House Subcommittee OKs FY21 Health Spending Bill

The House Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS-Ed) Appropriations Subcommittee approved on July 7 its draft fiscal year (FY) 2021 spending bill by a party-line vote of 9-6, in advance of full committee consideration scheduled for July 13. Based on preliminary details, the spending package rejects many of the president’s FY 2021 budget proposals and provides increased funding for many agencies and programs impacting academic medicine.

According to the accompanying press release and summary, the bill includes a total of $196.5 billion — $2.4 billion (1.2%) more in discretionary spending compared to the enacted FY 2020 bill, including $96.4 billion for the Department of Health and Human Services (HHS), which is an increase of $1.5 billion (1.6%) over the comparable FY 2020 funding level.

“In the bill, we seek to do more to help our constituents to access new cures, new treatments, new research, new protections, to help them and their families live healthier lives. To fight Alzheimer's, cancer, opioid addiction, antibiotic resistant infections, gun violence, to support food safety, address maternal health, and eliminate HIV-AIDS,” said Subcommittee Chairwoman Rosa DeLauro (D-Conn.) in her opening remarks.

The draft bill provides a total of $47 billion for the NIH in FY 2021 — an increase of $500 million, according to full committee Chairwoman Nita Lowey (D-N.Y.) The bill also includes $5 billion in emergency spending for research, including money to fund research projects that were interrupted by the COVID-19 pandemic, Chairwoman Lowey added. The increase of $500 million (1.2%) above the FY 2020 enacted level would provide $42 billion in annual appropriations, with the $5 billion in emergency appropriations available through FY 2025. According to the committee-prepared summary, $5 billion in emergency funding may be used to offset costs related to reductions in laboratory productivity resulting from interruptions or shutdowns of research activity in FY 2020, and it would be provided to the Office of the Director with the requirement that at least $2.5 billion be distributed across the NIH proportionate to each institute’s and center’s FY 2020 funding level.

Within the total, the bill fully utilizes the $404 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 2021 budget request proposed $38.7 billion for the agency [see Washington Highlights, Feb. 14].

During the subcommittee markup, Ranking Member Tom Cole (R-Okla.) noted his disappointment “to see that almost the entire increase for the [NIH] is provided in the form of emergency spending. As I've said many times, continued steady growth at inflation-plus rates, building on what we have done in bipartisan, bicameral investments over the last several years in our nation's biomedical infrastructure is making a difference.”

“I fear that using an emergency designation that has not been agreed upon by the other body and the administration is creating a false sense of accomplishment … Given the funding constraints we are operating under, I think this will make it extremely difficult to continue the trajectory that we've been on for funding this important agency. And I think that's unfortunate,” Cole concluded.

The Ad Hoc Group for Medical Research, which the AAMC convenes, issued a statement in advance of the markup, noting that the coalition is “grateful that the Subcommittee continues to recognize the NIH as a key national priority despite the restrictive subcommittee funding allocation imposed by the impractical pre-pandemic discretionary spending caps.”

The statement continues, “We welcome the $47 billion provided for the NIH in the Subcommittee’s FY 2021 draft, though we recognize that the unworkable spending caps forced $5 billion of this funding to be provided outside of the NIH’s base budget. If coupled with additional emergency supplemental spending legislation to provide at least $10 billion in dedicated research relief for NIH, the Subcommittee’s FY 2021 bill would represent an important investment to advance new progress toward cures.”

The text of the draft spending bill includes language allowing the extension of funds from multiyear NIH grants originating from FY 2015 to be available through FY 2021. The spending bill also increases by $12.5 million funding for firearm injury and mortality prevention research at both the NIH and the Centers for Disease Control and Prevention (CDC), for a total of $25 million at each agency.

For other public health agencies, the draft spending bill provides a total of $8 billion for the CDC — an increase of $232 million (3%) above the FY 2020 enacted level. In addition, the bill includes $9 billion in emergency supplemental appropriations for the CDC to improve the nation’s preparedness for public health emergencies. The draft spending bill also provides a total of $343 million for the Agency for Healthcare Research and Quality — an increase of $5 million (1.5%) over the comparable FY 2020 funding level.

Additionally, the bill provides $7.2 billion for the Health Resources and Services Administration (HRSA) — a $157 million (2.2%) increase over the FY 2020 enacted levels for the agency. The subcommittee’s draft bill includes $1.24 billion for the HRSA Bureau of Health Workforce (BHW), which is a $48 million (4%) increase over FY 2020 enacted levels. Within the BHW allocation, $55 million was provided for the Title VII Medical Student Education program, which is a $5 million (20%) increase over FY 2020 levels.

The draft legislation also provides $120 million for the National Health Service Corps (NHSC), flat-funded from FY 2020. The NHSC also receives $310 million through its mandatory funding mechanism, which is set to expire on Nov. 30 [see Washington Highlights, March 27]. Under the HRSA Office of Rural Health, the draft bill would provide $11 million for the Rural Residency Planning and Development Program — a $1 million (10%) increase over FY 2020.

The draft legislation also provides increased funding for the Department of Education. According to the press release, the Federal Work Study program received $1.2 billion for FY 2021 — a $30 million (2.5%) increase over FY 2020 enacted levels. The draft bill also provides $50 million for the Temporary Extended Public Service Loan Forgiveness (PSLF) program and $2.3 million for an information campaign requiring the department to provide additional information to borrowers about the PSLF program.