Bush Budget Tightens Belt
on Discretionary Spending
February 7, 2003 - President Bush released the details
of his $2.23 trillion budget
proposal for FY 2004 on Feb. 3. The budget proposes record
federal budget deficits of $304 billion for FY 2003 and $307
billion for FY 2004. In the absence of final FY 2003 numbers,
all of the comparisons in the President's budget are to what
was proposed by the Administration for FY 2003.
The budget calls for total discretionary spending - spending
determined through the annual appropriations process - to
be increased in FY 2004 by 4 percent ($30 billion) to $782
billion. Defense spending would be increased by 4.2 percent
($15 billion) to $380 billion; homeland security would be
increased by 5.5 percent ($1 billion) to $28 billion; and
non-defense, non-homeland security spending would be increased
by 3.8 percent ($14 billion) to $374 billion. For the Department
of Health and Human Services, the President's budget includes
$66.2 billion in discretionary budget authority, a 2.5 percent
($1.6 billion) increase.
National
Institutes of Health -The President's budget proposes
$27.893 billion for the NIH, an increase of $549 million (2
percent) over the FY 2003 request. However, the budget proposes
to convert about $1.4 billion in one-time, nonrecurring costs
in FY 2003 for facilities construction and anthrax procurement
to research in FY 2004, resulting in a 7.5 percent ($1.9 billion)
increase for overall research programs and support. When adjusted
for the one-time facilities costs in FY 2003, the total available
for NIH non-biodefense research programs increases by 4.3
percent. If biodefense facilities funds and the $250 million
for one-time anthrax vaccine procurement from FY 2003 are
excluded, support for biodefense research increases by 117
percent to $1.625 billion
The budget proposal increases the number of new and competing
renewal research project grants (RPGs) by 344 to a total of
10,509. This would result in an estimated success rate of
29 percent. The average cost for RPGs would be increased by
2.7 percent. The budget proposes to give NIH the authority
to fully fund 322 new, mostly small, RPGs. In the coming year,
NIH will study whether other grants can reasonably be fully
funded from the point of view of both financial stewardship
and scientific accountability.
The budget once again proposes to reduce the extramural salary
cap to Executive Level II. The budget eliminates funding for
extramural construction through the National Center for Research
Resources (NCRR). The Senate had proposed $125 million for
this program in FY 2003. The budget proposes to increase the
number of National Research Service Awards (NRSAs) by 80 to
17,197 with 74 of the new awards slated for biodefense. The
budget proposes increasing pre-doctoral stipends by 4 percent
(bringing the stipends to $19,632) and post-doctoral stipends
on a sliding scale from 4 percent to 1 percent based on experience
(bringing those stipends to a range from $33,624 to $49,584).
Health professions - The President's budget again
slates most of the Title VII health professions programs for
elimination. Just as in the FY 2003 proposed budget, the Administration
provides $11 million for Title VII, which includes $10 million
for Scholarships for Disadvantaged Students and $1 million
for the workforce information and analysis programs. Funding
for all other Title VII programs is eliminated.
The budget proposes $98 million for the Title VIII nursing
programs, with $72 million for basic nurse education and $26
million for advanced nursing education. From the Title VIII
total, $7 million is designated for the newly authorized nurse
scholarship program.
The Agency for Health Research and Quality (AHRQ)
receives $278 million in the President's FY 2004 budget, an
11.6 percent increase over the FY 2003 budget request, but
less than the $299 million in the FY 2003 bill introduced
in the House and $308 million in the Senate-passed omnibus
appropriations bill. The budget directs $84 million of the
total for patient safety research, which includes $50 million
for hospital-based information technology investments, with
an emphasis on small community and rural hospitals; $10 million
for information technology improvements in health care; and
$24 million for other collaborative patient safety efforts.
The budget also recommends $55 million for the Medical Expenditure
Panel Survey (MEPS), a $2 million increase over the FY 2003
request. The President would fund the entire $279 million
from evaluation funds.
The budget proposal provides $199 million for the Children's
Hospitals Graduate Medical Education program, $1 million
less than the amount recommended in FY 2003. The Senate-passed
omnibus FY 2003 bill provides $285 million, level with the
FY 2002 appropriation, while the House FY 2003 bill includes
an increase to $292 million. The President's 2004 budget again
recommends eliminating the Community Access Program (CAP),
which received $120 million in FY 2002.
Bioterrorism Preparedness - As in FY 2003, the president's
budget includes $518 million for the hospital bioterrorism
preparedness program, administered by the Health Resources
and Services Administration (HRSA). Also in the HRSA budget
is $60 million for bioterrorism curriculum development. Another
$1.1 billion is allocated for bioterrorism preparedness through
the CDC, with $940 million designated for the states to implement
their plans, $158 million to improve CDC's internal preparedness,
and $18 million for anthrax research. The NIH budget includes
$1.6 billion for biodefense research, an increase of $121
million over last year's request. Included in the new Department
of Homeland Security FY 2004 budget is $400 million to strengthen
and maintain the pharmaceutical stockpile. $900 million is
provided to pre-purchase critically needed vaccines or medication.
This funding is part of the 10-year, $6 billion Project BioShield,
which is a new authority designed to speed up the acquisition
of biodefense countermeasures.
National Health Service Corps - The President's budget
proposes $213 million for FY 2004, an increase of $24 million
(12.7 percent) over the FY 2003 request. The NHSC, along with
the Community Health Centers program, is one of the centerpieces
of the President's plan to provide health care services in
underserved areas.
Veterans Health Administration - The President's budget
provides a $2.6 billion (11.4 percent) increase for VA medical
care, for a total funding level of $25.41 billion. For VA
Medical Research, the President's budget proposes $822 million
in FY 2004. This number reflects a restructuring of the VA
research account to include research support funding previously
appropriated through the Medical Care account. This figure
represents a 3.5 percent ($28 million) increase over comparable
figures in the FY 2003 budget request. Of the $822 million,
$408 million is directed toward the direct costs of research,
an increase of $14 million (3.6 percent) over the President's
FY 03 request.
For the National Science Foundation (NSF), the budget
request recommends $5.48 billion, an increase of $450 million
(9.0 percent), including $4.11 billion for NSF Research, an
increase of $330 million (8.5 percent). Because both the House
and Senate proposed higher FY 2003 funding levels for the
NSF than the President proposed, the exact increases recommended
will not be clear until the FY 2003 process is completed.
Infomation:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Jonathan Fishburn, Director, Research, Education and Veterans' Legislative Affairs
AAMC Government Relations
jfishburn@aamc.org
(202) 828-0525
Erica Froyd, Director, Public Health and Research Legislative Affairs
AAMC Government Relations
efroyd@aamc.org
(202) 828-0525
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