The Senate Appropriations Committee June 28 approved, 30-1, its fiscal year (FY) 2019 Labor-HHS-Education spending bill (S. 3158, S. Rept. 115-289) with a $2 billion increase for the National Institutes of Health (NIH), two days after the corresponding subcommittee June 26 approved the measure. While House appropriators had hoped to move their version of the spending bill as well [see Washington Highlights, June 15] the House Appropriations Committee postponed consideration of the bill originally scheduled for June 26, though they did release the draft report to accompany their spending bill.
According to the committee summary, the Senate Labor-HHS bill includes $179.3 billion for programs in the Departments of Labor, Health and Human Services, and Education, representing a $2.2 billion increase over FY 2018 funding levels.
Within that total, the Senate committee bill provides $39.1 billion for NIH in FY 2019, an increase of $2 billion (5.4 percent) above the FY 2018 enacted level, including funding provided through the NIH Innovation Account established through the 21st Century Cures Act (P.L. 114-255). This funding level compares to the House bill which includes a $1.25 billion (3.4 percent) increase for NIH, totaling $38.3 billion for FY 2019. The president’s FY 2019 budget request proposed $35.5 billion for the agency [see Washington Highlights, Feb. 16].
In both Senate markups, Labor-HHS-Education Chair Roy Blunt (R-Mo.) stated that the Senate committee bill represents “the fourth consecutive increase for the NIH, bringing the total NIH increase to $9 billion, or 30 percent” over four years.
Both the House subcommittee- and Senate committee-approved bills maintain the salary cap at Executive Level II of the federal pay scale, rejecting the president’s proposal to reduce the cap to Executive Level V. Similarly, neither bill adopts the president’s proposal to limit the percentage of a researcher’s salary that may be supported with NIH funding, with the draft report noting that “the impact of this policy change is unclear” and that an analysis of its expected impact on grants and academic institutions should accompany the administration’s proposal in FY 2020.
The two bodies also both reject the president’s proposal for NIH to absorb the Agency for Healthcare Research and Quality (AHRQ) and two other entities, instead maintaining funding for AHRQ at the FY 2018 level of $334 million.
The House includes a new $200 million for Graduate Medical Education (GME) through the Health Resources and Services Administration (HRSA). Citing physician shortages, particularly in primary care, the bill establishes grants for “four year public universities to support expanded and existing [GME] programs for health professions.” HRSA is directed to prioritize applications from colleges of medicine in states with projected primary care shortages, serving large Medicaid beneficiaries, or in states with a significant proportion of Federally recognized Tribes. The Senate does not adopt the new House GME program.
Both the House and Senate bills include $325 million for Children’s Hospital GME, a $10 million (3 percent) increase over FY 2018. The Senate continues $15 million HRSA Rural Residency program established in the FY 2018 omnibus, while the House bill reduces funding to $10 million.
The HRSA Title VII and Title VIII health professions programs are largely flat-funded in both the House and Senate versions, with the notable exception of the House elimination of the Health Career Opportunity Program (HCOP), which received $14.2 million under the FY 2018 omnibus. The House also cuts the Title VIII Advanced Education Nursing program by $8 million (10.7 percent) from FY 2018. The Senate version preserves funding for HCOP and Advanced Nursing Education, and increases Area Health Education Centers by $2 million (5.2 percent) to a total of $40.45 million in FY 2019.
Both bills include $105 million in discretionary funding for the National Health Service Corps (NHSC), matching the FY 2018 omnibus and bringing total funding for the program to $415 million for FY 2019.
During the Subcommittee markup, Ranking Member Patty Murray (D-Wash.) thanked Chairman Blunt for his collaboration in producing a bipartisan bill, and shared her pride “that so many of us worked together…to push aside partisan poison pills … [to provide] serious new commitments to healthcare, research and innovation.”
Senator Lamar Alexander (R-Tenn.) added his support for the bill, noting that prioritizing biomedical research through an increased investment in NIH is a signal to young researchers “that there is an opportunity out there.” Senator Dick Durbin (D-Ill.) echoed the sentiment in the full committee session, saying that, “Lives will be saved because of your good work.”
AAMC President and CEO Darrell G. Kirch, MD, issued a June 29 statement praising the committee “for working in a bipartisan manner to advance a bill that will bolster medical research supported by the National Institutes of Health (NIH), while also maintaining a strong commitment to other agencies along the health care continuum.”
The Ad Hoc Group for Medical Research, which the AAMC convenes, also issued a statement following subcommittee markup, applauding Chairman Blunt and Ranking Member Murray for their “bipartisan efforts to continue the Subcommittee’s exceptional commitment to medical research.”