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  • Washington Highlights

    President Signs FY 2018 Omnibus with $3 Billion NIH Increase, Boost for Other Health Programs

    Tannaz Rasouli, Sr. Director, Public Policy & Strategic Outreach
    Matthew Shick, Sr. Director, Gov't Relations & Regulatory Affairs

    Through bipartisan votes of 256-167 in the House of Representatives March 22 and 67-30 in the Senate early March 23, lawmakers passed the Consolidated Appropriations Act, 2018 (H.R. 1625), the omnibus funding bill that will fund the federal government through fiscal year (FY) 2018, including a $3 billion increase for the National Institutes of Health (NIH) and additional funding for several other health programs. The president announced he had signed the bill March 23. 

    Congressional leaders March 21 posted text and accompanying reports for the omnibus, which includes all 12 of the annual spending bills. In addition to the increase for NIH, the Labor-HHS-Education Appropriations spending bill, Division H of the package, provides substantial increases for many agencies and programs within the Department of Health and Human Services (HHS), including the most substantial increase in years for the Centers for Disease Control and Prevention (CDC) and additional resources across HHS to address the opioid epidemic, among others. 

    Soon after the House of Representatives approved the omnibus, AAMC President and CEO Darrell G. Kirch, MD, issued a statement calling the bill “a milestone for all Americans, especially those who are awaiting cures.” Dr. Kirch also applauded House and Senate Labor-HHS-Education Appropriations Subcommittee Chairs Tom Cole (R-Okla.) and Roy Blunt (R-Mo.) and Ranking Members Rosa DeLauro (D-Conn.) and Patty Murray (D-Wash.), for their “deft hand in prioritizing budget growth for public health and research programs that bolster our nation’s health security,” a sentiment he echoed in a March 23 statement released after Senate passage of the bill. 

    Additionally, the Ad Hoc Group for Medical Research, a coalition of more than 300 NIH advocacy organizations convened by AAMC, issued a March 21 statement congratulating lawmakers for their bipartisan investment in NIH, saying the bill “marks a day of real hope and opportunity.” The AAMC also joined a March 22 letter coordinated by the American Council of Education, expressing strong support for the passage of the omnibus. The letter notes that the NIH funding included in the legislation will “allow for more life-changing research to be performed” and enable “major scientific breakthroughs.” 

    Funding levels for many programs included in the omnibus far exceed the levels proposed in the president’s FY 2018 budget request, and even in some cases, the levels proposed by the House and Senate Appropriations Committees. The Senate voted its Labor-HHS spending bill out of the Senate Appropriations Committee on Sept. 7, 2017 [See Washington Highlights, Sept. 8] while full House approved its spending bills Sept. 15 [See Washington Highlights, Sept. 15]. After months of an apparent stalemate and a series of continuing resolutions, the logjam broke when Congress approved the Bipartisan Budget Act (P.L. 115-123), which increased discretionary spending caps above sequestration levels and gave appropriators additional flexibility to invest in domestic and defense priorities. 

    Besides funding levels for federal programs, lawmakers also reportedly negotiated over 100 policy riders. The final spending package retains the so-called “Dickey amendment,” which prohibits HHS funds from being used to promote or advocate gun control. However, the accompanying report notes, “the Secretary of Health and Human Services has stated the CDC has the authority to conduct research on the causes of gun violence.” 

    Among other agencies and programs of interest to medical schools and teaching hospitals:

    National Institutes of Health. The omnibus provides $37.084 billion for NIH, including the full $496 million from the 21st Century Cures Act Innovation Account and $500 million in new funding for opioid research, including the agency’s public-private partnership with pharmaceutical companies, who will  have a matching requirement for any funds received, and academic institutions. The total funding level for NIH represents a $3 billion increase over the comparable FY 2017 program level for the agency.

    Additionally, the bill includes language prohibiting the administration from modifying NIH support for facilities and administrative expenses and retains the salary cap at Executive Level II of the federal pay scale. The omnibus also directs NIH to delay enforcement of the new clinical trials policy published in September 2017, except for research projects that would have been considered clinical trials under the prior policy, until NIH can consult with the basic research community.

    Agency for Healthcare Research and Quality (AHRQ). The omnibus provides $334 million for AHRQ, a $10 million (3.1 percent) increase over the comparable FY 2017 funding level.

    Health Resources and Services Administration (HRSA) Workforce Programs: The FY 2018 omnibus provides $645.7 million for HRSA Title VII and Title VIII programs, a $102 million (19 percent) increase over the comparable FY 2017 level. The bill provides a new $5 million for "Screening and Treatment for Maternal Depression," authorized under the 21st Century Cures Act. Of particular note is a $27 million (272 percent) increase for Mental and Behavioral Health Education and Training. The Health Careers Opportunity Program (HCOP), Faculty Loan Repayment, and Public Health and Preventative Medicine programs are flat-funded.

    For other HRSA Title VII programs, the FY 2018 omnibus provides Primary Care Medicine $49.9 million, a $10 million (26 percent) increase; Area Health Education Centers (AHECs) $39 million, a $8 million (26 percent) increase; and Centers of Excellence $24.2 million, a $2 million (9 percent) increase.

    The package includes $105 million in new FY 2018 appropriations for the National Health Service Corps (NHSC) on top of the $310 million mandatory fund, bringing its total to $415 million, a 33.9 percent increase over FY 2017. The measure opens the NHSC to substance use disorder counselors, and directs $30 million of the amount provided to a new Rural Communities Opioid Response initiative within the HRSA Office of Rural Health.

    The omnibus provides $315 million for Children’s Hospital GME, a $15 million (5 percent) increase over FY 2017.

    The agreement also establishes a new $15 million “Rural Residency Program” for planning and development costs leading to ACGME accreditation to “expand the number of rural residency training programs with a focus on developing programs that are sustainable beyond Federal funding.” The agreement encourages HRSA to support “rural hospitals, medical schools, and community-based ambulatory settings with rural designation along with a consortia of urban and rural partnerships.”

    Department of Veterans Affairs (VA). The omnibus includes $722 million for the Medical and Prosthetic Research program, a $47 million (7 percent) increase adopted from the Senate Appropriations Committee’s MilCon-VA proposal for FY 2018. The omnibus also includes $8.4 billion in advance funding for Medical Community Care, but does not provide additional funding for the Veterans Choice program which is expected to run out of funds in early June.

    Department of Education Public Service Loan Forgiveness (PSLF). The omnibus provides $2.3 million to the Secretary of Education to conduct outreach to borrowers who intend to apply for PSLF to ensure they meet the terms and conditions of the program. The bill also provides $350 million toward a technical fix for borrowers who would otherwise qualify for PSLF but are enrolled in ineligible loan repayment plans.