Wednesday, September 25th, 2019: The House Committee on Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies hosted a hearing on Wednesday, September 25 regarding “Investments in Medical Research at Five Institutes and Centers of the National Institutes of Health” (NIH). Along with NIH Director, Dr. Francis Collins and four other institute and center directors, Dr. Bruce Tromberg, the Director of the National Institute of Biomedical Imaging and Bioengineering (NIBIB), provided testimony and updates. As was noted at the hearing, it has been a long time since the committee has heard from many of the 27 institute and center directors as had been done in the past, making this opportunity even more important for those who now rarely get to present.
During Dr. Tromberg’s opening testimony, he showcased his passion and vision for the work being done at NIBIB, saying, “We ( NIBIB ) support cutting edge technology that can be applied to a broad range of biomedical healthcare problems, by building strong partnerships with industry, academia, federal agencies, and every NIH Institute and Center our programs lead to better, faster, and less costly ways to advance technology.” Dr. Tromberg captured the attention of House Committee on Appropriations LHHS Subcommittee Chairwoman, Rosa DeLauro (D-CT) and all Members of the Committee when he described the capabilities of several point of care technologies he had brought with him. He further highlighted a range of ongoing innovative technology and research at the NIBIB including; a rapid point-of-contact technology that can detect food allergens in under 10 minutes at your table, a new, and much less painful breast imaging technology that utilizes 3D imaging to help to detect and diagnose tumors, and finally a new minimally invasive method of brain surgery utilizing ultrasound that will not require the use of a scalpel.
The Academy is grateful to Chairwoman DeLauro for providing NIBIB and the other ICs the opportunity to engage in this hearing and for her constant devotion in ensuring the NIH is provided sustained funding.
Institutes and Centers at hearing: NIH Office of the Director, NIBIB, National Institute on Minority and Health Disparities (NIMHD), National Center for Complementary and Integrative Health (NCCIH), National Library of Medicine (NLM), and National Center for Advancing Transnational Sciences (NCATS).
To watch entire hearing, visit C-Span at https://www.c-span.org/video/?464689-1/house-appropriations-hearing-nih-research
Thursday, September 19th, 2019: The Senate Appropriations Committee released its FY 2020 Labor-HHS funding bill yesterday morning. Upon review this bill includes a program level of $42.084 billion for the National Institutes of Health (NIH), a $3 billion dollar increase from FY 2019 program level. This tremendous investment towards the future of NIH will work to accelerate the promise of better health for patients while ensuring stability for our nation’s research scope.
The Academy is so grateful to Subcommittee Chair Roy Blunt (R-MO) and Ranking Member Patty Murray (D-WA), and their colleagues in the House, for the continued support they have shown for NIH and its life-saving research Institutes and Centers. In addition to this increased funding for NIH, the Senate bill is providing $411,496,000 to the National Institute of Biomedical Imaging and Bioengineering ( NIBIB ) an increase of $22,045,000 over FY19, as their research impacts the lives of all Americans.
Stayed tuned as it is unclear how the Senate will proceed, with possible action being taken today. Committee Chairman Richard Shelby (R-AL) stating that the Senate plans to “Vote on whether to consider the first package of FY 2020 spending bills passed by the House of Representatives.” The Academy will continue to update you as the information becomes available.
Monday, August 5, 2019 – Friday afternoon President Trump signed the Bipartisan Budget Act (BBA) (H.R. 3877). The BBA is an important two-year $2.7 trillion budget deal that permanently ends the threat of sequestration and suspends the debt ceiling until July 31, 2021. The Academy, along with the Washington advocacy community, has been asking for this deal to be reached for months. The BBA provides for an increase in funding for both defense and non-defense discretionary programs, which is very important for domestic programs including the NIH. With the BBA in place, we are urging Congress to quickly work to enact the FY2020 appropriations bills when they return from recess to fund the Federal Government by the September 30th fiscal year-end.
Thursday, August 1, 2019 – The Senate passed the Bipartisan Budget Act (H.R. 3877) (see additional details in July 26 update) by a vote of 67-28. The legislation now goes to President Trump for his consideration and signature.
Friday, July 26, 2019 – Yesterday afternoon the House passed the Bipartisan Budget Act (BBA) (H.R. 3877), the massive $2.7 trillion two year budget deal agreed to by the White House, by a vote of 284 – 149. With this agreement, the debt ceiling is suspended until July 31, 2021, sequestration is ended permanently and Congress is provided the significant resources it needs to provide increases to both defense and non-defense discretionary (NDD) programs. Without this deal a funding freeze would have necessitated cuts in many domestic programs, including important medical imaging advancements at research institutions across the country.
The BBA provides an increase in funding for NDD programs by $56.5 billion above the 2019 levels, over the next two years. This increase in NDD funding will help to create more robust funding opportunities for the National Institutes of Health, and in turn, the National Institute for Biomedical Imaging and Bioengineering.
The BBA will now head to the Senate, where it is expected to pass next week before they leave for August recess. The Academy will continue to post updates as this bill continues to progress in Washington.
Wednesday, June 19, 2019 – The House of Representatives has passed H.R. 2740, a $985 billion, four-bill spending package, by a vote of 226-203, with no Republicans voting for the measure and 7 Democrats voting against. This spending bill includes a $2 billion dollar FY2020 increase for the National Institutes of Health (NIH), which will enable the NIH to continue advancing science, innovation, and economic growth. It was combined with spending bills for Defense, State-Foreign Operations and Energy and Water Development.
The Senate has not advanced any of its FY2020 appropriations bills, with leadership declining to move forward until there is a bipartisan agreement lifting budget caps imposed by the Budget Control Act of 2011. It is important to remember that if President Trump and Congress aren’t able to reach a budget agreement, these statutory caps would result in a cut of ten percent to the NIH’s budget.
The House has begun consideration of the second spending package, H.R. 3055.
Friday, May 10, 2019 – Wednesday, the House Appropriations Committee (HAC) reported out the Labor-HHS spending bill (30-23) after a day-long markup. Labor-HHS is the first bill to move through the full committee this year. There are 11 more to go. It’s the first time in many years that Labor-HHS has moved first, and so early. We are grateful and encouraged by the $2 billion increase for the National Institutes of Health (NIH) to a level of $41.08 billion, and the $19 million increase for the National Institute for Biomedical Imaging and Bioengineering (NIBIB) to a level of $408.5 million.
The bill provides sufficient funding to do across- the-board increases of approximately five percent for all I/Cs, boosting the best peer-reviewed research across all disciplines. The Committee provided this funding to address concerns that Congress had moved too far in the direction of targeted funding for specific initiatives, which has resulted in less funding being available for foundational research that may lead to unforeseeable scientific breakthroughs.
House Democratic Leader Steny Hoyer (D-MD) has reserved June for floor action on appropriations bills. Rumor has it the plan is to once again pair Labor-HHS with the Defense spending bill since the minibus pairing strategy was so successful last year as Defense is considered a “must pass” bill. The Senate LHHS Appropriations Subcommittee plans to markup its version of the legislation on June 4.
Sustaining these investments will require action to raise the discretionary spending caps under the Budget Control Act. A failure to do so will result in a damaging reduction in medical research rather than the robust increase provided in this bill. The Academy will continue to work with lawmakers in both chambers toward quick enactment of a bipartisan bill that provides a robust increase for NIH in FY 2020.
May, 2019 – The Academy has submitted written testimony from Academy Vice President, Mitchell D. Schnall, MD, PhD, Chair of Radiology at the University of Pennsylvania. It is our hope that Dr. Schnall be selected to testify in front of Congress this coming spring of 2019. Throughout his written testimony Dr. Schnall echoes the Academy’s ask for no less than $41.6 billion in funding for the National Institutes of Health (NIH) and an additional increase of $25 million for the National Institute for Biomedical Imaging and Bioengineering (NIBIB) in FY20. Dr. Schnall’s full written testimony can be found here.
- Roy Blunt (R-MO), Chairman
- Richard Shelby (R-AL)
- Lamar Alexander (R-TN)
- Lindsey Graham (R-SC)
- Jerry Moran (R-KS)
- Shelley Moore Capito (R-WVA)
- John Kennedy (R-LA)
- Cindy Hyde-Smith (R-MS)
- Marco Rubio (R-FL)
- James Lankford (R-OK)
- Patty Murray (D-WA), Ranking Member
- Richard Durbin (D-IL)
- Jack Reed (D-RI)
- Jeanne Shaheen (D-NH)
- Jeff Merkley (D-OR)
- Brian Schatz (D-HI)
- Tammy Baldwin (D-WI)
- Chris Murphy (D-CT)
- Joe Manchin (D-WVA)
House Labor, Health and Human Services, and Education, and Related Agencies Subcommittee on Appropriations
- Rosa DeLauro (D-CT), Chairwoman
- Vice Chair Lucille Roybal-Allard (D-CA)
- Barbara Lee (D-CA)
- Mark Pocan (D-WI)
- Katherine Clark (D-MA)
- Lois Frankel (D-FL)
- Cheri Bustos (D-IL)
- Bonnie Watson Coleman (D-NJ)
- Tom Cole (R-OK), Ranking Member
- Andy Harris (R-MD)
- Jaime Hererra Beutler (R-WA)
- John Moolenaar (R-MI)
- Tom Graves (R-GA)
- The new House Appropriations Committee Chair is Nita Lowey (D-NY) and Ranking Memeber is Kay Granger (R-TX). The Labor-HHS Subcommittee Chair is Rosa DeLauro (D-CT) and Ranking Member is Tom Cole (R-OK).
- The Senate Appropriations Committee Chair is Richard Shelby (R-AL) and Ranking Member is Patrick Leahy (D-VT). The Labor-HHS Subcommittee Chair is Roy Blunt (R-MO) and Ranking Member is Patty Murray (D-WA).
Tuesday September 18th, 2018 – The Senate voted in favor of the compromise agreement on the FY 2019 Labor-HHS and Defense spending bills (H.R. 6157), agreed to late last Friday which includes $2 billion of increased funding for the NIH, reaching a $39.1 billion total (5.4 percent increase). With the Senate vote, attention turns to the House (currently in recess for the week) which is expected to vote next week. Assuming the House votes in favor the bill is sent to the President for his signature.
If all this happens by Sept 30th, it will be the first time since 1996 that the next fiscal year funding for Labor-HHS will be in place at the start of the fiscal year.
In the agreement the NIH total includes the funding for the 21st Century Cures Act and also increases investments in several critical research initiatives as follows, according to the House committee-prepared summary:
The bill provides increases for several critical research initiatives, including:
• $2.34 billion, a $425 million increase, for Alzheimer’s disease research,
• $400 million, a $100 million increase, for the Cancer Moonshot research initiative,
• $429 million, a $29 million increase, for the Brain Research through Application of Innovative Neurotechnologies (BRAIN) initiative,
• $376 million, an $86 million increase, for the All of Us research initiative,
• $140 million, an increase of $40 million, for research to develop a universal influenza vaccine,
• $550 million, an increase of $37 million, for research on Combating Antibiotic-Resistant Bacteria,
• $362 million, an increase of $11 million, for Institutional Development Awards, and
• $12.6 million for the Gabriella Miller “Kids First” pediatric cancer research initiative.
Further, the conference agreement maintains the salary cap at Executive Level II of the federal pay scale and continues a prohibition on changes to NIH support for facilities and administrative expenses, language that was in the House and Senate versions of the original bills. The conferees did not adopt a provision in the House committee-passed bill that effectively would have prohibited fetal tissue research.
The Academy is thanking senators for their important vote today and has turned its attention to the House to encourage members to complete this spending bill with the $2 billion increase for NIH before Sept. 30. The Academy joined with the AdHoc Group for Medical Research as well as other coalitions to ensure the message gets to all offices on the Hill this week and next.
Tuesday September 4, 2018 – House Speaker Paul Ryan and Senate Republican Leader Mitch McConnell have agreed to proceed to conference on the Defense/Labor-HHS appropriations package in the coming weeks. They are first focusing on enacting the other two minibus packages (Energy-Water/MilCon-VA/Legislative Branch minibus and Ag-FDA/T-HUD/Financial Services/Interior-Environment minibus.) Lawmakers will start the effort this week. The goal is to send as many appropriations bills to the president’s desk for his signature before the September 30 fiscal year end—which unfortunately is just 11 working days away.
Any bills not completed by September 30 will need to be included in a continuing resolution (CR) and that at a minimum, the CR will include State-Foreign Ops, Homeland Security, and Commerce-Justice-Science. Currently, the CR is rumored to run into December but it has also been rumored that the president may opt to veto a Homeland Security bill because it lacks funding for one of his core priorities – Trump’s southern border wall – to make border wall funding a more prominent political issue before midterm elections.
Status of Appropriations:
Thursday August 23, 2018 – The Senate voted 85-7 to approve the FY 2019 Labor-HHS Appropriations bill, which includes a $2 billion (5.4 percent) increase in funding over FY 2018 for the NIH. (The dissenting votes were cast by Senators Mike Crapo, Jeff Flake, Mike Lee, Rand Paul, Jim Risch, Bernie Sanders, and Pat Toomey.) Specifically, the Senate passed H.R. 6157, which combines the Senate Appropriations Committee-passed FY 2019 Labor-HHS spending bill (S. 3158) with the text of the Senate committee-passed Defense spending bill (S. 3159). With the passage of the Defense and Labor-HHS measures–the two largest of the 12 spending bills–the Senate has now moved the most appropriations bills across the floor since 2009. It’s also the fastest the chamber has completed action on spending bills since 1994.
Attention now turns to the House; whose own version of the Labor-HHS bill awaits consideration by the full chamber after the House Appropriations Committee approved the bill on July 11. The House passed its Defense bill but hasn’t taken up the Labor-HHS bill (and isn’t expected to when they return, at least not as a standalone). The House can now go to conference with the Senate on the Defense/Labor-HHS minibus because the House has passed its Defense measure, or it could take up the Senate minibus (unlikely). In any event, the path forward hasn’t yet been determined and there is much to be worked out between the two bills.
Wednesday July 11, 2018 – The House Appropriations Committee has approved the $177.1 billion House version of the FY19 bill to fund the departments of Labor, Education, and Health and Human Services.
The House Appropriations committee has now approved 11 out of 12 FY19 spending measures.
Senate Appropriators are looking to combine its Labor HHS bill with the Defense measure, but, the House of Representatives has already passed the National Defense Authorization Act for FY19. If the Senate can pass a combined bill and send it to the House of Representatives, the House may skip a floor vote on Labor HHS FY19 and head straight to conference.
LEGISLATIVE UPDATE: Rescission Package & the Status of Appropriations
The Senate has voted down a key White House priority when it defeated the House amended rescission package, in a procedural 48-50 vote. The vote on the measure, which had already passed in the House, was held open for 90 minutes. The Academy is delighted that the Senate is continuing to support NIH and its increases, by defeating this rescission package.
Status of Appropriations:
June 28, 2018 – The Senate Committee on Appropriations has advanced the Labor, Health and Human Services, Education, and Related Agencies Appropriations Act, 2019, the largest non-defense bill. The committee approved funding measure contains $179.3 billion, an increase of $2.2 billion from FY2018, of base discretionary funding for the Departments of Labor, Health and Human Services, and Education and Related Agencies. This bill also includes $711 million in accordance with the 21st Century Cures Act, $2.3 billion for Alzheimer’s disease research, $429 million for the BRAIN initiative, $560 million for the Clinical and Translational Science Award, $376 million for the All of Us precision medicine initiative, and $120 million for research on a universal flu vaccine. This measure was passed with a vote of 30-1.
The House Appropriations Committee was scheduled to consider its version of the FY 2019 spending bill, but the committee has postponed that markup until a date to be determined; the House committee did, however, post the report to accompany the committee’s spending bill, with language on NIH running from pages 51 through 75 of the report and funding tables on pages 211 through 213.
LEGISLATIVE UPDATE: Rescission Package
The Trump administration has submitted to Congress last Thursday a $15.4 billion rescissions package. The rescission package does not directly impact the FY2018 Omnibus nor does it take any funds from NIH. Nearly half of the cuts, or $7 billion, would come from unspent Children’s Health Insurance Program funds, and almost $5 billion would be cut from dormant Energy Department loan programs, in addition to other programs listed.
It is not clear yet whether there is any potential indirect impact on FY2019 appropriations efforts re subcommittee allocations. This is important to note as Congress understood that these “unallocated or dormant” funds would be available to them in the appropriations process when it set overall funding levels in the 2017 budget deal for FY2018 and FY2019. Congress was already, in essence, including responsible rescissions of CHIP funds and the “changes in mandatory programs savings” (CHIMPS) to make room in the bill for more adequate funding levels for public health and health research. To take them back now is a backdoor way of reneging on the deal and would reduce nondefense discretionary funding BELOW what members of Congress agreed to in the two year budget deal, particularly for the Labor-HHS bill, where NIH receives its funds.
Under the 1974 Impoundment Control Act (ICA) budget law, Congress will have 45 calendar days “of continuous session” (includes weekends and holidays, but not days where Congress recesses for more than 3 days) to consider the rescission package. If the relevant committees have not acted within 25 days, a member of either chamber supporting the rescissions measure may seek to discharge the package from committee with the support of at least one-fifth of the chamber in question. It is expected that the House will pass the package. It is far less certain what will happen in the Senate. The Senate parliamentarian is likely looking into the requirement for a 60-vote threshold.
The following is a summary on the status of funding for NIH broadly and NIBIB specifically. The most recent Consolidated Appropriations Act of 2018 signed into law last Friday, March 23rd paved the way for large budget increases for NIH and NIBIB. This is great news and the Academy and the medical research advocacy community hope to continue that robust budget trajectory into the FY2019 appropriation determinations.
Recall, in February of this year, a two-year budget deal (Bipartisan Budget Act of 2018) was agreed to by Congress that raised the spending caps for both defense and non-defense spending for FY2018 and FY2019 by $296 billion. Thus, while more than a majority goes to defense it did provide non-defense discretionary spending with an additional $60 billion in FY2018 and $18 billion in FY2019. Please note that in FY19 the money available will be just a fraction of the extra money they were able to spread around for FY2018 (from 60B to 18B), and the competition for this will be strong.
When discussing appropriations, there are many complicating factors. One must know if they are talking about budget authority (the amount Congress appropriates) or outlays (the amount the agency actually spends). It does not matter which you use, as long as the numbers are consistent. We generally will use budget authority, because that is the lobbying target. Outlays are influenced by a series of external factors that we often cannot control. The numbers below are stated in budget authority.
The Consolidated Appropriations Act of 2018 provides $37.084 billion for NIH, including the full $496 million from the 21st Century Cures Act Innovation Account and $500 million split evenly between NINDS and NIDA for research related to opioid addiction, development of opioid alternatives, pain management, and addiction treatment (available through Sept. 30, 2019). The total funding level for NIH represents a $3 billion increase over the comparable FY 2017 program level for the agency.
For every patient awaiting a cure, for every researcher working toward the next breakthrough, and for every aspiring scientist considering a career in the lab, this increase marks a day of real hope and opportunity.
This is an important increase in NIH funding – not only in both dollar terms and as a percentage of the base but also for specific targeted programs as mentioned previously – since the completion of the doubling in FY2003. During that time, the value of NIH funding has dropped by more than 20 percent and the success rate for NIH grantees has plunged to unprecedented levels. Note, that when adjusting for inflation, the FY 2018 NIH budget is only still just above where it was in 2003
The increase is a wonderful recognition of NIH when you consider the fact that the Health and Human Services Department, the Education Department and the Labor Department all come from and therefore compete for money within the same congressional subcommittee allocation. For FY2018 the amount was set at $177.1 billion, compared with $161 billion for the prior fiscal year. Out of that $16 billion increase, the $34 billion NIH received a $3 billion boost while the $70.9 billion Education Department got a $4 billion spending hike and the Labor Department received a $192 million increase.
The unexpected increase is not enough yet to reverse the decline, however, it is perhaps indicative of a commitment by members of Congress that have been champions for NIH to continue to fight for its investment and the results of many years of hard fought by the health research community that is paying dividends.
For researchers who have struggled under tight budgets and low success rates, this money creates new opportunities. Since 84 percent of NIH’s funding is spent extramurally (versus 10 percent intramural and six percent on administration), we should strongly encourage researchers to seek funding aggressively utilizing existing Investigator-Initiated Research mechanisms and current Program Announcements. We must encourage our investigators to pursue grants and to reach out to NIH directly to ask questions to determine how to act quickly and to create the strongest possible applications based on the current state of the science.
What does the success for FY18 indicate about the likelihood of success in FY2019? The short answer is “really not sure in the current political environment”
Every appropriation year is an entity unto itself. As of today, despite the budget agreement and the release of the President’s proposed budget for FY2019, we do not know what Congress will decide for FY2019 as many events occur prior to final decision-making, not the least of which is the 2018 election.
We believe our congressional champions will continue to support NIH and we will work to avoid any feeling that NIH “got more” this year and they need to put money in other health or non-health agencies. (After the doubling of the NIH budget in 2003 this was the feeling of many in Congress and was responsible for more than a decade of flat budgets.)
The two-year budget agreement provides the advantage of taking the numbers game off the table with bottom line number for government spending for FY2019 moves the committee discussion to where it needs to be – on the funding levels for the different agencies. We remain focused on the LHHS bill funding level which will only increase by $18 billion next year.
We haven’t solved the NIH funding issue by getting this increase in this year as the goal in research funding must be to obtain steady, predictable and robust funding increases every year. We cannot have the NIH flat-funded going forward as we have seen what devastating effects that has on research and those choosing careers in science. We all agree that research funding is not a faucet that should be turned on and turned off at will.
The Academy, along with the rest of the health research community, would be well-served by maintaining and even intensifying the focus on research funding in 2019. To do less risks losing the gains already obtained. Advocacy is a team sport, without efforts from each of you we may not be where we are today with this positive momentum Congress has created!
February 8, 2018
A two-year deal to lift strict discretionary budget caps on defense and domestic spending was agreed to by Congressional leaders putting an end to the series of short-term congressional resolutions (CR) to keep the government funded. The deal increases defense and domestic spending by about $300 billion over two years (FY18 and FY19) as well lift the debt ceiling and disaster aid. While the bill is not perfect it was a hard negotiation between Democratic and Republican leaders that found common ground around what the American people need.
Under the agreement, in FY18 defense spending will increase by $80 billion and nondefense (domestic) by $63 billion beyond the budget caps. For FY 19 the increases are $85 and $68 respectively. The deal also included $140 billion for defense and $20 billion for emergency spending over two years. The agreement also includes a commitment to provide “$2 billion for important research at NIH (above the CURES Act increases)” and also specifies that the figures cited are “over two years”. The documents do not provide additional details about whether the deal would reserve a minimum of $1 billion for increases to NIH in FY 2018 and another $1 billion for increases in FY 2019, or distribute the NIH funding another way.
President Trump has signaled he supports the bill. However, House Minority Leader Nancy Pelosi does not support the agreement without a commitment from House Speaker Ryan to vote on an immigration bill to protect DACA immigrants, though the Speaker has already said he will only take up an immigration bill that Trump supports. It is expected that the House Freedom Caucus of hardline GOP conservatives will oppose the budget deal-making Speaker Ryan need Democratic votes to pass the bill in the House.
What happens next is the Senate amends the House CR bill to include the deal that was reached and votes it out, sending the bill back to the House for approval prior to tomorrow’s Feb 8th deadline. This will keep the government funded until March 23 by which time Congress will have written a new spending bill that outlines the levels set by the budget deal. This deal also potentially avoids a budget showdown in an election year.