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Health Appropriations: Billion-Dollar Increases for NIH, But Conflict Elsewhere

Over the past two weeks, in their respective FY 2016 Labor, Health and Human Services, and Related Agencies appropriations bills (known as Labor-H), House and Senate appropriators have shown support for biomedical research funding by recommending NIH budget levels higher than even the Administration had requested. But controversy still reigns over other parts of the bill, particularly patient-centered outcomes research associated with the Affordable Care Act.

The Senate bill (S. 1695) was passed Thursday the 25th by a narrow 16-14 vote, while the House bill (comittee summary) was approved the day before on a 30-21 vote. Here's a quick look at research-related funding in both bills.

National Institutes of Health (funding table)

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NIH funding is, of course, the science gorilla in the room. The Administration had requested a $1 billion or 3.3 percent increase from FY 2015 levels (excluding supplemental Ebola-related funding), and appropriators in both chambers topped this request: the House by $100 million for a 3.6 percent increase above FY 2015, and the Senate by a full $1 billion. The latter figure would amount to a 6.6 percent increase for NIH, which would mean the largest single-year increase, if approved, since the end of the agency's budget doubling over a decade ago. Such a sum would fully return NIH to pre-sequester spending levels (see chart at right).

Administration priorities in the request for NIH included investments in Alzheimer's research, new initiatives in precision medicine and antibiotic-resistant bacteria, big data, and the BRAIN Initiative. All of these priorities are mostly reflected in both bills, though there was some variation. In the House bill, for instance, while overall NIH program funding would top the request and every institute would see at least a nominal increase, several individual institutes would come up slightly short of the request, and in fact many would not keep pace with inflation. Of the House's $1.1 billion increase, nearly a third is concentrated on the National Institute on Aging (NIA) for additional Alzheimer's funding, and another $139 million is allocated to the Office of the Director, mostly for an increase in Common Fund activities. Both sums far exceed the request for each. The Senate committee adopted a similar stance on NIA and the Director's Office, though every institute would receive at least a 2.1 percent increase above the request in that bill. 

The House committee has also granted an additional $25 million above the request for the BRAIN Initiative, while the Senate would match the request at $135 million total funding. The House did not provide quite the emphasis on the National Center for Advancing Translational Science (NCATS) sought by the Administration, while Senate appropriators granted a 10.1 percent increase for NCATS, one of the largest increases in their bill.

Both committees also continue to ensure NIH is a net recipient of Public Health Service evaluation funding transfers, rather than a net payer. These transfers, established in the early 1970s, "tap" certain health agencies for funding to evaluate public health programs.

Other Issues and Agencies

As as been reported elsewhere, the big source of controversy in the bills remain cuts to other healthcare programs, including a House recommendation to de-fund the Agency for Healthcare Research and Quality (AHRQ). AHRQ plays a big role in advancing evidence-based healthcare research to identify best practices for quality, cost, and safety, an area that has become a target for Republicans given the association with the Affordable Care Act, which has a major hand in funding these activities. See this coverage from Modern Healthcare for a good rundown of the debate as it stands. During the House markup, Labor-H Subcommittee Ranking Member Rosa DeLauro (D-CT) and Rep. Lucille Roybal-Allard (D-CA) each offered amendments that would have restored this funding, but both were rejected.

The House committee also matched the Administration's request for the Centers for Disease Control and Prevention (CDC), but flat-funded the Biomedical Advanced Research and Development Authority (BARDA), which is tasked with preparing for and responding to public health emergencies, and played a part in last year's Ebola response. The Administration had asked for an additional $107 million for BARDA and $391 million for the associated Project BioShield, but received neither, and DeLauro offered an unsuccessful amendment to provide this funding. On the other hand, the Senate committee trimmed CDC funding while providing a bit extra for BARDA.

Also unsuccessful on the House side was an amendment from Nita Lowey (D-NY) that would have allowed CDC to pursue research related to gun violence.

The House appropriations bill will likely be considered next week on the House floor, while the Senate bill is stuck in limbo for the time being, given the Democratic block on all spending bills over disagreements on sequestration-level spending. The Administration has expressed its concern, and will likely threaten to veto both bills in their current form.

Cover photo credit: NIAID Flickr