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In Hearing with Dr. Collins, Senate Appropriators Reiterate Concerns About Mandatory Funding for NIH in President’s FY2017 Budget Request

Legislative Update
April 8, 2016

NIH Director Francis Collins, M.D., Ph.D.
NIH Director Francis Collins, M.D., Ph.D.
On April 7, the Senate Labor, Health and Human Services, and Education (LHHS) Appropriations Subcommittee held a hearing with National Institutes of Health (NIH) Director Francis Collins, M.D., Ph.D. and several of his senior staff (see below) regarding the President’s Fiscal Year (FY) 2017 budget request for NIH, submitted to Congress on February 9. As in the Subcommittee’s March 3 hearing with Department of Health and Human Services Secretary Sylvia Burwell (and the House Subcommittee’s February 25 hearing with Secretary Burwell and March 16 hearing with Dr. Collins), a major issue was the budget’s reliance on mandatory funding, specifically the $33.1 billion NIH budget that includes mandatory funding of $1.825 billion, reflecting $1 billion of that which was previously discretionary funding—essentially supplanting the discretionary base—and $825 million for new and existing trans-NIH initiatives, including the National Cancer Moonshot, Precision Medicine Initiative PMI), and the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative (BI).

In his opening statement, Subcommittee Chairman Roy Blunt (R-MO) reiterated his concern that, due to the uncertain nature of mandatory funding, the budget could essentially amount to a $1 billion cut. He emphasized the importance of increasing the discretionary base funding for NIH stating that, “Last year’s funding increase cannot and should not be a one-time investment. A pattern is started in a second year, and I believe we must seize the opportunity this year to start a pattern of sustained increases for NIH. It is time for a long-term commitment to medical research.”

In her opening statement, Subcommittee Ranking Member Patty Murray (D-WA) reiterated the importance of working within the budget framework in the Bipartisan Budget Act of 2015 to have a Subcommittee allocation that enables NIH to address its priority issues. Full Senate Appropriations Committee Vice Chair Barbara Mikulski (D-MD) stated that she was “squeamish” about the President’s use of mandatory funding, and that Congress must increase the discretionary base. Since she is retiring after this session and this was her last hearing with Dr. Collins, she expressed her desire to leave NIH “in good financial health,” advising her colleagues to: “do no harm,” as in impose a government shutdown or further sequester cuts; capitalize on existing research programs by having sustained and predictable funding; and to “go for the big ideas,” as in supporting the new initiatives. In kind, Dr. Collins commented that this was also likely his last appearance before the Subcommittee and that he appreciated the Senator’s tireless support.

As in his March 16 House verbal testimony, Dr. Collins built upon his written testimony by describing ten areas in which NIH’s basic science is moving research forward. Dr. Collins was accompanied by Institute Directors as follows:

  • Christopher Austin, M.D., National Center for Advancing Translational Sciences (NCATS)
  • Richard Hodes, M.D., National Institute of Aging (NIA)
  • Walter Koroshetz, M.D., National Institute of Neurological Disorders and Stroke (NINDS)
  • Douglas Lowy, M.D., National Cancer Institute (NCI)
  • Nora Volkow, M.D. National Institute on Drug Abuse (NIDA)
In the ensuing question and answer period, Chairman Blunt asked Dr. Collins for his thoughts on discretionary versus mandatory funding, to which Dr. Collins replied:
“When it comes to discussion about the discretionary budget versus mandatory budgets, I think all of us at NIH are a little puzzled by what the consequences of those particular options might be. Our concern is to try to see, by some means, an increase in the support for biomedical research at a time of such great opportunity. So I’m not sure I can weigh the balance, but it would certainly be, as a bottom-line, deeply unfortunate if these kinds of conversations resulted in an overall decrease in the resources that we have.”

Subcommittee member and Senate Health, Education, Labor and Pensions (HELP) Committee Chairman Lamar Alexander (R-TN) reported that on the previous day, April 6, the Committee voted to advance the final five medical innovation bills of a total of 19 that will comprise the Senate’s companion package to the House’s 21st Century Cures Act passed in July 2015 (supported by NAEVR). He built upon comments he made at the Subcommittee’s March 3 hearing with Secretary Burwell in which he described a “path forward” that would include “surge” mandatory funding for key NIH initiatives, such as PMI, BI, Cancer Moonshot and early-stage investigators, while continuing to grow the discretionary base. While supporting this approach, he expressed his concern about oversight of how such “surge” funding would be used for the key initiatives and whether it ultimately sets NIH up for a “fiscal cliff.”

Currently, at issue is whether Democratic and Republican authorizers can reach a consensus on “supplemental” mandatory funding, as well as the budget offsets necessary to pay for it. Although Chairman Alexander and Senate HELP Ranking Member Murray have expressed optimism about reaching a deal, nothing is yet certain. Democrats have signaled that their support for a Senate “Cures” package is contingent upon mandatory funding for the NIH (and the Food and Drug Administration, FDA), while Republicans are concerned about oversight and a potential cliff associated with mandatory funding.

On April 8, NAEVR submitted its written testimony to the Subcommittee’s hearing file urging the Senate to appropriate at least $34.5 billion for NIH and $770 million for the NEI in FY2017, a 7.5 percent increase over FY2016 for each that reflects five percent real growth above the projected 2.5 percent rate of biomedical inflation. NAEVR also expressed its disappointment in the President’s use of mandatory funding in his budget proposal to supplant NIH’s discretionary base by $1 billion, especially at it relates to most of the Institutes and Centers (I/Cs) which are flat-funded, including the National Eye Institute (NEI). The President requests NEI funding at $708 million—the same as its FY2016 operating budget, which was reduced from its enacted level of $715.9 million due to pass-throughs. The flat-funding relies, however, on mandatory funding—without it, I/Cs would be funded at the level proposed in the President’s FY2016 budget request. For NEI, that would be $687 million. The budget proposal essentially reduces the discretionary funding base for I/Cs.