National Journal : A Tug of War Over Funding NIH

National Journal - Rachel Roubein

The Na­tion­al In­sti­tutes of Health has some lofty goals: at­tempt­ing to cure can­cer and in­di­vidu­al­ize dis­ease treat­ments, es­tab­lish­ing a one mil­lion-plus re­search co­hort, and re­vo­lu­tion­iz­ing how sci­ent­ists un­der­stand the hu­man brain.

Un­sur­pris­ingly, those mis­sions have plenty of bi­par­tis­an sup­port. What they don’t have are bi­par­tis­an agree­ments on which pot of gov­ern­ment money they should draw from.

Last fisc­al year, the NIH saw a $2 bil­lion in­crease in funds—its biggest boost in about a dozen years. Now, the two le­gis­lat­ive items cru­cial to help­ing sus­tain NIH’s ven­tures are com­ing down the pike al­most in tan­dem: a pack­age of bio­med­ic­al-in­nov­a­tion bills and the start of the an­nu­al ap­pro­pri­ations pro­cess.

“If I have any anxi­ety right now, it’s that we have two pos­sible ways of fund­ing some of these things,” NIH Dir­ect­or Fran­cis Collins said in an in­ter­view. “One be­ing the reg­u­lar ap­pro­pri­ations pro­cess, which of course is based on dis­cre­tion­ary fund­ing, and then we have this ex­cep­tion­al op­por­tun­ity—which star­ted in the House with 21st Cen­tury Cures and now in the Sen­ate with in­nov­a­tions—which would be man­dat­ory funds.”

He ad­ded: “Ob­vi­ously, in our view right now, the op­por­tun­ity to tap in­to both of those sources is really ex­cit­ing be­cause it means we could really ramp up this ef­fort at the level it de­serves. But if some­how the ex­ist­ence of those two pos­sib­il­it­ies causes both of them to fail, then we are go­ing to really be in bad shape.”

Sen. Patty Mur­ray—the top Demo­crat on the Sen­ate Health, Edu­ca­tion, Labor, and Pen­sions Com­mit­tee—has tied in­clud­ing man­dat­ory fund­ing for NIH and the Food and Drug Ad­min­is­tra­tion in the Sen­ate’s bio­med­ic­al-in­nov­a­tion bills to her sup­port of the over­all pack­age. Pres­id­ent Obama’s fisc­al 2017 budget in­cludes new man­dat­ory fund­ing for NIH but makes dis­cre­tion­ary cuts, which has some Re­pub­lic­ans balk­ing.

Last week, the HELP pan­el held its last of three markups for 19 total bio­med­ic­al-in­nov­a­tion bills, the up­per cham­ber’s com­pan­ion le­gis­la­tion to the House-passed 21st Cen­tury Cures bill.

“I’m very hope­ful we can reach a bi­par­tis­an agree­ment that re­flects the strong work done by mem­bers on both sides of the aisle, up­holds the highest stand­ards of pa­tient and con­sumer safety, and en­sures that we in­vest in real­iz­ing the goals we’ve laid out in the many bills we’ve worked on so far—by boost­ing in­vest­ments in med­ic­al re­search and de­vel­op­ment at the NIH and the FDA,” Mur­ray said at last week’s hear­ing. “If we can reach this agree­ment—and I be­lieve that we can—we’d be able to make a real dif­fer­ence in the lives of pa­tients and fam­il­ies across the coun­try.”

The com­mit­tee is con­tinu­ing to work on com­ing up with fund­ing both cham­bers can sup­port and the pres­id­ent will sign, Chair­man Lamar Al­ex­an­der said at the hear­ing. He men­tioned the pos­sible in­clu­sion of an “NIH In­nov­a­tion Fund,” which would dole out one-time fund­ing to five big-tick­et pro­jects, in­clud­ing the Pre­ci­sion Medi­cine Ini­ti­at­ive and Can­cer Moon­shot. (The House Cures bill in­cluded $8.75 bil­lion in off­set man­dat­ory funds for NIH and $550 mil­lion to the FDA.)

“Sen. Al­ex­an­der said that he be­lieves the case can be made for one-time sup­port for lim­ited man­dat­ory fund­ing at the NIH for high pri­or­ity ini­ti­at­ives, which have a be­gin­ning and end,” an Al­ex­an­der aide wrote in an email. “There is no sim­il­ar jus­ti­fic­a­tion for man­dat­ory fund­ing at the FDA, which is fun­ded through both ap­pro­pri­ations and in­dustry user fees.”

On the ap­pro­pri­ations side, the White House’s budget funds NIH at $33.1 bil­lion, which is an in­crease due to the in­clu­sion of $1.8 bil­lion in new man­dat­ory funds, ac­cord­ing to NIH. But that’s a $1 bil­lion de­crease in dis­cre­tion­ary funds, which top GOP health ap­pro­pri­at­ors say is a non­starter.

Rep. Tom Cole—who chairs the House Ap­pro­pri­ations sub­com­mit­tee charged with over­see­ing NIH’s funds—called the in­clu­sion of man­dat­ory funds a “gim­mick game.” In an in­ter­view, the Ok­lahoma Re­pub­lic­an said the dis­cre­tion­ary cuts the White House pro­posed are “just not go­ing to hap­pen in my bill.” At the min­im­um, Cole said he aims to match this fisc­al year’s funds and al­loc­ate even more if pos­sible.

“Sadly, if we’re go­ing to ac­tu­ally do what needs to be done at NIH and con­tin­ue on this path of re­in­vig­or­at­ing bio­med­ic­al re­search and hav­ing a sus­tain­able growth pat­tern, we’re go­ing to have make some dif­fi­cult de­cisions else­where in the budget,” Cole told Na­tion­al Journ­al.

At a Sen­ate Ap­pro­pri­ations sub­com­mit­tee hear­ing last week, Demo­crat­ic Sen. Bar­bara Mikul­ski said she was “squeam­ish” about man­dat­ory fund­ing. She ques­tioned Collins on what ex­actly would con­sti­tute a healthy in­vest­ment in NIH. His re­sponse: to grow NIH’s budget at a rate of in­fla­tion plus 5 per­cent for mul­tiple years in a row.

“That would be the most amaz­ing thing that any­body could do for pro­gress in health and medi­cine,” Collins told Na­tion­al Journ­al. “That would be the kind of path where you could ac­tu­ally make longer-range plans, where young in­vest­ig­at­ors could feel con­fid­ent they had a ca­reer path that they could take risks. That’s what we need.”

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