An unusual coalition of Democrats and conservative Republicans is calling for increased funding for the National Institutes of Health, but the lawmakers must contend with spending caps known as the sequester.
Bipartisan legislation introduced this week, called 21st Century Cures, would provide billions of dollars in new funding for medical research at NIH.
The caps provide a major obstacle. But coming on the heels of a major deal to reform Medicare payments, the passage of the bill would be another bipartisan accomplishment on healthcare.
{mosads}After years of mostly flat funding that NIH says has left the agency under-resourced, supporters hope a breakthrough could be getting closer.
Prominent Republicans like former Speaker Newt Gingrich and former House Majority Leader Eric Cantor have both called for increasing NIH funding in the past month.
“It’s not only a compassionate thing,” said conservative Rep. Matt Salmon (R-Ariz.), a champion of increased NIH funding. “It’s also an economic issue, when we look at the dollars that are never earned because of cancer.”
Sen. Roy Blunt (R-Mo.), the chairman of the appropriations health subcommittee, said Thursday that he is “pleased” that President Obama requested an additional $1 billion for NIH in his budget.
The 21st Century Cures bill, led by House Energy and Commerce Chairman Fred Upton (R-Mich.) and Rep. Diana DeGette (D-Colo.), would ramp up NIH funding to around $35 billion by 2018, about $5 billion more than its current level.
The problem is not so much a lack of support for this funding, but that a 2011 law imposes spending caps on Congress, which Republicans stuck to in their budget.
Under the blueprint, House appropriators must cut $3.7 billion from the spending bill that covers healthcare, meaning even if the 21st Century Cures Bill authorizes new funding, it might not get through the appropriations committees.
“Just maintaining NIH spending would be a heck of a struggle when they have to pare $3 billion,” said Harry Stein, director of fiscal policy at the left-leaning Center for American Progress.
However, $10 billion over five years set aside in the Cures bill for an innovation fund at NIH has a better chance of being enacted because it is considered mandatory spending not subject to the same caps and appropriations process.
Those funds would help support young emerging scientists and back precision medicine initiatives, a priority of President Obama.
“Of course we all support biomedical research,” House health appropriations chairman Tom Cole (R-Okla.) told NIH officials at a hearing in March. “Unfortunately, right now sequester is the law of the land and, given the reality of the funding allocations, we won’t be able to do everything the administration is proposing.”
On the Senate side, Blunt told NIH officials Thursday that the committee would be “as supportive as we possibly can.”
The barrier of the spending caps has led some Democrats to push for another deal, similar to the 2013 agreement between Sen. Patty Murray (D-Wash.) and Rep. Paul Ryan (R-Wis.), to ease the limits.
President Obama has said he will not sign spending bills that do not ease sequestration, raising pressure for a deal to occur.
“We’ve got to build on that bipartisan agreement and replace those automatic spending cuts for 2016 and beyond,” Murray said at an NIH hearing this week. She noted Obama’s budget, lifting the caps, “makes it possible to provide a $1 billion increase in funding to support NIH efforts.”
Sen. Dick Durbin (Ill.), the Senate’s No. 2 Democrat, said at the same hearing that he has spoken to Republicans on the committee about the possibility of a deal to increase NIH funding.
Salmon, though, said, freeing up funds through entitlement reform, a far harder process, is the real solution.
“I hope that we don’t get to another Ryan-Murray deal,” he said. “I hope that we get to responsible budgeting and entitlement reform.”
An added wrinkle is that some Republicans say they will not agree to increase the funding without new restrictions for the agency.
Rep. Michael Burgess (R-Texas), who has worked on the Cures bill, said he hopes to seek some restrictions on how the money is spent, such as caps on the agency’s overhead spending.
“We’re going to at least have to ask those questions. Before we actually get to what the final tally is, there’s still work to be done,” he said. “There are some real concerns.”
“Congress needs to know the NIH is wisely spending the money it currently receives,” Rep. Andy Harris (R-Md.) said in a statement.
And NIH funding was not without controversy in the drafting of the bill. The release had been held up for nearly a week, in part because Democrats including Rep. Frank Pallone (D-N.J.) had demanded more funds for the NIH.
The NIH budget has stayed mostly flat since 2003, and has not kept up with inflation. Dr. Francis Collins, NIH director, says that $1 billion would allow NIH to give 1,200 more grants.
“We have seen over the course of the last 12 years a significant diminution in NIH’s ability to do research across the board,” Collins told a Senate hearing last week. “Our most important resource, the people doing the work, are clearly pretty stressed at the moment.”
But the agency’s officials have cheered the Cures bill.
“Thank you, thank you, thank you, thank you,” Kathy Hudson, an NIH deputy director, told the House hearing on the Cures bill Thursday. “The research community is ecstatic.”
“I think we’re going from a very dreary phase of biomedical research to a much brighter phase,” she said.