NIH Could Receive Multi-Billion Dollar Boost in ‘Cures’ Legislation

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Publication date: 
18 November 2016
Number: 
144

Congressional leaders have said that passage of a “21st Century Cures Act” is a top priority for the remainder of the current Congress. This bill could provide a multi-billion dollar funding boost to the National Institutes of Health outside of the regular appropriations process.

Congress appears intent on passing a major biomedical innovation bill this year that could provide a multi-billion dollar funding boost to the National Institutes of Health. Although the bill text has not yet been made public, it will likely be largely derived from the “21st Century Cures Act”—a sweeping biomedical innovation bill which the House passed by a vote of 344 to 77 in July 2015—and a set of 19 bipartisan bills the Senate Health, Education, Labor, and Pensions Committee approved this spring. Reports indicate the legislation could surface soon after Congress returns from its Thanksgiving break.

Both Senate Majority Leader Mitch McConnell (R-KY) and Speaker of the House Paul Ryan (R-WI) have indicated that they support finalizing the legislation. In a press conference immediately following the Nov. 8 election, McConnell indicated that passing a Cures act was his first priority for the lame duck session after funding the government for fiscal year 2017, and cited the personal interest national leaders have taken in the legislation: “The president is interested in the precision medicine part of that, the vice president is interested in the cancer moonshot part of it, I’m interested in the regenerative medicine part of it. … I’d like to see us finish that important new measure this year.”

Mandatory money

Among its numerous provisions, the House-passed Cures Act would establish a “NIH and Cures Innovation Fund” that would provide NIH with $1.75 billion each year on top of what the agency receives in annual discretionary appropriations up until fiscal year 2021. These expenditures would be offset, at least in part, by selling millions of barrels of oil from the Strategic Petroleum Reserve.

The fiscal year 2016 appropriation for NIH was $32.31 billion, so this influx would amount to about a 5 percent increase per year (if the discretionary funding for NIH were to remain mostly flat over this period).

A broad coalition of research organizations and patients groups, have urged Congress to pass the legislation this year, although others are opposed to use of mandatory funding in the bill. Biomedical research advocates argue that increases to the NIH budget are well-justified, pointing to how NIH’s purchasing power has declined over the past decade.

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NIH Appropriations 1994-2016

Appropriations for NIH from fiscal year 1994 to 2016. Figures in the right-hand graph are adjusted for inflation using the Biomedical Research and Development Price Index. Funding from the American Recovery and Reinvestment Act excluded.

Typically, almost all federal R&D programs are funded out of the discretionary portion of the budget and the amounts are determined through annual appropriations bills. In contrast, the Cures and Innovation Fund would lock in spending for multiple years through an authorization bill, establishing a so-called “mandatory” funding stream.

Many members of Congress often oppose establishment of such funding streams, as they can make it harder to maintain control of overall federal spending. The rising cost of programs funded through mandatory means, such as Social Security and Medicare, has squeezed the discretionary portion of the budget and spurred efforts to limit federal spending through imposition of budget caps.

However, establishing a mandatory funding stream for R&D is not unprecedented. One example is NIH’s Special Diabetes Program, which in recent years has received about $150 million per year in mandatory funding for Type 1 diabetes research.

Although none of the 19 Senate bills establish an analogue to the Innovation Fund, reports indicate that the compromise bill being negotiated will include some form of funding boost for NIH. The debate is now likely centered on the total amount of money, how much will be allocated toward specific initiatives, and how the spending will be offset.

Reports indicate that the final bill will likely include dedicated funds for the Obama Administration’s Cancer Moonshot effort. The initiative had not gained much traction within the appropriations process this year, as the appropriations committees did not provide any of the $680 million in mandatory funding the president requested for NIH in support of the moonshot. See FYI #134 for a summary of some aspects of the initiative that are relevant to the physical sciences.

At a time when there is widespread unease in the scientific community about whether the next administration will be supportive of large federal investments in R&D, the bipartisan push to pass the Cures legislation serves as a reminder of the broad support for federally funded biomedical research in Congress. As Sen. Lamar Alexander (R-TN) noted in an op-ed this summer, “In this year of political turmoil, the ‘21st Cures’ Act offers a welcome opportunity for consensus.”

 

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