Budget/Appropriations
Senate Panel Approves HHS Spending Bill
On July 30th, the Senate Appropriations Committee approved 29 - 1 its version of the FY 2010 Labor-HHS-Education Appropriations bill (H.R. 3293) two days after the corresponding subcommittee approved the spending bill by voice vote. In a July 28th statement, Subcommittee Chair Tom Harkin (D-IA) referenced $10.4 billion for NIH and other funding provided in the American Recovery and Reinvestment Act (ARRA, P.L. 111-5) as "a major factor in shaping this bill." He described that the committee's bill "instead emphasizes several other important programs" that did not receive substantial ARRA funding.
National Institutes of Health (NIH): According to a summary released by the committee, the bill includes the President's request of $30.8 billion for the NIH, a $442 million increase over the FY 2009 level. This total includes $300 million to be transferred from NIH to the Global Fund to Fight HIV/AIDS, Malaria, and Tuberculosis.
The Senate Committee's bill concurs with the House-passed version in rejecting the Administration's proposal to earmark increases for cancer and autism research. The committee report accompanying the bill notes "the President's plan would set a dangerous precedent. The Committee has long subscribed to the view that funding levels for individual diseases should be determined without political interference."The House-approved version of the bill (H.R. 3293) provides $31.3 billion for NIH, $500 million more than the Senate and the President's request.
Health Professions: The Senate committee provides $460.1 million for the Title VII and Title VIII health professions programs, a $67.4 million (17.2%) increase over FY 2009, and $68 million less than the President's budget request. For Title VII, the bill provides $243.4 million, a $21.7 million (9.8%) increase over FY 2009. The bill includes the President's proposed increases for the Title VII Centers of Excellence and Health Careers Opportunity Program, and also increases funding for the Primary Care Medicine and Dentistry program. The bill also provides $5.7 million for Title VII Health Professions Workforce Information and Analysis; the program has received no funding since FY 2005, when it was funded at $716,000.The House-approved bill provides $529.7 million for the health professions programs, including $266.3 million for Title VII.
National Health Service Corps (NHSC): Like the House, the Senate committee's bill provides $142 million for the NHSC, a $7 million (5.2%) increase over FY 2009 and $27 million less than the President proposed.
Agency for Healthcare Research and Quality (AHRQ): The bill provides $372.1 million for AHRQ, as provided in FY 2009, the President's budget, and the House-approved bill.
Children's GME: The bill provides $315 million for the Children's Hospitals Graduate Medical Education program, $5 million (1.6%) more than FY 2009 and the President's request. The House-approved bill provides $320 million for the program.
Centers for Disease Control and Prevention (CDC): The bill provides $6.828 billion in program level funding for CDC, a $158.9 million (2.4%) increase over FY 2009, and $130 million more than the President's request. The House bill provides $6.737 billion in program level funding for CDC.
No date has been set for Senate floor consideration of the bill.
House Appropriations Subcommittee Approves FY10 Labor-HHS-Education Bill – Increases NIH Budget by $942 Billion
On July 10th, the House Labor-HHS Appropriations Subcommittee approved the FY 2010 Labor-Health and Human Services-Education Appropriations bill. The bill includes a $6.037 billion increase over FY 2009 for the Department of Health and Human Services (HHS), which is $1.953 billion over President Obama's FY10 request.
Of special note, the bill appropriates $30.967 for the National Institutes of Health, an increase of $500 million over the President Obama’s request, and $942 million (3.1%) over FY09. A statement from Appropriations Committee Chair David Obey (D-WI) indicates that the Subcommittee is "rejecting the Administration's targeted funding approach and ensuring that all institutes and centers receive funding to offset biomedical research inflation."
According to the statement by Chairman Obey, the bill provides "$530 million in HRSA to expand training programs across the health professions and nursing fields, which provides a 34.9% increase over 2009, and the same amount as the request." The legislation also includes $6.643 billion for the Centers for Disease Control and Prevention for public health activities. This represents a $67 million increase over FY09. According to the Chairman's statement, the Subcommittee has also dedicated "$204 million across HHS to continue the Subcommittee's aggressive campaign to dramatically reduce life-threatening hospital infections," which contribute to many deaths and increased health care costs for Americans.
White House Unveils Detailed FY 2010 Budget Request
In early May, President Obama revealed agency and program specific details of his FY 2010 budget. The budget proposal is normally unveiled in early February, but with the inauguration of a new President in January, the release was pushed back. The Office of Management and Budget (OMB) also released a list of terminations, reductions, and savings, highlighting the programs that the Administration proposes to eliminate or scale back.
In February, OMB did release a budget overview, laying out the Administration's priorities and the broad outlines of the budget. The February documents did not include discretionary program information, nor did they address details on several of the Administration's mandatory and tax policies, such as the international tax and tax compliance initiatives. This budget fills in those details.
What follows is a summary of discretionary spending proposals of interest to academic medicine.
National Institutes of Health: The President's budget calls for an FY 2010 program level of $30.996 billion for NIH. This is an increase of $443 million (1.5%) over the FY 2009 comparable number and excludes funding provided to NIH through the American Recovery and Reinvestment Act (ARRA, P.L. 111-5).
The NIH program level includes $150 million for Type I Diabetes research, $79 million in funding transferred from the Interior appropriation to NIH for Superfund research activities through the National Institute of Environmental Health Sciences (NIEHS), and $8 million in Public Health Service evaluation funds transferred to the National Library of Medicine.
Identified as strategic priorities, the President's budget plans to invest over $6 billion for cancer research across NIH, reflecting the first year of an eight year strategy to double cancer research by FY 2017. The FY 2010 request represents an increase of $268 million (5%) over the estimated FY 2009 level in this area. The budget also includes $141 million for NIH's share of a $211 million HHS-wide initiative on autism spectrum disorders that also encompasses the Centers for Disease Control and Prevention (CDC) and the Health Resources Services Administration (HRSA) in FY 2010. For NIH, this represents an increase of $19 million, or 16% above the estimated FY 2009 level. The budget also includes a $9 million increase to NIEHS for a new initiative to support nanotechnology safety research, and $5 million from the Office of the Director to launch a new effort in bioethics, which will be funded in coordination with the Institute and Centers (ICs).
NIH estimates the budget would fund a total of 9,849 new and competing renewal research project grants (RPGs), an increase of seven RPGs over the estimated FY 2009 level. For noncompeting continuation awards, the President's Budget provides inflationary increases of 2%. The average cost of competing RPGs increases by 2% over the FY 2009 level. Due to the receipt of ARRA funds in FY 2009, NIH temporarily will suspend the NIH Director's Bridge Award program in FY 2010; the vast majority of these funds are redistributed to the ICs.
Health Professions: The President's budget requests $264.7 million for the Title VII health professions training programs, a $43 million (19.4%) increase over the FY 2009 omnibus. Within this total, the request proposes increases for the Health Careers Opportunity Program ($22.1 million, a $3 million or 15.7%), the Centers of Excellence ($24.6 million, a $4 million or 19.4%), the primary care medicine and dentistry training programs ($56.4 million, an $8 million or 16.5%), the geriatric training programs ($42 million, an $11 million or 35.5%), and the Scholarships for Disadvantaged Students ($52.8 million, a $7 million or 15.3%). The budget request also proposes a $10 million boost for state dental health workforce grants that are authorized in a different part of the Public Health Service Act, but have been funded through the Title VII allied health program since FY 2008.
The budget also proposes a substantial increase for the Title VIII Nursing Education Loan Repayment Program (NELRP), recommending $125 million, an $87.9 million (237%) increase over FY 2009. The Title VIII Nursing Faculty Loan program also is increased to $16 million, a $4.5 million (39.1%) increase. The budget proposes funding all other Title VIII programs at FY 2009 levels, yielding $263.4 million for the Title VIII programs in total (a $92.4 million or 54% increase).
The budget identifies the state oral health grants, the Title VIII NELRP and the Faculty Loan program, as well as the National Health Service Corps (NHSC), as part of the President's Health Workforce Initiative.
National Health Service Corps: The President's budget requests $169 million for the NHSC, a $34 million (25.2%) increase over FY 2009.
Agency for Healthcare Research and Quality: The President's budget proposes $372 million for AHRQ, as provided in the FY 2009 omnibus. The request recommends maintaining AHRQ's base funding for comparative effectiveness research (CER) at $50 million, as provided in the FY 2009 omnibus. ARRA provided $300 million directly to AHRQ for CER, which the HHS "budget in brief" identifies as part of the President's health reform agenda.
Children's Hospitals Graduate Medical Education Program: The President's budget recommends freezing the Children's GME program at the FY 2009 level of $310 million.
Centers for Disease Control and Prevention: The President's budget recommends $6.4 billion in discretionary budget authority for the CDC, the same as the comparable FY 2009 funding level. Within the total, most programs receive modest increases accommodated primarily through cuts to funds for CDC buildings and facilities, the health marketing program, Congressional projects, and elimination of the Anthrax vaccine research program. The public health research program is maintained at the FY 2009 level of $31 million.
Department of Veterans Affairs Medical and Prosthetic Research: The President's budget requests $580 million for the program, a $70 million, 13.7% increase over FY 2009.
House Members Call for Increased NIH Funding
A bipartisan group of 128 Members of the House of Representatives sent a letter calling for an increase "of at least 7 percent" in funding for the National Institutes of Health (NIH) in FY 2010. The letter, which was sent to Reps. David Obey (D-WI) and Todd Tiahrt (R-KS), the chair and ranking member, respectively, of the House Labor-HHS-Education Appropriations Subcommittee, states this level of funding "is essential to sustain advances in science and the economic impacts of NIH-funded research."
The letter states, "NIH research is a critical part of health care reform, strengthening our economy, inspiring the next generation of scientists and researchers, and maintaining our nation's leadership in innovation." Noting that "a substantial portion of projected health care spending comes from expenses associated with managing diabetes, cancer, Alzheimer's, stroke, and many other chronic or life-threatening diseases," the letter avers that NIH research "is essential to containing soaring health care costs."
The letter was organized by Reps. Ed Markey (D-MA), Dave Reichert (R-WA), Janice Schakowsky (D-IL), Joe Courtney (D-CT), Michael Castle (R-DE), Susan Davis (D-CA), and Brian Bilbray (R-CA). Thirteen members of the New York delegation were among those who cosigned the letter.
President Signs FY 2009 Spending Bill
On March 11th, President Obama signed the fiscal year 2009 omnibus spending package (H.R. 1105) into law. The federal fiscal year had begun on October 1st, but Congress and the President were not able to agree on annual spending bills until almost half way through the fiscal year.
The $410 billion omnibus proposal includes the nine FY 2009 appropriations bills that were not finished by the 110th Congress. The omnibus provides $151.8 billion for programs in the Labor-HHS-Education bill, a $6.7 billion (4.6%) over the FY 2008 comparable funding level. This includes:
- $30.3 billion for NIH, a $938 million (3.2%) increase
- $222 million for Title VII health professions programs, a $48 million (14.3%) increase;
- $372 million for the Agency for Healthcare Research and Quality, a $37.5 million (11.2%) increase; and
- $135 million for the National Health Service Corps, an $11.5 million (9.3%) increase.
Biomedical Research Big Winner in Stimulus Package
Thanks to Senator Arlen Specter (R-PA) and a strong grass roots effort by patient advocates, scientists, research universities, and academic medical centers, the American Recovery and Reinvestment Act includes $10 billion for the National Institutes of Health (NIH). Columbia University Medical Center faculty, staff, and students were a big part of this effort, accounting for almost half of all the emails that came in through the Association of American Medical Colleges advocacy tool website.
The bill provides $10 billion for NIH. Of this amount, $8.2 billion is appropriated to the Office of the Director, with $7.4 billion designated for transfer to the Institutes, Centers, and Common Fund. The conference agreement adopts the Senate guidance that, to the extent possible, the $800 million retained in the Office of the Director "shall be used for purposes that can be completed within two years, with priority placed on short-term grants that focus on specific scientific challenges, new research that expands the scope of ongoing projects, and research on public and international health priorities." The conferees also included legislative language that excludes the NIH funds in the recovery package from the set-aside requirements of the Small Business Innovation Research and Small Business Technology Transfer programs.
The conference agreement also provides $1.3 billion for the National Center for Research Resources (NCRR), with $1 billion for "competitive awards for the construction and renovation of extramural research facilities" and $300 million for "shared instrumentation and other capital equipment." The conference agreement includes a House proposal to waive non-Federal match requirements for extramural facilities and a statement that the conferees "expect NCRR will give priority to those applications that are expected to generate demonstrable energy-saving or beneficial environmental effects." In addition, the conference agreement also provides $500 million for the Buildings and Facilities account to be used for construction and renovation of NIH intramural buildings.
Finally, the bill also includes $1.1 billion for Agency for Health Quality Research to fund comparative effectiveness research. Of this amount, $400 is to be transferred to the NIH. This is above and beyond the $10 billion.
House Panel Unveils Recovery Package
On January 15th the House Appropriations Committee released its version of an economic recovery package that appropriators describe as designed to create and preserve jobs, invest in infrastructure, energy efficiency, and science, and provide state and local fiscal relief.
The "American Recovery and Reinvestment Act of 2009" (ARRA) adopts many of the funding recommendations outlined by the Association of American Medical Colleges in an October 29th letter to Congressional leadership. The full House may consider the bill the week of January 28th, with a goal of completing the bill by February 13th.
A press release from the House Ways and Means Committee suggests that Medicare and Medicaid provisions will be included in separate legislation. A summary prepared by the Appropriations Committee references an extension of moratoria on unspecified Medicare and Medicaid regulations and "Medicaid aid to states."
The ARRA provides $1.5 billion to the National Institutes of Health (NIH) Office of the Director for research grants. Half of this funding ($750 million) becomes available Oct. 1. The funds provided in FY 2010 will provide the second year of support for the new research grants supported with the FY 2009 funding. The bill specifies that funds are to be transferred to the NIH institutes and centers and the common fund "in proportion to the appropriations otherwise made to such Institutes, Centers, and Common Fund for fiscal year 2009."
The bill also provides $1.5 billion to the NIH's National Center for Research Resources (NCRR) to renovate or repair existing non-Federal research facilities or for "shared instrumentation and other capital research equipment." NCRR is to give priority to applications "that are expected to generate demonstrable energy-saving or beneficial environmental effects." An additional $500 million is provided to update buildings on the NIH campus.
In addition to the funding provided directly to NIH, the bill also provides $700 million to the Agency for Healthcare Research and Quality (AHRQ) for comparative effectiveness research. The bill directs AHRQ to transfer $400 million of this funding to the NIH Office of the Director to be distributed among the NIH institutes and centers and the common fund for comparative effectiveness research. The bill also provides an additional $400 million for comparative effectiveness research, to be allocated at the discretion of the Secretary of Health and Human Services. In total, the bill provides $1.1 billion for comparative effectiveness research.
The bill also provides $430 million to the Public Health and Social Services Emergency Fund for the Biomedical Advanced Research and Development Authority (BARDA) and an additional $420 million for pandemic influenza preparedness and response activities.
The ARRA provides $600 million (half of which becomes available Oct. 1, 2009) to the Health Resources and Services Administration (HRSA) for "primary care training." Though the bill does not specify specific funding levels, it directs HRSA to provide the funding for "the training of nurses and primary care physicians and dentists" through Title VII and VIII health professions programs, the National Health Service Corps, and the patient navigator program authorized under Title III of the Public Health Service Act.
The National Science Foundation (NSF) also receives a boost in the package. The bill provides $3 billion for NSF, including $2.5 billion for research and related activities. The bill also directs $2 billion to the Department of Energy's Office of Science and the Centers for Disease Control and Prevention (CDC) receives $462 million for "equipment, construction, and renovation of facilities."
AAMC Urges NIH Funding in Stimulus
Columbia University Medical Center joined with the AAMC and nearly 200 patient groups, scientific societies, research organizations and companies to send a letter to President-Elect Barack Obama endorsing a recommendation to include at least $1.2 billion funding for the National Institutes of Health (NIH) in any immediate economic-stimulus effort, and to include this funding in the base for subsequent budget years.
The letter states, "Research contributes to the economic strength of the nation by creating skilled jobs in communities nationwide, new products, and improved technologies." The letter also notes, "The recent history of the NIH budget has hindered scientific discovery and is limiting the capacity of a key engine for today's innovation-based economy."
The groups also called on the President-elect to appoint a permanent NIH director "who understands the complexity and breadth of NIH's mission and who can help deploy scientific research investments wisely for maximum economic and health benefit."
Appropriations Archives
