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| National Institutes of Health in the FY 2000 Budget
Kei Koizumi, AAAS |
HIGHLIGHTS
INTRODUCTION AND POLITICAL ENVIRONMENT The National Institutes of Health (NIH) is the second-largest supporter of R&D in the federal government, after the Department of Defense. In its mission to promote biomedical research and other fundamental inquiries that may lead to medical advances, it is by far the largest federal supporter of basic research, applied research, and R&D at colleges and universities, and has a disproportionate impact on support for biological sciences and related fields. The FY 2000 budget request of $15.9 billion for NIH would be a 2.1 percent increase (see Table II-9). NIH classifies 96 percent of its budget as R&D. (The remainder is for overhead and research training.) Its FY 2000 R&D would total $15.3 billion, also a 2.1 percent increase. The proposed increase would follow an increase of nearly 15 percent in FY 1999. Last year, as in past years, Congress added to the President's request, which had called for an 8 percent increase as the first installment of a plan to boost the NIH budget by 50 percent by FY 2003. The requested increase, though smaller than last year's increase, would keep NIH on last year's planned trajectory toward a $20 billion NIH budget in FY 2003. This year's budget projections for FY 2001 through FY 2004, however, depart significantly from last year's projections. The FY 2000 budget projects NIH's budget will stay flat at $15.9 billion from FY 2000 to FY 2004, and allocates increases to other areas of discretionary spending instead, notably defense (see Chapter 7) and education. Although there is a footnote in the budget that indicates that an unallocated discretionary reserve may eventually become available for NIH and other high-priority areas, this reserve totals only $30 billion over four years, and NIH is only one of the high priorities that could benefit from it (the others are national defense and education). Last year, the long-term funding profile of NIH (and many other nondefense R&D agencies) showed projected increases because of receipts from proposed tobacco legislation. Congress killed tobacco legislation last June, and chose to fund the FY 1999 increase without tobacco revenues. This year, the FY 2000 budget still relies on tobacco revenues as well as a portion of projected future budget surpluses to fund discretionary programs, but only education and defense programs would receive significant increases. In response to the President's request, Congress is likely to up the ante once again in response to popular support for the federal investment in health research. Well before the release of the President's budget, key lawmakers had already promised to try to find the resources to provide a 15 percent increase for NIH in FY 2000. Representative John Porter (R-IL), chairman of the House Appropriations subcommittee in charge of NIH appropriations, has publicly endorsed doubling the NIH budget in five years and has stated that last year's increase was only the first step. As Congress prepares to take up FY 2000 appropriations, there is support for at least attempting to accommodate a 15 percent increase to NIH within a constrained total discretionary budget. A 15 percent increase would bring the NIH budget to $18 billion. As lawmakers compete to outdo each other in awarding large increases to NIH, many scientific and engineering societies also endorse the concept of doubling the NIH budget over five years. The Federation of American Societies for Experimental Biology (FASEB), which issues an annual report of funding recommendations for the coming fiscal year, called for a 15 percent increase in NIH in FY 1999. As in the past few appropriations cycles, the FASEB recommendation closely foreshadowed the eventual FY 1999 NIH appropriation. For FY 2000, FASEB has called for another 15 percent increase. FUNDING REQUEST AND PRIORITIES NIH's highest priority among its funding mechanisms in FY 2000 would be Research Project Grants (RPGs), which are investigator initiated, peer reviewed, and competitively awarded. (NIH funding by institute is found in Table II-9; its budget by funding mechanism is found in Table II-10.) RPGs, which make up the majority of NIH funding, would increase by 2.6 percent in FY 2000 to reach $8.8 billion. These funds would support nearly 30,000 RPGs, a record number, of which 4,866 would be new competing grants (total $1.3 billion). RPG success rates, however, are expected to decline to 27 percent in FY 2000, after three years above 30 percent. The FY 2000 budget proposes $512 million for research training grants, slightly above the FY 1999 level. With the request, NIH expects to be able to support nearly 15,700 full-time research trainees and give them stipends at the FY 1999 level, after a large increase between FY 1998 and FY 1999. NIH distributes 82 percent of its budget to extramural performers; 10 percent to intramural research, mostly at NIH's Bethesda, Maryland, campus; and the remaining 8 percent to management, administration costs, and intramural facilities. The majority of NIH's extramural support goes to colleges and universities. NIH is by far the largest federal supporter of R&D at universities and colleges. In the FY 2000 budget, NIH would account for approximately 60 percent of total federal R&D to colleges and universities. The federal government sponsors 60 percent of all R&D performed at colleges and universities, more than all other sources (state and local governments, institutional funds, industry) combined. NIH is expected to fund one-third of all academic R&D in FY 1999 and to continue to be the majority source for many universities with medical schools. NIH funds R&D in industry primarily through the Small Business Innovative Research (SBIR) activity, which was created by Congress through a percentage set-aside in each of the major research supporting agencies. A few years ago, due to the interest in technology transfer, Congress created the Small Business Technology Transfer Pilot Program (STTR), which operates at a much smaller level and is generally joined with SBIR in calculating dollars. The programs are formula driven, i.e., a percentage of NIH's total funds, so they have grown in proportion to the NIH budget. Under the formula, NIH's support of SBIR/STTR awards would total $317 million in FY 2000, a 2.1 percent increase. These research awards are made solely to profit-making small businesses. They, in turn, frequently bring in university scientists and engineers to help develop their ideas. NIH has announced four research themes in its FY 2000 budget, representing its judgment on where the best scientific opportunities are: the exploitation of genomic discoveries, interdisciplinary research, the reinvigoration of clinical research, and the elimination of health disparities. In genomics, NIH plans to accelerate the Human Genome Project by increasing capacity at major sequencing centers. Due to a number of methodological advances over the past year, the Project is expected to be complete in 2003, two years earlier than originally planned. The National Human Genome Research Institute (NHGRI), the lead NIH participant in the Project, would receive $272 million in FY 2000 (up 4.1 percent). The other major federal participant is the Department of Energy through its Biological and Environmental Research program. NIH'S INSTITUTES AND CENTERS NIH institutes' budgets are somewhat complicated by the perennial controversy over how to fund AIDS research. As in the past several years, the President's budget would fund all NIH AIDS research through the Office of AIDS Research (OAR), located in the Office of the Director. OAR would then distribute AIDS research funds among the institutes based on its comprehensive research plan. In the past four years, however, Congress has opposed this proposed consolidation and given AIDS funds directly to the institutes. (Table II-9 shows FY 1998 and 1999 AIDS funds, dispersed to the institutes, consolidated under the OAR line for comparability with the FY 2000 request.) The $1.8 billion proposal for OAR would represent a 1.9 percent increase. The National Institute for Allergy and Infectious Diseases (NIAID; $826 million), the National Cancer Institute (NCI; $240 million), and the National Institute on Drug Abuse (NIDA; $194 million) would receive the majority of these funds. It is likely that Congress will reject the proposal and once again limit OAR to a coordinating, rather than a funding, role. The FY 2000 budget contains a $50 million request for the National Center for Complementary and Alternative Medicine (NACCM), the newest of NIH's institutes and centers. NACCM was established as part of the FY 1999 NIH appropriation, and its efforts in FY 2000 will focus on evaluating the efficacy of complementary and alternative medicine products, supporting clinical studies on the interactive effects of these products with standard medications, and evaluating alternative techniques such as acupuncture. In the Buildings and Facilities appropriation, FY 2000 would provide the last installment of funds for the construction of NIH's Clinical Research Center, now scheduled for completion in 2002. OTHER HEALTH RESEARCH IN THE FEDERAL BUDGET Although NIH is the dominant funding source for health-related research in the federal budget, other agencies in the Department of Health and Human Services (HHS) also fund health-related research and would see funding increases under the President's request (see Table II-8). The Agency for Health Care Policy and Research (AHCPR) would see an apparent decline in its budget to $27 million in FY 2000, down from $100 million, but these funds cover only appropriated funds. Including funds transferred from other HHS agencies, AHCPR's research program in FY 2000 is expected to total $206 million, up from $171 million. AHCPR's programs evaluate the quality and delivery of health care services, finance research on health care outcomes, explore ethnic and racial disparities in health care, and evaluate changes in the health care market. The Centers for Disease Control and Prevention (CDC) received emergency funds in FY 1999 for research and other programs related to bioterrorism. The FY 2000 R&D budget of $478 million (up $40 million or 9.1 percent) would expand CDC's bioterrorism research, and would continue to fund research on occupational safety and health, infectious diseases, and food safety. The Health Care Financing Administration (HCFA) requests $55 million (up $5 million) for its R&D program, which supports research and demonstration projects to develop new health care financing policies and to evaluate the impact of HCFA programs on beneficiaries and other affected groups. HCFA's major programs are Medicare and Medicaid. Included in the FY 2000 program is research on the future of Medicare, research on new ways of providing Medicare coverage, and development of new methods for delivering fee-for-service medicine. Outside HHS, the Department of Veterans Affairs (VA) performs clinical, epidemiological, and behavioral research at its hospitals. Its R&D budget would decline slightly from $674 million to $663 million (down 1.6 percent) in FY 2000, and would focus on research on aging, chronic diseases, Gulf War illness, and other topics that affect veterans' medical care and health. | |
