The harsh realities of increasing the NIH budget

Ben Corb explores proposed budgetary increases to the National Institute of Health and if they have any chance of becoming reality.

So while we support and truly appreciate the spirit of these spending bills as it relates to seeing the value and putting a priority on investments in biomedical research, we should underscore to policy makers that budgetary policy need not be a zero-sum game. The spending caps established by Congress are a self-inflicted wound. If Congress would spend time repealing these austerity measures, the desperately needed increases to the NIH and other science budgets could be made a reality.

The past couple of weeks have been the sort we don’t often get advocating for the National Institutes of Health. The U.S. House and Senate introduced their respective Labor, Health and Human Services appropriations bills, they marked up those bills and they passed those bills through the full committees. Senate Appropriations Chair Thad Cochran, R-Mississippi, and House Chair Hal Rodgers, R-Kentucky, deserve credit for setting an aggressive timeline and completing these bills.

Why are we applauding Congress authoring and moving bills through committee when that is their job? Well, over the past several years, the LHHS appropriations bills haven’t even been released much less voted through subcommittee. That’s because other programs funded in these bills, like the Affordable Care Act, Planned Parenthood, food stamps and others, are so politically charged they often prevent a bill from being debated.

This year the NIH received significant support. The House Appropriations committee proposed to fund the NIH at $31.1 billion, a $1.1 billion increase over fiscal 2015, and 10 percent higher than President Obama’s request. The Senate Appropriations committee nearly doubled the House increase with a proposed funding level of $32 billion for the NIH in FY16. That’s the funding level for which advocates have largely been asking for two years! Queue up the Steve Miller Band because my friends, it’s time to “Take the Money and Run!”

Now for the splash of cold water. These funding bills aren’t going anywhere. We live in a period of budget austerity and spending caps. These caps mean that increases to one program mean budget cuts to others. So for all of the agencies like the NIH that would receive budget increases, several would also be cut. As expected, many of the programs that would be cut are these politically charged programs.

First, Obama will not sign into law any bill that disassembles parts or all of the signature policy initiative of his presidency. For example, the House LHHS bill defunds the Agency for Healthcare Research and Quality. AHRQ is an independent agency that researches various disease treatments and identifies which are most effective from a health and economic perspective. AHRQ’s work helps identify appropriate treatment plans for patients with a variety of health problems, and is a critical component to the ACA.

Beyond this, the House and Senate appropriations committees propose funding levels for the entire LHHS bill that are billions below FY15 levels. These cuts are not just to ACA programs, but to a variety of public health programs across the board. Calling the caps unnecessary and impossible to appropriately fund federal spending, Obama has threatened to veto every spending bill that does not fund above the level of the spending cap.

In support of Obama, Senate Democrats plan to filibuster every appropriations bill that comes to the floor of the Senate. Democrats want to find a deal which lifts the spending caps, if not eliminate them altogether, and their plan is to obstruct all spending bills to force Republicans to negotiate. Failure to negotiate will lead to a government shutdown that Democrats feel will hurt Republicans entering a Presidential election year.

In better days without a political lightning rod like the ACA or without austerity measures like the spending caps, the story might end there. NIH gets a budget increase, scientists see pay lines improve, Americans live healthier lives thanks to biomedical research. But these aren’t the days we live in. The politics surrounding programs outside of the NIH mean that these bills are unlikely to be signed into law

Nevertheless, the intentions behind the NIH increases are genuine. Biomedical research has broad, bipartisan support in Congress. It isn’t an accident that appropriators in both chambers of Congress found the NIH a fitting program to see sizeable increases and end more than a decade of stagnation. The lawmakers behind these proposed increases, Democrats and Republicans alike, should be roundly applauded for their efforts. In many parts of the political sphere, proposals to increase federal investments in anything are looked down upon, but today it seems Congress is willing to make this one important investment. We can all benefit from this change of attitude.

And it’s not just appropriators. Rep. Fred Upton, R-Michigan, and Rep. Dianna DeGette, D-Colorado, have spent the better part of 18 months talking about, meeting on and writing the 21st Century Cures Act. This is a piece of legislation that opens pathways for biomedical innovation and supports investments in research to benefit patients in need. Their bill may not be perfect, but it’s an example of bipartisan statesmanship that favors the NIH.

The intensity of support for the NIH is palpable, and it hasn’t gone unnoticed by advocates on the Hill. We thank policy makers for moving us to the point where we can have discussions not about whether they should increase the NIH’s budget, but rather how to best increase the NIH’s budget. It’s a welcome change.

So while we support and truly appreciate the spirit of these spending bills as it relates to seeing the value and putting a priority on investments in biomedical research, we should underscore to policy makers that budgetary policy need not be a zero-sum game. The spending caps established by Congress are a self-inflicted wound. If Congress would spend time repealing these austerity measures, the desperately needed increases to the NIH and other science budgets could be made a reality.

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  1. Pingback: Floor debate begins on HR 6 – 21st Century Cures | ASBMB Policy Blotter

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