlements such as Medicaid and Supplemental Security Income (SSI). Discretionary funds, which account for less than 20% of total funds in the bill, tend to be the focus of congressional debate during the appropriations process.focus of congressional debate during the appropriations process.43 This is because the This is because the
appropriations process generally has little control over the amount of mandatory funding provided appropriations process generally has little control over the amount of mandatory funding provided
for appropriated entitlements; rather, the authorizing statute controls the program parameters for appropriated entitlements; rather, the authorizing statute controls the program parameters
(e.g., eligibility rules, benefit levels) that entitle certain recipients to payments. Consequently, the (e.g., eligibility rules, benefit levels) that entitle certain recipients to payments. Consequently, the
focus of this report generally is on the discretionary spending that has been or would be provided focus of this report generally is on the discretionary spending that has been or would be provided
for LHHS programs and activities under various laws and proposals. for LHHS programs and activities under various laws and proposals.
Even though discretionary appropriations represent a relatively small share of the entire LHHS Even though discretionary appropriations represent a relatively small share of the entire LHHS
bill, the bill is typically the largest single source of nondefense discretionary funding for the bill, the bill is typically the largest single source of nondefense discretionary funding for the
federal government. (The Department of Defense bill is the largest single source of discretionary federal government. (The Department of Defense bill is the largest single source of discretionary
funding overall.) funding overall.)
Calculating Total LHHS Budget Authority
Budget authority is the amount of money a federal agency is legally authorized to commit or spend. Appropriations is the amount of money a federal agency is legally authorized to commit or spend. Appropriations
~~bil s~~bills may include budget authority that becomes available in the current fiscal year, in future fiscal years, or some may include budget authority that becomes available in the current fiscal year, in future fiscal years, or some
combination. Amounts that become available in future fiscal years are typically referred to as combination. Amounts that become available in future fiscal years are typically referred to as advance
appropriations (e.g., the FY2024 LHHS appropriations act generally would contain advance appropriations that (e.g., the FY2024 LHHS appropriations act generally would contain advance appropriations that
become available in FY2025 and FY2026 for certain programs and activities). In addition, while new budget become available in FY2025 and FY2026 for certain programs and activities). In addition, while new budget
authority is generally subject to a variety of statutory and congressional rules that are intended to control the authority is generally subject to a variety of statutory and congressional rules that are intended to control the
budget (i.e., budget (i.e., budget controls), some budget authority may be effectively exempted from those controls, including ), some budget authority may be effectively exempted from those controls, including
budget authority for emergency requirements, health care fraud and abuse control, and continuing disability budget authority for emergency requirements, health care fraud and abuse control, and continuing disability
reviews and redeterminations. reviews and redeterminations.
The amount of LHHS budget authority can be tabulated in various ways. The total amount of budget authority The amount of LHHS budget authority can be tabulated in various ways. The total amount of budget authority
provided in an appropriations provided in an appropriations ~~bil~~ bill (i.e., (i.e., total in the bill) would be calculated regardless of the year in which the ) would be calculated regardless of the year in which the
funding becomes available.funding becomes available.54 In some cases, such as the 302(b) suballocations (discussed later), the total is based on In some cases, such as the 302(b) suballocations (discussed later), the total is based on
current-year appropriations (i.e., the amount of appropriations (i.e., the amount of budget authority available for obligation in a given fiscal year), which is , which is
calculated regardless of the year in which it was first appropriated.calculated regardless of the year in which it was first appropriated.65 Additionally, budgetary totals may or may not Additionally, budgetary totals may or may not
include Congressional Budget Office (CBO) scorekeeping and other adjustments to reflect budget enforcement include Congressional Budget Office (CBO) scorekeeping and other adjustments to reflect budget enforcement
conventions and special instructions of Congress.conventions and special instructions of Congress.76 Finally, calculations of LHHS budget authority might include or Finally, calculations of LHHS budget authority might include or
exclude budget authority that is exempted from budget controls. exclude budget authority that is exempted from budget controls.
Context for FY2024
Under the congressional budget process, congressional consideration of annual appropriations Under the congressional budget process, congressional consideration of annual appropriations
traditionally is preceded by the submission of the President’s budget request and the adoption of traditionally is preceded by the submission of the President’s budget request and the adoption of
the congressional budget resolution. However, the FY2024 cycle has been affected by a number the congressional budget resolution. However, the FY2024 cycle has been affected by a number
of issues, including the circumstances affecting the timing of the President’s budget and the of issues, including the circumstances affecting the timing of the President’s budget and the
~~recent imposition of statutory discretionary spending limits on defense and nondefense spending.~~
~~Background related to these issues is provided below.~~

4 3 For an illustrative discussion of the distribution of funds among the different titles of the bill, and between For an illustrative discussion of the distribution of funds among the different titles of the bill, and between
discretionary and mandatory spending, see the summary of FY2023 LHHS appropriations in CRS Report R47345, discretionary and mandatory spending, see the summary of FY2023 LHHS appropriations in CRS Report R47345,
Labor, Health and Human Services, and Education: FY2023 Appropriations. .
54 Such figures include advance appropriations provided in the bill for future fiscal years, but do not include advance Such figures include advance appropriations provided in the bill for future fiscal years, but do not include advance
appropriations provided in prior years’ appropriations bills that become available in the current year. appropriations provided in prior years’ appropriations bills that become available in the current year.
65 Such figures typically exclude advance appropriations for future years, but include advance appropriations from prior Such figures typically exclude advance appropriations for future years, but include advance appropriations from prior
years that become available in the given fiscal year. years that become available in the given fiscal year.
76 For more information on scorekeeping, see CRS Report 98-560, For more information on scorekeeping, see CRS Report 98-560, Baselines and Scorekeeping in the Federal Budget
Process. See also a discussion of key scorekeeping guidelines included in the joint explanatory statement . See also a discussion of key scorekeeping guidelines included in the joint explanatory statement
accompanying the conference report to the Balanced Budget Act of 1997 (H.Rept. 105-217, pp. 1007-1014). accompanying the conference report to the Balanced Budget Act of 1997 (H.Rept. 105-217, pp. 1007-1014).
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Status of FY2023 LHHS Appropriations: In Brief

recent imposition of statutory discretionary spending limits on defense and nondefense spending. Background related to these issues is provided below. FY2024 President’s Budget Submission
The Budget and Accounting Act of 1921 (P.L. 67-13), as amended, requires the President to The Budget and Accounting Act of 1921 (P.L. 67-13), as amended, requires the President to
submit an annual consolidated federal budget to Congress at the beginning of each regular submit an annual consolidated federal budget to Congress at the beginning of each regular
congressional session, not later than the first Monday in February. Many of the proposals in the congressional session, not later than the first Monday in February. Many of the proposals in the
President’s budget would require changes to laws that govern President’s budget would require changes to laws that govern mandatory spending levels or levels or
policies, which are typically established on a multiyear or permanent basis. policies, which are typically established on a multiyear or permanent basis. Discretionary
spending, however, which is roughly one-third of the federal budget,, however, which is roughly one-third of the federal budget,87 is decided and controlled is decided and controlled
each fiscal year through the annual appropriations process. While Congress is ultimately not each fiscal year through the annual appropriations process. While Congress is ultimately not
required to adopt the President’s proposals or recommendations, the submission of the President’s required to adopt the President’s proposals or recommendations, the submission of the President’s
budget typically initiates the congressional budget process and informs Congress of the budget typically initiates the congressional budget process and informs Congress of the
President’s recommended spending levels for agencies and programs.President’s recommended spending levels for agencies and programs.98
The President’s budget request for FY2024 was submitted on March 9, 2023, about five weeks The President’s budget request for FY2024 was submitted on March 9, 2023, about five weeks
after it was due. It was preceded by the enactment of FY2023 full-year annual appropriations after it was due. It was preceded by the enactment of FY2023 full-year annual appropriations
(P.L. 117-328) on December 29, 2022, about three months into the fiscal year. The delay of the (P.L. 117-328) on December 29, 2022, about three months into the fiscal year. The delay of the
budget submission allowed the FY2023 funding amounts displayed in the budget materials budget submission allowed the FY2023 funding amounts displayed in the budget materials
generally to reflect the annual appropriations in December. generally to reflect the annual appropriations in December.
On May 9, the President submitted amendments to the FY2024 budget request that included On May 9, the President submitted amendments to the FY2024 budget request that included
changes to the amounts requested for specified Department of Education accounts.changes to the amounts requested for specified Department of Education accounts.109 In addition, two supplemental appropriations proposals made since that time have included requests for LHHS-related discretionary funding. The request for “critical national security funding needs” made on October 20 included funding for HHS and DOL accounts.10 The request for “critical domestic needs” made on October 25 included funding for HHS and ED accounts.11
FY2024 Discretionary Spending Levels and Appropriations
Allocations
For FY2024, the discretionary spending levels in appropriations measures are enforceable by both For FY2024, the discretionary spending levels in appropriations measures are enforceable by both
statutory and procedural means. Statutory budget enforcement is through the discretionary statutory and procedural means. Statutory budget enforcement is through the discretionary
spending limits in the Balanced Budget and Emergency Deficit Control Act of 1985 (BBEDCA; spending limits in the Balanced Budget and Emergency Deficit Control Act of 1985 (BBEDCA;
P.L. 99-177), as amended. These statutory limits are enforced through P.L. 99-177), as amended. These statutory limits are enforced through sequestration: largely : largely
across-the-board reductions made to the category of spending that is in excess of the limitacross-the-board reductions made to the category of spending that is in excess of the limit
~~(defense or nondefense), to eliminate the excess spending.11 Procedural budget enforcement is~~
~~primarily associated with the budget resolution, which provides a process for the House and~~
~~Senate to agree on budgetary targets ahead of consideration of spending and revenue legislation.~~
~~These targets are enforced through points of order.~~
~~Certain spending is effectively exempt from these limits (commonly referred to as adjustments to~~
~~those limits). In recent years, adjustments that have been applied to LHHS appropriations are for~~
emergency requirements, to accommodate new budget authority for specified “program integrity”
initiatives at HHS (health care fraud and abuse control), the SSA (continuing disability reviews

8 7 Congressional Budget Office (CBO), Congressional Budget Office (CBO), The 2022 Long-Term Budget Outlook, July 2022, p. 18, https://www.cbo.gov/, July 2022, p. 18, https://www.cbo.gov/
system/files/2022-07/57971-LTBO.pdf. system/files/2022-07/57971-LTBO.pdf.
98 For more information, see CRS Report R47019, For more information, see CRS Report R47019, The Executive Budget Process: An Overview. .
109 See the budget amendments package at https://www.whitehouse.gov/wp-content/uploads/2023/05/ See the budget amendments package at https://www.whitehouse.gov/wp-content/uploads/2023/05/
FY_2024_Budget_Amendment_Corrections_5-9-23.pdf. FY_2024_Budget_Amendment_Corrections_5-9-23.pdf.
~~11 The Fiscal Responsibility Act of 2023 (FRA; P.L. 118-5) also contains procedures by which these limits might be~~
~~temporarily or permanently adjusted in the case of a continuing resolution. For a summary of these adjustments, see~~
~~CRS Insight IN12168, Discretionary Spending Caps in the Fiscal Responsibility Act of 2023.~~
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~~Status of FY2023 LHHS Appropriations: In Brief~~

10 See Executive Office of the President (EOP), Office of Management and Budget (OMB), “Letter Regarding Critical National Security Funding Needs for FY 2024,” October 20, 2023, https://www.whitehouse.gov/omb/briefing-room/2023/10/20/letter-regarding-critical-national-security-funding-needs-for-fy-2024/. 11 See EOP, OMB, “FACT SHEET: White House Calls on Congress to Support Critical Domestic Needs,” October 25, 2023, https://www.whitehouse.gov/briefing-room/statements-releases/2023/10/25/fact-sheet-white-house-calls-on-congress-to-support-critical-domestic-needs/; and EOP, OMB, “Funding Request to meet Critical Needs,” undated, https://www.whitehouse.gov/wp-content/uploads/2023/10/Funding-Request-to-Meet-Critical-Needs.pdf. Congressional Research Service 3 Status of FY2023 LHHS Appropriations: In Brief (defense or nondefense), to eliminate the excess spending.12 Procedural budget enforcement is primarily associated with the budget resolution, which provides a process for the House and Senate to agree on budgetary targets ahead of consideration of spending and revenue legislation. These targets are enforced through points of order. Certain spending is effectively exempt from these limits (commonly referred to as adjustments to those limits). In recent years, adjustments that have been applied to LHHS appropriations are for emergency requirements, to accommodate new budget authority for specified “program integrity” initiatives at HHS (health care fraud and abuse control), the SSA (continuing disability reviews and redeterminations), and for DOL to fund ), and for DOL to fund reemployment services and eligibility assessments
conducted by the states related to unemployment compensation.conducted by the states related to unemployment compensation.1213
Statutory Spending Limits
The statutory limits on discretionary spending that are currently in effect were enacted as part of The statutory limits on discretionary spending that are currently in effect were enacted as part of
the Fiscal Responsibility Act of 2023 (FRA; P.L. 118-5) on June 3, 2023.the Fiscal Responsibility Act of 2023 (FRA; P.L. 118-5) on June 3, 2023.1314 Prior to the FRA, Prior to the FRA,
statutory limits on discretionary spending had been in effect statutory limits on discretionary spending had been in effect ~~between~~from FY2012 FY2012 ~~and~~through FY2021 FY2021
(having expired at the end of FY2021(having expired at the end of FY2021~~.14)~~).15 The FRA amended the BBEDCA to provide limits on The FRA amended the BBEDCA to provide limits on
defense discretionary (all spending under budget function 050) and nondefense discretionary (all defense discretionary (all spending under budget function 050) and nondefense discretionary (all
other spending) for FY2024 and FY2025.other spending) for FY2024 and FY2025.15 All funding in the LHHS bill is subject to the All funding in the LHHS bill is subject to the
nondefense limit. The statutory limit on nondefense discretionary spending for FY2024 is nondefense limit. The statutory limit on nondefense discretionary spending for FY2024 is
$703.65 billion. This would be a $40.2 billion (-5%) reduction relative to FY2023 enacted $703.65 billion. This would be a $40.2 billion (-5%) reduction relative to FY2023 enacted
nondefense discretionary spending when accounting for Congressional Budget Office (CBO) nondefense discretionary spending when accounting for Congressional Budget Office (CBO)
scorekeeping, and prior to any adjustments to the limits pursuant to BBEDCA authorities.16 For scorekeeping, and prior to any adjustments to the limits pursuant to BBEDCA authorities.16 For
LHHS programs and activities, the FRA also provided for adjustments to the nondefense LHHS programs and activities, the FRA also provided for adjustments to the nondefense
spending limit for health care fraud and abuse control, continuing disability reviews and spending limit for health care fraud and abuse control, continuing disability reviews and
redeterminations, and reemployment services and eligibility assessments, up to a specified redeterminations, and reemployment services and eligibility assessments, up to a specified
~~amount of funding for each of FY2024 and FY2025.17 The maximum amount of funding allowed~~
~~for these LHHS adjustments is $2.447 billion total in FY2024 and $2.531 billion in FY2025.~~
~~Appropriations Allocations Under the Budget Resolution~~
~~The budget resolution process dates back to the Congressional Budget Act of 1974, and is used~~
~~each year to impose a limit on total discretionary spending available to the appropriations~~
~~committees (commonly referred to as a 302(a) allocation) and subsequently, limits on spending~~

12 12 The Fiscal Responsibility Act of 2023 (FRA; P.L. 118-5) also contains procedures by which these limits might be temporarily or permanently adjusted in the case of a continuing resolution. For a summary of these adjustments, see CRS Insight IN12168, Discretionary Spending Caps in the Fiscal Responsibility Act of 2023. 13 For further information on how these generally function, see Appendix A in CRS Report R47345, For further information on how these generally function, see Appendix A in CRS Report R47345, Labor, Health and
Human Services, and Education: FY2023 Appropriations. .
1314 For more information, see CRS Insight IN12168, For more information, see CRS Insight IN12168, Discretionary Spending Caps in the Fiscal Responsibility Act of
2023. .
1415 These limits were initially established in 2011 by the amendments made by the Budget Control Act of 2011 (BCA; These limits were initially established in 2011 by the amendments made by the Budget Control Act of 2011 (BCA;
P.L. 112-25) to the BBEDCA, but they were subsequently revised several times over the course of their effective P.L. 112-25) to the BBEDCA, but they were subsequently revised several times over the course of their effective
period. For a summary of these changes, see CRS Insight IN11148, period. For a summary of these changes, see CRS Insight IN11148, The Bipartisan Budget Act of 2019: Changes to the
BCA and Debt Limit. .
~~15 For further information about the categories of the limits, see CRS Report R44874,~~ ~~The Budget Control Act:~~
~~Frequently Asked Questions~~.
16 These calculations are based on CBO, 16 These calculations are based on CBO, Report on the Status of Discretionary Appropriations, Fiscal Year 2023, U.S.
Senate, February 10, 2023, https://www.cbo.gov/system/files?file=2023-02/FY2023-Senate-2022-12-23.pdf. Note that , https://www.cbo.gov/system/files?file=2023-02/FY2023-Senate-2022-12-23.pdf. Note that
CBO tabulates a slightly different amount of funding using House conventions in CBO, CBO tabulates a slightly different amount of funding using House conventions in CBO, Report on the Status of
Discretionary Appropriations, Fiscal Year 2023, U.S. House of Representatives, February 10, 2023, ,
https://www.cbo.gov/system/files?file=2023-02/FY2023-House-2022-12-23.pdf. The FRA includes a provision https://www.cbo.gov/system/files?file=2023-02/FY2023-House-2022-12-23.pdf. The FRA includes a provision
described as incentivizing Members to enact regular full-year appropriations legislation. The FRA states that in the described as incentivizing Members to enact regular full-year appropriations legislation. The FRA states that in the
event that a continuing resolution (CR) is in effect on January 1 of 2024 or 2025 for any budget account, the event that a continuing resolution (CR) is in effect on January 1 of 2024 or 2025 for any budget account, the
discretionary spending limits for that fiscal year are automatically revised. The revision would result in an increase in discretionary spending limits for that fiscal year are automatically revised. The revision would result in an increase in
nondefense discretionary budget authority and a decrease for defense discretionary spending levels when compared nondefense discretionary budget authority and a decrease for defense discretionary spending levels when compared
with the original levels. Under such a scenario, a sequester order would be issued on April 30 of either 2024 or 2025. with the original levels. Under such a scenario, a sequester order would be issued on April 30 of either 2024 or 2025.
The FRA states that the revised limits would revert to the original FRA limits if full-year appropriations were enacted The FRA states that the revised limits would revert to the original FRA limits if full-year appropriations were enacted
before April 30. For more information, see CRS Insight IN12183, before April 30. For more information, see CRS Insight IN12183, The FRA’s Discretionary Spending Caps Under a
CR: FAQs. .
~~17 The FRA also provided for a designation for emergency requirements, which would generally be available for~~
~~funding under the purview of any appropriations act (not just LHHS).~~
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~~link to page 9 link to page 9~~ ~~Status of FY2023 LHHS Appropriations: In Brief~~

Congressional Research Service 4 link to page 10 Status of FY2023 LHHS Appropriations: In Brief amount of funding for each of FY2024 and FY2025.17 The maximum amount of funding allowed for these LHHS adjustments is $2.447 billion total in FY2024 and $2.531 billion in FY2025. Appropriations Allocations Under the Budget Resolution The budget resolution process dates back to the Congressional Budget Act of 1974, and is used each year to impose a limit on total discretionary spending available to the appropriations committees (commonly referred to as a 302(a) allocation) and subsequently, limits on spending under the jurisdiction of each appropriations subcommittee (referred to as under the jurisdiction of each appropriations subcommittee (referred to as 302(b)
suballocations).18 ).18
As of the cover date of this report, there has been no House or Senate action on a FY2024 budget As of the cover date of this report, there has been no House or Senate action on a FY2024 budget
resolution.resolution.19 For the purposes of providing 302(a) allocations and budgetary aggregates for the For the purposes of providing 302(a) allocations and budgetary aggregates for the
consideration of FY2024 appropriations, as well as other matters that would have been consideration of FY2024 appropriations, as well as other matters that would have been
traditionally associated with the budget resolution, the FRA directed the Chairs of the House traditionally associated with the budget resolution, the FRA directed the Chairs of the House
Budget Committee and the Senate Budget Committee to enter those amounts into the Budget Committee and the Senate Budget Committee to enter those amounts into the
Congressional Record as soon as practicable. These were published in the Senate on June 21, as soon as practicable. These were published in the Senate on June 21,
2023, but have not yet been published in the House.2023, but have not yet been published in the House.1920
Generally, the next step in the appropriations process is for each of the appropriations committees Generally, the next step in the appropriations process is for each of the appropriations committees
to adopt suballocations from the total amount allocated to them. These 302(b) suballocations to adopt suballocations from the total amount allocated to them. These 302(b) suballocations
provide a limit on current-year (i.e., FY2024) appropriations within each subcommittee’s provide a limit on current-year (i.e., FY2024) appropriations within each subcommittee’s
jurisdiction and incorporate any applicable scorekeeping adjustments made by CBO.jurisdiction and incorporate any applicable scorekeeping adjustments made by CBO.2021 On June On June
15, 2023, the House Appropriations Committee voted to 15, 2023, the House Appropriations Committee voted to ~~report its initial~~approve draft suballocations for all 12 suballocations for all 12
subcommittees, including LHHS (33-27).subcommittees, including LHHS (33-27).2122 Subsequently, the Senate Appropriations Committee Subsequently, the Senate Appropriations Committee
~~voted to report~~reported its suballocations on June 22, 2023 (15-13). its suballocations on June 22, 2023 (15-13).2223 These suballocations are displayed These suballocations are displayed
inin Table 1. FY2024 LHHS Legislative Action FY2024 Continuing Appropriations FY2024 LHHS regular appropriations are currently being provided by a CR, which was signed into law on September 30, 2023 (Division A of H.R. 5860; P.L. 118-15). The CR provides continuing appropriations for all 12 of the annual appropriations acts (including LHHS) through November 17, 2023. H.R. 5860 was introduced by Representative Granger, the House 17 The FRA also provided for a designation for emergency requirements, which would generally be available for funding under the purview of any appropriations act (not just LHHS). 18 For further information, see CRS Report 98-815, Budget Resolution Enforcement. 19 The House Budget Committee voted to report a FY2024 budget resolution on September 20, 2023, but the measure has not yet been reported. 20 “Budget Enforcement Levels,” Congressional Record, daily edition, vol. 169, no. 108 (June 21, 2023), pp. S2180-S2181. 21 Such suballocations are commonly revised throughout the appropriations process to reflect changing budgetary priorities. 22 The House Appropriations Committee suballocations have not yet been formally reported, but they have been published by the committee at https://appropriations.house.gov/sites/republicans.appropriations.house.gov/files/documents/FY24%20House%20Subcommittee%20Allocations%206.13.23_0.pdf. 23 S.Rept. 118-45. These suballocations were subsequently revised in S.Rept. 118-57, S.Rept. 118-69, S.Rept. 118-78, and S.Rept. 118-98. Congressional Research Service 5 link to page 10 Status of FY2023 LHHS Appropriations: In Brief Appropriations Committee Chair, on September 30, 2023. That same day, the measure was passed by both the House (335-91) and the Senate (88-9), and signed into law. In general, the FY2024 CR funds discretionary programs at the same rate and under the same conditions as in FY2023 annual appropriations acts (§101), with specified exceptions, and funds annually appropriated entitlements at their current law levels (§111).24 The CR also includes a few provisions that are specific to LHHS accounts or related activities (§§101(8), 133).25 Congressional Action on a LHHS Bill In the Senate, the FY2024 LHHS bill has been reported out of the Senate Appropriations Committee, but has not received floor consideration. On July 27, 2023, the Senate Appropriations Committee voted to report the FY2024 LHHS bill, 26-2; the measure was subsequently reported to the Senate that same day (S. 2624; S.Rept. 118-84). The measure was not formally marked up in subcommittee prior to full committee action. In the House, the FY2024 LHHS bill has received some House Appropriations Committee consideration, but has not been marked up by the full committee. The draft bill was approved in subcommittee on July 14, 2023, by a voice vote.26 Most recently, on October 6, 2023, Representative Aderholt, Chair of the House Appropriations LHHS Subcommittee, introduced an LHHS bill (H.R. 5894). Because H.R. 5894 has not received any congressional action, this report does not discuss this measure. Table 1.
~~FY2024 LHHS Legislative Action~~
~~Although neither the House Appropriations Committee nor the Senate Appropriations Committee~~
~~has voted to report its respective version of the LHHS bill, the respective suballocations for~~
~~LHHS that were adopted by the House and the Senate Appropriations Committees provide a basis~~
~~for comparison to prior-year levels.~~
Table 1 displays the CBO estimate of enacted LHHS discretionary appropriations for FY2022 displays the CBO estimate of enacted LHHS discretionary appropriations for FY2022
and FY2023, alongside the FY2024 and FY2023, alongside the FY2024 ~~initial House and Senate Appropriations Committee~~
~~suballocations for LHHS. The amount~~draft House suballocation for LHHS27 and the FY2024 Senate committee-reported bill (S. 2624). The amounts shown for “regular discretionary appropriations” shown for “regular discretionary appropriations” ~~does~~do not not
include any funding that is subject to program integrity adjustments or emergency designations. include any funding that is subject to program integrity adjustments or emergency designations.
~~The amount shown represents~~The amounts shown represent current-year budget authority subject to the spending limits and current-year budget authority subject to the spending limits and
~~takes~~take into account any applicable CBO scorekeeping adjustments. Under this method of into account any applicable CBO scorekeeping adjustments. Under this method of
estimating the bill, the House proposal would reduce regular discretionary appropriations for estimating the bill, the House proposal would reduce regular discretionary appropriations for
~~LHHS by 29% (-$60.3 billion) relative to FY2023 and by 25% (-$49.9 billion) relative to~~
~~FY2022.23 The Senate proposal would reduce discretionary appropriations for LHHS by 6% (-~~
~~$12.1 billion) relative to FY2023 and by 1% (-$1.8 billion) relative to FY2022. It cannot be~~
~~determined based on these suballocations alone the extent to which these reductions would be~~

~~18 For further information, see CRS Report 98-815, Budget Resolution Enforcement.~~
~~19 “Budget Enforcement Levels,” Congressional Record, daily edition, vol. 169, no. 108 (June 21, 2023), pp. S2180-~~
~~S2181.~~
~~20 Such suballocations are commonly revised throughout the appropriations process to reflect changing budgetary~~
~~priorities.~~
~~21 The House Appropriations Committee suballocations have not yet been formally reported, but they have been~~
~~published by the committee at https://appropriations.house.gov/sites/republicans.appropriations.house.gov/files/~~
~~documents/FY24%20House%20Subcommittee%20Allocations%206.13.23_0.pdf.~~
~~22 S.Rept. 118-45.~~
~~23 This CRS estimate is based on a comparison of the CBO estimate for FY2022 enacted (CBO,~~ ~~Report on the Status of~~
~~Discretionary Appropriations, Fiscal Year 2022, House of Representatives, as of May 26, 2022, https://www.cbo.gov/~~
~~system/files?file=2022-05/FY2022-House-2022-05-26.pdf) to the total discretionary spending budget authority~~
~~allocation.~~
~~Congressional Research Service~~

5

~~link to page 6 link to page 6 link to page 10 link to page 10~~ ~~Status of FY2023 LHHS Appropriations: In Brief~~

~~achieved via rescissions to previously enacted funding and other related budgetary mechanisms,~~
~~versus reducing the amount of LHHS funding that would be newly enacted for FY2024.~~
LHHS by 29% (-$60.3 billion) relative to FY2023 and by 25% (-$49.9 billion) 24 For an estimate of the discretionary appropriations contained in Division A of H.R. 6833, see Estimated Discretionary Appropriations Under Division A of Senate Amendment Number 5745 to H.R. 6833, the Continuing Appropriations and Ukraine Supplemental Appropriations Act, 2023, with Adjustments Made in the Senate, September 28, 2022, https://www.cbo.gov/system/files/2021-09/57491-CBO-Estimate-for-HR5305.pdf. For an estimate of the discretionary appropriations contained in Division A of H.R. 1437, see Estimated Discretionary Appropriations Under Division A of the Further Continuing Appropriations and Extensions Act, 2023 (Rules Committee Print 117-72, the House Amendment to the Senate Amendment to H.R. 1437) as posted on the Rules Committee Website (https://rules.house.gov/bill/117/hr1437-sa), with Adjustments Made in the House, December 14, 2022, https://www.cbo.gov/system/files/2022-12/hr1437%28as_modified%29.pdf. 25 The LHHS-specific provisions in the CR are discussed in CRS Report R47749, Overview of Continuing Appropriations for FY2024 (Division A of P.L. 118-15). 26 See draft text linked to House Appropriations Committee, “Committee Releases FY24 Labor, Health and Human Services, Education, and Related Agencies Appropriations Bill,” July 13, 2023, https://appropriations.house.gov/news/press-releases/committee-releases-fy24-labor-health-and-human-services-education-and-related. 27 The House Appropriations Committee majority summary of the subcommittee draft LHHS bill indicated that total discretionary funding in the draft aligns with the draft subcommittee allocation. (See bill summary linked at House Appropriations Committee majority, “Committee Releases FY24 Labor, Health and Human Services, Education, and Related Agencies Appropriations Bill,” July 13 2023, https://appropriations.house.gov/news/press-releases/committee-releases-fy24-labor-health-and-human-services-education-and-related.) Congressional Research Service 6 link to page 6 link to page 6 link to page 11 Status of FY2023 LHHS Appropriations: In Brief relative to FY2022.28 The Senate proposal would reduce discretionary appropriations for LHHS by 6% (-$12.1 billion) relative to FY2023 and by 1% (-$1.8 billion) relative to FY2022.29 As mentioned previously, certain LHHS appropriations, such as those allowed for program As mentioned previously, certain LHHS appropriations, such as those allowed for program
integrity funding or designated as for emergency requirements, are effectively exempt from the integrity funding or designated as for emergency requirements, are effectively exempt from the
discretionary spending limits. (The “adjusted appropriations” total in the table includes funding discretionary spending limits. (The “adjusted appropriations” total in the table includes funding
under these adjustments, plus “regular discretionary appropriations.”) The draft House under these adjustments, plus “regular discretionary appropriations.”) The draft House
Appropriations Committee report on FY2024 suballocations for LHHS presents an aggregate Appropriations Committee report on FY2024 suballocations for LHHS presents an aggregate
total for the three “program integrity” adjustmentstotal for the three “program integrity” adjustments ($2.4 billion), which matches the maximum aggregate , which matches the maximum aggregate
amount available for the three LHHS “program integrity” adjustments under the FY2024 amount available for the three LHHS “program integrity” adjustments under the FY2024
statutory spending limits (see discussion in the statutory spending limits (see discussion in the “FY2024 Discretionary Spending Levels and
Appropriations Allocations” section). The House suballocations for LHHS do not include any section). The House suballocations for LHHS do not include any
FY2024 funding for emergency requirements. The FY2024 Senate FY2024 funding for emergency requirements. The FY2024 Senate ~~suballocation for LHHS did~~
~~not include any amounts for adjustments.~~committee-reported LHHS bill would provide the same total amount proposed by the House in program integrity adjustments, and $4.5 billion in emergency-designated discretionary funding.30
Table 1. LHHS Discretionary Appropriations: Comparison of FY2022 Enacted,
FY2023 Enacted, and FY2024 House and Senate Appropriations Committee Initial
302(b) Suballocations
(Budget authority in billions of dollars) (Budget authority in billions of dollars)

FY2024 ~~House~~Draft
FY2024 Senate
~~Committee~~House
Committee
- FY2022
FY2023
~~Initial~~
~~Initial~~Committee Reported Bill
Enacted
Enacted
Suballocation
~~Suballocatio~~na(S. 2624)
Regular discretionary Regular discretionary
196.994 196.994
207.367 207.367
147.096 147.096
195.231 195.231
appropriations appropriations
Adjustmen Adjustments:ba

Program Integrity Program Integrity
2.124 2.124
2.345 2.345
2.447 2.447
~~Not specified~~2.447
Health Care Fraud and
0.556
0.576
—
—0.604
Abuse Control (non-add)
Continuing Disability
1.435 1.435
1.511
—
—1.578
Reviews and
Redeterminations (non-
add)
Reemployment Services
0.133
0.258
—
—0.265 and Eligibility Assessments (non-add) 28 This CRS estimate is based on a comparison of the CBO estimate for FY2022 enacted (CBO, Report on the Status of Discretionary Appropriations, Fiscal Year 2022, House of Representatives, as of May 26, 2022, https://www.cbo.gov/system/files?file=2022-05/FY2022-House-2022-05-26.pdf) to the total discretionary spending budget authority allocation. 29 An alternative way of calculating the amount of the Senate-proposed reductions was provided in the committee report accompanying S. 2624. The subcommittee’s effective base discretionary funding allocation, which includes discretionary funding offset by savings in changes in mandatory programs and other similar adjustments is $1,218,000,000 below the comparable fiscal year 2023 level ( S.Rept. 118-84, p. 1). With regard to the House-proposed reductions, it cannot be determined based on the suballocations alone the extent to which these reductions would be achieved via rescissions to previously enacted funding and other related budgetary mechanisms, versus reducing the amount of LHHS funding that would be newly enacted for FY2024. 30 Emergency-designed funding in S. 2624 was proposed for a total of 11 accounts under the Health and Human Services (Title II) and Related Agencies (Title IV) titles in the bill. Congressional Research Service 7 Status of FY2023 LHHS Appropriations: In Brief FY2024 Draft FY2024 Senate House Committee- FY2022 FY2023 Committee Reported Bill Enacted Enacted Suballocation (S. 2624)
~~and Eligibility~~
~~Assessments (non-add)~~
Emergency requirements Emergency requirements
7.831
9.920
—
—4.500
Adjusted appropriations Adjusted appropriations
206.949 206.949
219.632 219.632
149.543 149.543
—202.178
Source: The FY2022 Enacted amounts are from CBO, The FY2022 Enacted amounts are from CBO, Report on the Status of Discretionary Appropriations, Fiscal
Year 2022, House of Representatives, as of May 26, 2022, https://www.cbo.gov/system/files?file=2022-05/FY2022-, https://www.cbo.gov/system/files?file=2022-05/FY2022-
House-2022-05-26.pdf; and Table 3 in CBO, cost estimate, “The Bipartisan Safer Communities Act would House-2022-05-26.pdf; and Table 3 in CBO, cost estimate, “The Bipartisan Safer Communities Act would
provide funding to encourage enactment of state laws aimed at provide funding to encourage enactment of state laws aimed at ~~control ing~~controlling access to guns and to support a access to guns and to support a
variety of other initiatives to enhance school safety, mental health programs, and violence prevention,” June 22, variety of other initiatives to enhance school safety, mental health programs, and violence prevention,” June 22,
2022, https://www.cbo.gov/system/files?file=2022-06/S2938.pdf.2022, https://www.cbo.gov/system/files?file=2022-06/S2938.pdf. TheThe FY2023 Enacted amounts are from CBO, FY2023 Enacted amounts are from CBO,
CBO Estimate for Divisions A through N of H.R. 2617 (as modified by S.A. 6552), the Consolidated Appropriations Act,
2023, December 21, 2022, https://www.cbo.gov/publication/58872; and CRS analysis of P.L. 117-180 and P.L. , December 21, 2022, https://www.cbo.gov/publication/58872; and CRS analysis of P.L. 117-180 and P.L.
117-328. The FY2024 House Appropriations Committee initial suballocations are as published at 117-328. The FY2024 House Appropriations Committee initial suballocations are as published at
https://appropriations.house.gov/sites/republicans.appropriations.house.gov/files/documents/https://appropriations.house.gov/sites/republicans.appropriations.house.gov/files/documents/
FY24%20House%20Subcommittee%20Allocations%206.13.23_0.pdf. The FY24%20House%20Subcommittee%20Allocations%206.13.23_0.pdf. The ~~FY2023 Senate Appropriations~~
~~Committee initial suballocations are as published in S.Rept. 118-45~~FY2024 Senate Committee-reported bill (S. 2624) amounts are from S.Rept. 118-84, p. 1, and CRS analysis of the text of S. 2624. “Regular discretionary appropriations” . “Regular discretionary appropriations”
exclude funds for which special rules apply under the spending limits (e.g., funds for certain exclude funds for which special rules apply under the spending limits (e.g., funds for certain program integrity ~~program integrity~~
~~Congressional Research Service~~

6

~~Status of FY2023 LHHS Appropriations: In Brief~~

activities and emergency requirements), as well as funds provided under authorities in the 21st Century Cures activities and emergency requirements), as well as funds provided under authorities in the 21st Century Cures
Act (P.L. 114-255) that are effectively exempt from the spending limits. Act (P.L. 114-255) that are effectively exempt from the spending limits.
Notes: Amounts reflect current-year discretionary budget authority subject to spending limits. Amounts reflect current-year discretionary budget authority subject to spending limits.
a. The a. The ~~Senate Appropriations Committee initial suballocation did not include any amounts for adjustments.~~
~~b. The~~ FY2022 enacted amounts for these activities are identified via CRS analysis of Division H of P.L. 117-FY2022 enacted amounts for these activities are identified via CRS analysis of Division H of P.L. 117-
103. The FY2023 enacted amounts for these activities are identified via CRS analysis of Division H of P.L. 103. The FY2023 enacted amounts for these activities are identified via CRS analysis of Division H of P.L.
117-328. Note that CBO tabulates these adjustments differently based on relevant procedures in CBO, 117-328. Note that CBO tabulates these adjustments differently based on relevant procedures in CBO,
Discretionary Spending in Fiscal Year 2023 Under Divisions A Through L of H.R. 2617 (as modified by Senate
Amendment 6552), the Consolidated Appropriations Act, 2023, December 21, 2022, https://www.cbo.gov/, December 21, 2022, https://www.cbo.gov/
system/files/2022-12/HR-2617_div-A%E2%80%93N.pdf. See also CBO, system/files/2022-12/HR-2617_div-A%E2%80%93N.pdf. See also CBO, Report on the Status of Discretionary
Appropriations, Fiscal Year 2023, House of Representatives, February 10, 2023, https://www.cbo.gov/system/, February 10, 2023, https://www.cbo.gov/system/
files?file=2023-02/FY2023-House-2022-12-23.pdf; and CBO, files?file=2023-02/FY2023-House-2022-12-23.pdf; and CBO, Report on the Status of Discretionary
Appropriations, Fiscal Year 2023, Senate, February 10, 2023, https://www.cbo.gov/system/files?file=2023-02/, February 10, 2023, https://www.cbo.gov/system/files?file=2023-02/
FY2023-Senate-2022-12-23.pdf. FY2023-Senate-2022-12-23.pdf.

Author Information

Karen E. Lynch Karen E. Lynch
Jessica Tollestrup Jessica Tollestrup
Specialist in Social Policy Specialist in Social Policy
Specialist in Social Policy Specialist in Social Policy

Congressional Research Service 8 Status of FY2023 LHHS Appropriations: In Brief

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