On Dec. 29, 2022, President Joe Biden signed the Consolidated Appropriations Act, 2023 (H.R. 2617) into law, which includes $1.7 trillion in fiscal year (FY) 2023 discretionary government funding for all 12 annual spending bills, as well as a number of other health care provisions. After prolonged negotiations to reach an agreement on various procedural issues following the bill’s Dec. 20, 2022, introduction, the Senate passed the omnibus on Dec. 22, 2022, by a vote of 68-29 and the House passed the package on Dec. 23, 2022, by a vote of 225-201.
The $1.7 trillion omnibus also included a host of other policy provisions relevant to academic medicine, including a number related to health care and pandemic preparedness [refer to related stories on health care and preparedness measures.]
Following the release of the omnibus text, AAMC President and CEO David J. Skorton, MD, and Chief Public Policy Officer Danielle Turnipseed, JD, MHSA, MPP, released a statement applauding Congress’ bipartisan efforts, thanking them for the investments in medical research, public health, the health workforce, and all components of the health infrastructure that improve the health of patients and communities, and urging swift passage of the measure.
The bill provides the following FY 2023 funding levels for agencies and their respective programs that are impactful for academic medicine:
National Institutes of Health (NIH)
The omnibus provides a total of $47.5 billion for the NIH in FY 2023, an increase of $2.5 billion (5.6%) above the FY 2022 enacted level. The bill provides increases to the Clinical and Translational Science Awards and the Institutional Development Award programs. The accompanying joint explanatory statement includes requirements regarding the reporting of the use of animals in research, funding for regional biocontainment laboratories and the workforce to support biosafety level 3-plus research, and funding to increase the diversity of the research workforce.
Advanced Research Projects Agency for Health (ARPA-H)
The omnibus provides $1.5 billion for ARPA-H through FY 2025 ($500 million or a 50% increase over FY 2022) through the Health and Human Services (HHS) Office of the Secretary in FY 2023. As in FY 2022, the secretary has the authority to transfer the funding to the NIH or another HHS agency within 30 days of the bill’s enactment. The bill also includes authorizing language for ARPA-H including its establishment separately within the NIH, allowance to be exempt from certain NIH policies, and guidance regarding location of ARPA-H offices. The bill authorizes $500 million per year for the agency for FY 2024 through FY 2028.
Gun Violence Prevention Research
For a fourth consecutive year, the legislation includes dedicated funding for firearm injury and mortality prevention research, with $12.5 million for the Centers for Disease Control and Prevention (CDC) and $12.5 million for the NIH, the same funding levels as FY 2022.
Agency for Healthcare Research and Quality (AHRQ)
The spending bill includes $373.5 million for AHRQ, which is an increase of $23.1 million (6.6%) above the FY 2022 enacted level.
Centers for Disease Control and Prevention (CDC)
The bill provides a total of $9.2 billion for the CDC, an increase of $760 million (8.9%) above the FY 2022 enacted level, which includes investments in maternal health, public health data modernization, and health equity including the Racial and Ethnic Approach to Community Health (REACH) program and Social Determinants of Health Accelerator plans.
Health Resources and Services Administration (HRSA)
The bill set aside $879.8 million for HRSA Title VII and Title VIII programs, which is a $60.6 million (12%) increase above the FY 2022 enacted level. The Title VII pathway programs (Centers of Excellence, Health Career Opportunity Program, Scholarships for Disadvantaged Students, and Faculty Loan Repayment) received increases in funding across the board. Preventing Burnout in the Health Workforce program, authorized by the AAMC-endorsed Dr. Lorna Breen Health Care Provider Protection Act (P.L. 117-105), did not receive any funding in the bill despite the proposed funding in both the House and Senate FY 2023 draft spending bill.
Additionally, the bill includes $125.6 million for the National Health Service Corps, a $4 million (3.28%) increase over the FY 2022 appropriation. The bill provides $385 million for the Children’s Hospitals Graduate Medical Education program, a $10 million (2.7%) increase over FY 2022. Lastly, the bill includes $12.5 million for Rural Residency Planning and Development grants, which is an increase of $2 million (19%) over FY 2022.
$305 million, a $9.5 million or 3.2% increase over FY 2022 levels, was allocated for the Hospital Preparedness Program (HPP) under the Office of the Assistant Secretary for Preparedness and Response. Within that $305 million total for the HPP, $7.5 million was set aside for the National Emerging Special Pathogens Training and Education Center, and $21 million (flat funding) for the Regional Emerging Special Pathogen Treatment Centers.
Department of Education
The bill provides $50 million in research infrastructure investments at Historically Black Colleges and Universities, Tribal Colleges and Universities, and Minority-Serving Institutions.
Department of Veterans Affairs
The bill provides a total of $916 million for the Veterans Affairs (VA) Medical and Prosthetic Research program in FY 2023, a $34 million (3.9%) increase above the FY 2022 funding level, with the joint explanatory statement including text regarding the use of animals in research and access to clinical oncology trials.
Regarding VA health care funding, the bill provides an additional $216 million for VA Medical Services for FY 2023 beyond the previously approved advanced appropriations for FY 2023 representing a total of $70.6 billion for FY 2023, a $11.7 billion (19.8%) increase over the comparable FY 2022 spending level. The bill also provides $74 billion in FY 2024 advanced appropriations.
For medical community care, the bill provides an additional investment of $4.3 billion for FY 2023 beyond the previously approved advanced appropriations for FY 2023 representing a total of $28.5 billion for FY 2023, a $5 billion (21.5%) increase in FY 2023 over the comparable FY 2022 spending level. The bill also provides $33 billion in FY 2024 advanced appropriations.
The omnibus also includes text of the AAMC-endorsed VA Infrastructure Powers Exceptional Research Act of 2021 (H.R. 5721), which aims to improve the functionality and efficiency of the VA Medical and Prosthetic Research program while also ensuring continuity of existing research affiliations in light of updated guidance from the VA that would impact outside salary support for VA researchers [refer to Washington Highlights, Dec. 9, 2022].
National Science Foundation (NSF)
The bill provides a total of $9.9 billion for the NSF through the Commerce, Justice, Science, and Related Agencies appropriations provisions as well as through supplemental funding. The funding total would represent an increase of $1.04 billion (12%) over the comparable FY 2022 funding level and includes specific funding for the implementation of the CHIPS and Science Act [refer to Washington Highlights, July 29, 2022].