The House Labor-HHS-Education Appropriations Subcommittee June 15 approved its draft fiscal year (FY) 2019 spending bill, teeing up full committee consideration as soon as the week of June 18. The spending package rejects many of the president’s FY 2019 budget provisions, including proposals to dramatically reduce funding for the National Institutes of Health (NIH) and to condense the Agency for Healthcare Research and Quality (AHRQ) into NIH.
According to a committee-prepared summary, the bill includes $177.1 billion in discretionary funding overall for programs at the Departments of Labor, Health and Human Services (HHS), and Education, matching the FY 2018 enacted level.
Within that total, the committee reports that the measure provides “a total of $38.3 billion for NIH, an increase of $1.25 billion above the fiscal year 2018 enacted level.” In the markup, Chairman Tom Cole (R-Okla.) stated that the committee needs to build upon previous funding increases for the NIH and that this draft bill “is a floor, not a ceiling for biomedical research funding.” Within the total, the bill fully utilizes the $711 million designated for specific NIH initiatives in the Innovation Account established in the 21st Century Cures Act (P.L. 114-255). The president’s FY 2019 budget request proposed $35.5 billion for the agency [see Washington Highlights, Feb. 16].
Ranking Member Rosa DeLauro (D-Conn.) commented that with an increase of $18 billion in nondefense discretionary spending for the entire FY 2019 budget, the Labor-HHS bill should have received a proportional increase of $5.5 billion for its FY 2019 allocation. The Ad Hoc Group for Medical Research, which the AAMC convenes, issued a statement on the draft spending bill, sharing its appreciation for “the Subcommittee’s continued support of the National Institutes of Health (NIH) as a key national priority” while also recognizing that “the Subcommittee was limited in its ability to invest more fully in the agency due to its inadequate spending allocation.”
The bill also maintains the HHS salary cap at Executive Level II of the federal pay scale, rather than Executive Level V as the president had proposed. The subcommittee maintained funding for the Agency for Healthcare Research and Quality (AHRQ) at the FY 2018 level of $334 million as an independent agency, rather than a new NIH institute as proposed in the budget request.
Additionally, the bill provides $6.5 billion for the Health Resources and Services Administration (HRSA), nearly $200 million less than the FY 2018 enacted level for the agency. While the bill language does not provide specific dollar allocations for each of HRSA’s workforce programs, the committee’s summary reveals that the bill increases funding for the Children’s Hospitals Graduate Medical Education (CHGME) program by $10 million to $325 million, and eliminates the $14 million Health Careers Opportunity Program (HCOP), as proposed in the president’s request. The Health Professions and Nursing Education Coalition (HPNEC), an AAMC-led group of over 60 organizations who advocate on behalf of Title VII and Title VIII programs, recommends $690 million for the workforce programs.
The committee-prepared summary also indicates that the bill provides $280 million, a $15 million (5.7 percent) increase for the Hospital Preparedness Program within the office of the Assistant Secretary for Preparedness and Response (ASPR), and transfers the Strategic National Stockpile from the Centers for Disease Control and Prevention (CDC) to ASPR. According to the summary, after accounting for the transfer and “the one-time facilities funding in fiscal year 2018, the legislation provides an increase of $427 million for CDC on a comparable program level,” including $848 million in transfers from the Prevention and Public Health Fund. The bill reportedly provides a total of $7.6 billion for CDC in FY 2019.
Shortly after the subcommittee released bill text, AAMC President and CEO Darrell G. Kirch, M.D., issued a June 14 statement where he indicated that the association “appreciates that the subcommittee once again has proposed to invest substantially in the National Institutes of Health (NIH)” but also urges lawmakers to “avoid inclusion of problematic policy riders that may prevent the bipartisan support needed for timely enactment of a final spending bill.” He added that “to fully realize the benefits of medical research, Congress also needs to invest across the health care continuum,” including through other agencies and programs such as AHRQ and the Title VII and VIII workforce programs.
While the Subcommittee did approve the bill by voice vote, full committee Ranking Member Nita Lowey (D-N.Y.) commented that she hopes the full committee can improve this bill and build on its good points, and that Democrats cannot support the bill in its current form.