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House Appropriators Begin Mark-Ups Without Final Budget Resolution; NAEVR Educates Hill About Public Health Implications of Eye Disease

Legislative Update
June 9, 2004

Budget Process:
The Senate has yet to vote on the Budget Resolution Conference Report, although the House approved this measure on May 19 by a vote of 216-213, which included an FY2005 discretionary spending cap of $821.4 billion (a 4.4% increase over FY2004). Non-defense/homeland security spending would increase by only .9%. Although the Senate leadership could bring the measure to the floor at any time after this week's schedule of events honoring former President Reagan, negotiators are still attempting to secure the 60 votes necessary for Senate passage. Three Republican Senators oppose the conference report since it would exempt $27.5 billion in tax cuts from "pay/go" requirements (that is, offsetting any new spending with cuts to existing programs or previously-enacted tax cuts). Pressure is intensifying, since the House Appropriations Committee and its various Subcommittees have already begun the mark-up process for the 13 appropriations bills. But larger forces are in play, too, as recent deficit forecasts indicate that Congress will likely need to pass an increase in the debt ceiling shortly, as well as the anticipated House action on new budget enforcement mechanisms that could impact this year's process. Clearly, the shortened legislative calendar is also weighing heavily, even more so after this week's set-aside of Congressional business.

Appropriations Process:
With the various Subcommittee hearings ended, House Appropriations Committee Chair Bill Young (R-FL) has begun an orderly mark-up process of the 13 appropriations bills, which he hopes to report out of his Committee by the planned House summer recess of July 23. Last week, in the midst of the beginning of mark-ups for the Defense and Homeland Security bills (with the Interior, Legislative Branch, Energy and Water, and Agriculture bills to follow), Cong. Young released the "section 302(b)" allocations for the Appropriations Subcommittees. The Labor, Health and Human Services, and Education (LHHS) bill, the largest of the domestic spending measures, would see a $3.4 billion increase over the FY04 total of $139 billion to $142.3 billion in FY2005. Although the actual budgetary amounts for programs such as the National Institutes of Health (NIH) generally, and the National Eye Institute (NEI), specifically, will be forthcoming in the LHHS appropriations bill mark-up process, one should generally assume the President's budget numbers (e.g., for NEI, that would be $672 million or a 2.9% increase from FY04). However, although various sources are reporting that the LHHS bill will "likely increase funding for education and medical research," specific numbers are not yet known, and increases in some programs will mean cuts to other programs. The LHHS bill may not move until after the July 4 recess and, when it does, it could be contentious since it reflects an increase when other appropriations bills are receiving cuts for the second year.

NAEVR remains vigilant and diligent in its efforts to educate Capitol Hill about the value and cost-effectiveness of eye and vision research and advocate for an FY2005 NEI appropriation of $711 million. Subsequent to its May 13 "Aging Eye" Capitol Hill briefing , which featured the recently released NEI data about the increased incidence of age-related eye disease, NAEVR has continued to keep in contact with House and Senate appropriators. It has also met with key committees (e.g. the Senate Special Committee on Aging) and Caucuses (e.g. the Black and Hispanic Caucuses, since the data also reveal a disproportionate incidence of glaucoma and cataracts in these populations).

NIH Hearings:
Congress also continues its oversight activities. Last week, the House Energy and Commerce Committee's Health Subcommittee, chaired by Cong. Bilirakis (R-FL), held a hearing on "NIH Priority Setting." In opening statements, full Committee Chair Joe Barton (R-TX) noted that this was the fifth hearing this Congress regarding NIH issues, and that it was being held in anticipation of drafting legislation to reauthorize the NIH (which has not been done since 1993). Chairman Barton specifically stated that "the dollars are too big and the consequences are too big" for this process not to occur (the delay for which he squarely placed on his Committee's shoulders). Chairman Barton acknowledged the doubling of the NIH's budget (noting that it was a bipartisan effort) and the concomitant Committee concern about how these additional dollars are being spent (especially in light of constituent communications about the need for increased funding for specific Institutes and programs) and that these processes are transparent. Barton's comments were echoed in opening statements by other Subcommittee members, who balanced laudatory comments about the work of the NIH with concern that it is effectively using funds so that it maintains the public's trust.

NIH Director Dr. Elias Zerhouni spoke, as did Dr. Fauci (Director, National Institute of Allergy and Infectious Diseases) and Dr. von Eschenbach (National Cancer Institute). As in the Senate and House Appropriations hearings, Dr. Zerhouni laid out his efforts to create a rational and transparent priority-setting process (e.g. reorganized Steering Committee; trans-Institute committees, such as that established for obesity; and the NIH Roadmap ). He acknowledged that NIH priority setting must be dynamic and respond to scientific discoveries that may change its focus over time (e.g., acute to chronic diseases) or immediately (e.g., identifying the cause of SARS). At the same time, however, he noted limitations, such as the need for better Information Systems to analyze the NIH portfolio of research; the need for a common pool of funds for trans-Institute initiatives; and the need for better outcomes measures from its research (e.g, as measured in terms of cost, public health impact, or scientific opportunities). When asked about the tight FY2005 budget process, he noted that programs such as the Roadmap would enable him to use available funds more efficiently and effectively.

Surgeon General's Report on Smoking Identifies Increased Incidence of Cataracts:
In a May 27 report, Surgeon General Richard Carmona released a report on smoking and health, noting that smoking causes diseases in nearly every organ of the body. Published 40 years after the first report on smoking, this newest report conclusively links smoking to additional diseases such as cataracts, pneumonia, leukemia, and cancers of the cervix, kidney, pancreas and stomach.