PEPFAR renewal at risk amid abortion fight and shutdown drama

What's happening: Republicans and some outside conservative groups contend President Biden altered PEPFAR by directing program funds to organizations that support abortion, while Democrats say existing policies prevent that from happening.

• The Trump administration for the first time applied the so-called Mexico City policy that bars funding to NGOs overseas that promote or perform abortions to PEPFAR.
• Biden rescinded the Mexico City policy when he became president.

What they're saying: Rep. Chris Smith, chair of the House Foreign Affairs subcommittee on Global Health, Global Human Rights and International Organizations, told Axios that he wants the policy reinstated and applied to PEPFAR again.

• Smith previously led the reauthorization of PEPFAR in 2018.
• He also objects to funds being provided to the UN Population Fund, which expressed support for "sexual health and reproductive rights" in a strategy document.
• Conservative anti-abortion groups have targeted PEPFAR, saying they'll score lawmakers on their support for the program and urging against a multi-year reauthorization without "life-protecting policies in the form of permanent legislative provisions that will ensure that NGOs that perform, promote or support abortion are not eligible for PEPFAR funds."
• The Biden administration has said that PEPFAR does not support abortion services and is pushing for a five-year reauthorization.

What we're watching: Lawmakers are discussing a range of options for keeping the program afloat, though there's no consensus on for how long or through what legislative vehicle with a shutdown looming.

• "It will be renewed almost without a doubt for one year. Whatever it comes down to, in the CR, omnibus, appropriations or a Foreign-Ops bill that somehow passes both the House and Senate," Smith told Axios.
• "But, a multi-year [reauthorization] means that those of us who are pro-life would be endorsing all the radical changes that President Biden has made. And we can't do that. He has changed the entire program," added Smith.
• Smith said a one-year reauthorization could mean a Republican president will be in office in time for the next program renewal, allowing the new administration to reimpose the Mexico City policy.
• "We've been talking. We're in the process of negotiating. It should be just a five-year extension, but we're negotiating," said Rep. Barbara Lee, one of the House leads on reauthorization as the top Democrat on the Appropriations subcommittee on State, Foreign Operations and related programs.
• Asked about the timeline on negotiations with a Sept. 30 deadline imminent, Lee said, "We're working on it."

The intrigue: Sen. Bob Menendez was the Senate lead for PEPFAR reauthorization but stepped down as chair of the Senate Foreign Relations Committee after he was charged with bribery last week.

• Menendez told Axios last week that no agreement had been reached with the House yet, but was insistent that a one-year authorization was too short.
• "One year doesn't work for me because it will be subject to the continuing challenges, their ability to plan out the delivery of services that they do to keep people alive," said Menendez. "We need at least three years."
• However, it remains to be seen how his successor might negotiate.
• Sen. Ben Cardin who is next in line, told reporters on Tuesday that he hadn't spoken to Senate Majority Leader Chuck Schumer about assuming the Foreign Relations chairmanship.

Of note: Eight out of the 12 House Appropriations bills, including State-Foreign Operations, contain policy riders on abortion or gender-affirming care.

Yes, but: Even if the reauthorization lapses, PEPFAR can continue to be funded, though experts say there are possible repercussions.

• "If it's not reauthorized that would be a significant departure, since it's had widespread bipartisan support among multiple Congress' and multiple administrations," said Jen Kates, director of the Global Health and HIV Policy Program at KFF, previously told Axios. "It also might send a message to partner countries that we're not so supportive of PEPFAR and weaken our partnerships there."
• And there are seven provisions within PEPFAR that would sunset at the end of the month absent congressional action. They mostly include how HIV funds are allocated, including a cap on how much the U.S. can contribute to the Global Fund to Fight AIDS, Tuberculosis and Malaria.