How the Budget Deal Took Medical Research off the Chopping Block

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By Jeannie Baumann

Universities and biomedical researchers narrowly escaped a White House cull in federal funding, saved by the recent budget deal that kept the NIH afloat at current levels.

The White House sent Feb. 12 to Congress its request for funding the federal government in fiscal year 2019, offering $34.8 billion for the National Institutes of Health, which is part of $95.4 billion in discretionary budget authority for Department of Health and Human Services, according to the HHS budget in brief.

That proposed NIH amount is roughly equal to the $34.1 billion provided under current spending and doesn’t include an additional $750 million for the agency’s role in combating the opioid epidemic. But that number comes after the budget deal Congress reached Feb. 7 to raise the cap on federal spending by more than $150 billion over two years for domestic spending, according to a copy of the agreement obtained by Bloomberg Tax.

The original budget proposal shows President Donald Trump’s administration wanted to gut nearly a third of the nation’s spending on medical research to bring the NIH’s budget down to $24.2 billion. That funding hasn’t been seen in more than 15 years, and it would be unprecedented, as medical research funding remains popular on Capitol Hill. Lawmakers just gave the NIH two consecutive $2 billion increases in the last two appropriations.

“Congress has made it really clear that NIH is a bipartisan, national priority,” Tannaz Rasouli, senior director, public policy and strategic outreach, for the Association of American Medical Colleges, told Bloomberg Law in a Feb. 12 interview.

Congress to Protect NIH

Lawmakers have proposed another increase for the NIH ranging from $1.1 billion to $2 billion in FY 2018, potentially resulting in three consecutive years of NIH increases. Congress has until March 23 to hammer out those details, when the latest spending authorization expires. “That’s really the pattern that we need to be sustaining,” she said, “is ensuring that we are investing above inflation in the base NIH budget across the wide spectrum of research that NIH supports.”

The budget deal provided another $9.2 billion for FY2019 as an addendum to the original $24 billion the White House originally requested, to bring the NIH’s budget back up to current levels. Trump’s team then decided to centralize that $9.2 billion into NIH Director Francis S. Collins’s spending pool, so his office could dole out the money to the 27 institutes and centers. That brought the NIH’s budget up to about $33.4 billion. The $34.8 billion cited by the HHS stems from another another $711 million provided through the biomedical innovation law 21st Century Cures ( Pub. L. 114-255) as well as $180 million in mandatory funding such as a special diabetes fund.

The addendum also provides $10 billion to fight the opioid crisis and address serious mental illness—about $750 million would go to the NIH. When accounting for these resources, the total for the NIH is $35.5 billion, or $1.4 billion above the FY 2018 continuing resolution, an NIH spokeswoman told Bloomberg Law.But despite a requested increase, the HHS budget in brief indicates the proposal still amounts to a cut for the agency, and 21 of the 27 institutes. Trump’s request includes a $72 million cut to cancer research and a $111 million cut in infectious diseases.

Reorganization Proposed

The Trump administration also proposed moving three agencies into the NIH, including the Agency for Healthcare Research and Quality, an occupational safety center under the Centers for Disease Control and Prevention, and the the National Institute on Disability, Independent Living, and Rehabilitation, within the Administration for Community Living.

“Initially, these activities would be established as separate Institutes, but NIH will assess the feasibility of integrating these research activities more fully into existing NIH Institutes and Centers over time,” the budget request said. A 2007 law that holds the number of NIH institutes and centers to 27 means three institutes or centers likely would have to be eliminated or consolidated to make room for these centers.

The White House proposed moving the AHRQ into the NIH last year when it proposed a nearly $6 billion cut to the NIH in March. Congress ultimately rejected both the cut and the reorganization.

Mary Woolley, president of Research!America, said folding the AHRQ into the NIH would be a strategic mistake. “Research supported by AHRQ has reduced medical errors, improved quality of care and produced robust data for health care professionals,” she said in a Feb. 12 statement. “Fortunately, this budget is not the last word on FY19 spending bills. Congressional leaders have stated their commitment to strengthening investments in research and innovation.”

The president’s funding proposal comes exactly four months after HHS Deputy Secretary Eric D. Hargan, who was acting secretary at the time, called the HHS’s role in advancing medical research a “cherished, important part of the mission of the department.”

“Advancing great American medicine and science is a top, top priority for this administration,” Hargan said.

To contact the reporter on this story: Jeannie Baumann in Washington at jbaumann@bloomberglaw.com

To contact the editor responsible for this story: Randy Kubetin at rkubetin@bloomberglaw.com

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