In February, President Obama transmitted his eighth and final budget proposal to Congress. For those of us who care about discretionary funding – or the appropriations process - the President’s budget adhered to the discretionary spending caps established by the Bipartisan Budget Act of 2015, which provide relatively level funding for the upcoming fiscal year. This means that if any agency or program receives increased funding above its current levels, there would have be offsetting cuts to other programs. To work around these austere discretionary budget caps, the President proposes to use unauthorized “mandatory” funding streams to provide targeted increases to various agencies including the National Institutes of Health (NIH).
The President’s request proposed $33.1 billion - an $825 million increase from FY16 -for NIH. That increase is targeted to areas of promising research. Specifically:
- $680 million for the National Cancer Moonshot, an initiative designed to accelerate progress on finding cures, prevention strategies and more effective treatments for the hundreds of diseases that make up cancer.
- $45 million increase for the BRAIN initiative, bringing the total investment to $195 million, to support basic neuroscience research, human neuroscience, neuroimaging and training initiatives and collaborations with industry to test novel devices in the human brain, new ways to address big data from the brain and developing devices for mapping and tuning brain circuitry.
- $100 million increase for the Precision Medicine Initiative, for a total of $200 million, to continue ramping up the cohort of one million or more volunteer participants.
But what’s in the details? While the narrative for the budget request looks great, and the Administration heralded the budget as a modest increase for NIH, a closer look reveals that the NIH budget is actually in line for a $1.067 billion cut in its base-line budget authority that’s backfilled with $1.825 billion in the new mandatory funding, bringing almost all of the NIH Institutes back up to their respective FY16 enacted funding levels.
What this means is a drop in competing research project grants from 10,753 to 9,946 and a decline in the applicant success rate from 19.2% to 17.5%. Moreover, when 2.4 percent biomedical inflation is factored in, the President’s budget actually results in a cut to the essential core of the biomedical research enterprise.
The reception by members of Congress to this unique funding scenario has ranged from concern to outright opposition. According to CQ HealthBeat, members of the House Appropriations Committee expressed worries about a funding cliff once the mandatory funding stream expires, the cuts to the NIH discretionary base and what would happen in the (likely) event that Congress rejects the idea of creating a mandatory funding stream for NIH.
Indeed, advocates should be deeply concerned. The tactic of utilizing mandatory funding to bolster traditionally discretionary programs during times of austerity or growth is not new. With the advent of the Affordable Care Act, Congress created a number of new mandatory programs such as the Prevention and Public Health Fund, the Maternal, Infant and Early Childhood Home Visiting Program and the Community Health Center Fund. The Prevention and Public Health Fund specifically has played an enormous role in backfilling the Centers for Disease Control and Prevention’s (CDC) baseline budget since its inception.
But it’s not just the Administration proposing these types of strategies. As a way to work around the discretionary budget caps and provide NIH with additional resources, the House last year approved the 21st Century Cures Act (H.R. 6), which provided a new five-year mandatory “Innovation Fund” for targeted research programs at NIH. While many advocates in the biomedical research community supported the Innovation Fund, others urged caution because of the aforementioned precedent of utilizing mandatory funding to backfill cuts to baseline discretionary budget authority and these fears were brought to life in the President’s FY17 budget. Advocates have long encouraged Congress to ensure that any mandatory funding for NIH should be utilized to supplement, not supplant core base funding, but in reality this is largely unenforceable through the legislative process.
Moving forward, it may be wise for advocates and Congress to tread carefully in the arena of mandatory funding and work to ensure no matter how NIH is funded, that Congress honors the longstanding tradition to support increased appropriations for all Institutes and Centers, recognizing that a discovery in one area of research may be applied to another. Maintaining flexibility, honoring the scientific peer-review process and supporting all research is critical to our endeavor to bring cures to Americans.