(CNN)It's not just Americans who worry about their jobs, health care or feeding their families depending on who sits in the Oval Office.
Even in the America First era, the US is the biggest foreign aid donor globally and the greatest single contributor to the World Food Program -- which gives people around the world reason to fret whenever a new administration rides into Washington. Tens of billions of dollars for food, water, education, health, security and other development needs are on the line.
"Every administration brings in its own new priorities," says Mark Green, the former head of USAID, the US's main foreign aid channel, who served during the Trump administration until this spring. The agency's mission to save lives, reduce poverty and promote democracy on behalf of the American people may not change, but it also must align with the executive branch. The agency itself declined to comment.
Though the current White House has launched programs for religious minorities and women, US President Donald Trump is what Green terms an "aid skeptic." He has repeatedly tried to slash USAID's budget by more than 20% and used aid cuts as a foreign policy cudgel, temporarily halting assistance to the impoverished "Northern Triangle" of Guatemala, Honduras and El Salvador over migration; erasing assistance for UN food, education and jobs programs in Gaza and the West Bank over peace talks; and strictly limiting who could receive health funding over abortion.
Green, now executive director of the McCain Institute, says it's "not uncommon" for the White House or Congress to place restrictions on assistance. "Sometimes it's for political reasons, sometimes it's for strategic reasons. It really varies but [USAID] do not have complete flexibility, I'll put it that way," he says.
The USAID budget battle
The Trump administration made annual attempts to shrink USAID's budget, though these largely were rejected by Congress. Its 2019 budget proposal for the aid agency was so low that Republican Sen. Lindsey Graham dismissed it as "ridiculous" at an April 2018 meeting of the Senate Appropriations Subcommittee on State, Foreign Operations, and Related Programs.
"Listen to this one," Graham said, listing the proposed reductions. "Africa -- 52.6 percent. Have things gotten better in Africa and I just missed it? (...) The people who did these cuts clearly don't know what they're talking about. They've spent zero time looking at Africa. They're just making up numbers to balance a budget."
"While the Administration views the State Department's and USAID's roles in diplomacy and development as critical to national security, this must be balanced with restraining overall non-defense discretionary spending, including for the State Department and USAID," a State Department spokesperson told CNN.
Green, whose job it was to defend the budget request at that hearing, says he didn't feel "second-guessed" by the President's attempts to take away millions of dollars in funding, but saw it as a healthy challenge. "President Trump, and not just President Trump but the team around President Trump -- I think they're aid skeptics. It's not a secret. But what that always meant for me and for the team at USAID was we took that as a challenge. And so, what we worked hard to do was to show how we were squeezing value from every program. And that these programs can be an essential tool in diplomatic statecraft and economic statecraft."
Before stepping down, he led a reorientation of the agency that seems partly designed to appeal to skeptics, promoting a "journey of self-reliance" for beneficiary countries with an ultimate goal to "work toward a time when foreign is assistance no longer necessary."
Still, he later adds, "Would I have liked more money? Absolutely. I would always be honest and say look, here's how it works. You give me $10, and I can deliver this. If you give me less. I do less."
At the massive scale of US foreign aid, even small spending changes can help or hurt hundreds of thousands of people.
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