Senate Appropriations Committee Chair Patrick Leahy (D-Vt.) released drafts of the committee’s 12 fiscal year (FY) 2023 spending bills on July 28, including funding for the departments of Labor, Health and Human Services, and Education (Labor-HHS). Spending bills for the Department of Veterans Affairs and the National Science Foundation were also introduced [refer to related story]. The House of Representatives passed six of its 12 bills earlier this month [refer to Washington Highlights, July 22].
Upon release of the Democratic draft bills, Leahy noted, “It is my goal to finish our work before the end of the 117th Congress. … I look forward to continuing to work with my dear friend, Vice Chairman Richard Shelby [R-Ala.], and I encourage good faith, bipartisan negotiations on toplines to resume with the urgency that this moment requires.” Leahy added, “Enacting full year bills as soon as possible is imperative.”
In response to the Democrats’ release of the spending bills, Shelby stated, “If we are going to get full year bills during this Congress, Democrats must commit to a bipartisan framework that abandons poison pills, preserves legacy riders, and demonstrates a serious commitment to our military. Wasteful, off-budget spending that fuels inflation will be a non-starter. Today’s effort shows we have a long way to go. Democrats need to get serious or, regrettably, I believe we will end up with a long-term [continuing resolution].”
Meanwhile, the House did not advance its Labor-HHS spending bill to floor consideration. Neither chamber is expected to take additional action on their FY 2023 spending bills until after members return from August recess in September, when lawmakers likely will need to pass a continuing resolution. Funding for the current fiscal year is set to expire on Sept. 30.
The draft Senate bills include proposed investments for agencies and programs important to academic medicine that are highlighted below.
National Institutes of Health (NIH)
The draft bill would provide $47 billion for the NIH base budget in FY 2023, a $2 billion (4.5%) increase in existing NIH institutes and centers compared to the president’s proposed $275 million increase and the House committee’s $2.5 billion increase. The bill also provides a $1 billion investment in the Advanced Research Projects Agency for Health “as a standalone agency within NIH” (same funding level as FY 2022), which would be available through Sept. 30, 2025. This results in what the committee reported as a total program level of $48 billion for the NIH in FY 2023.
The Ad Hoc Group for Medical Research issued a July 29 press statement in response to the Senate draft bill, recognizing a proposed eighth straight year of funding growth for the NIH and urging expeditious passage of robust funding growth for the agency. “To make continued progress against the myriad diseases and disorders affecting patients across this country, prepare for future public health threats, and support the research workforce and local economies, it will be essential to maximize the nation’s investment in medical research,” the coalition stated.
Health Resources and Services Administration (HRSA)
The explanatory statement accompanying the draft bill includes $995 million for the HRSA Title VII health professions and Title VIII nursing workforce development programs — a $196.1 million (25%) increase over FY 2022 enacted levels. The draft bill would provide increased funding for the HRSA Title VII workforce diversity programs and increases for the mental and behavioral health programs, closely matching what was proposed in the House.
The statement also set aside $30 million in new funding for the Preventing Burnout in the Health Workforce program, which is $5 million above the proposed House committee’s funding level [refer to Washington Highlights, July 1].
The bill would also provide $135.6 million for the National Health Service Corps (NHSC), a $14 million (11.5%) increase over the FY 2022 comparable level. The NHSC also receives additional mandatory funding. Additionally, the bill includes $12.5 million for Rural Residency Planning and Development grants, an increase of $2 million (19%) over FY 2022. The bill would also provide $385 million for the Children’s Hospitals Graduate Medical Education, an increase of $10 million (3%) over FY 2022 enacted levels.
Agency for Healthcare Research and Quality (AHRQ)
The bill would provide $385 million for AHRQ, a $35 million (10%) increase over FY 2022 enacted levels. The Senate proposal matches the House committee bill but falls short of the president’s $416 million request for AHRQ in FY 2023.
Centers for Disease Control and Prevention (CDC)
According to the explanatory statement, the bill would provide a total of $10.5 billion for the CDC, an increase of $2 billion (24%) above the FY 2022 enacted level.
Similar to the House committee report, the Senate explanatory statement included proposed investments in modernizing public health data surveillance and analytics at the CDC and state and local health departments; health equity, including funding to address the health impacts of climate change; community and youth violence prevention; and social determinants of health, including the Racial and Ethnic Approach to Community Health program.
Gun Violence Prevention Research
Like the House committee bill, the Senate draft spending bill would double funding for firearm injury and mortality prevention research at the NIH from $12.5 million in FY 2022 to $25 million and would increase funding by $22.5 million (180%) to $35 million at the CDC, as proposed by the president and supported by the AAMC.
Preparedness
The explanatory statement included $250 million for the Hospital Preparedness Program cooperative agreements under the purview of the Assistant Secretary for Preparedness and Response, an increase of $18.5 million (8%) over the FY 2022 enacted level and $12 million lower than the proposed House funding level; $8.5 million for National Emerging Special Pathogens Training and Education Center, an increase of $2 million (31%) over FY 2022 enacted levels and $500,000 above the proposed House funding level; and $36 million for the Regional Ebola and Other Special Pathogen Treatment Centers, $15 million above both the FY 2022 enacted level and the proposed House funding level.
Emergency Supplemental Funding
Leahy, as well as Labor-HHS Chair Patty Murray (D-Wash.) and State and Foreign Operations Chair Christopher Coons (D-Del.), announced additional emergency supplemental funding under Title VI of the Labor-HHS bill to provide $16 billion for domestic efforts to address COVID-19 “or any disease with potential for creating a pandemic.” Within this total, the bill specifies up to $9 billion for countermeasures through the Biomedical Advanced Research and Development Authority and $750 million for vaccine research to counter potential coronavirus variants. The committee also included another $5 billion through the spending bill for the State Department for global efforts related to coronaviruses.
Graduate Medical Education
In addition, both the House and Senate Labor-HHS reports contained language that clarifies congressional intent for the distribution of the 1,000 new, Medicare-supported graduate medical education (GME) slots provided in Section 126 of the Consolidated Appropriations Act, 2021 (P.L. 116-260) [refer to Washington Highlights, Dec. 23, 2020]. The Senate explanatory statement reiterated that Congress specified four categories of eligible hospitals for distribution of the slots: hospitals training residents over their cap, hospitals in states with new medical schools, hospitals in rural areas, and hospitals serving Health Professional Shortage Areas. It notes that the Centers for Medicare & Medicaid Services has created a “super prioritization” standard through rulemaking, which is heavily reliant on the location of the teaching hospital [refer to Washington Highlights, July 1, 2021]. The language stressed that this “super prioritization” is “not found in the statute and is not consistent with Congressional intent.” Further, the Senate language directed the CMS to “eliminate or partially modify the ‘super prioritization’ in fiscal year 2023 and beyond.” Both reports urge the CMS to “prioritize applications from any hospitals seeking to establish or expand residency training in certain needed specialties, such as primary care, geriatrics, and general surgery, as had been the priority with previous GME slot distribution programs.”
Department of Education
The bill also included $65 million for a new Research and Development Infrastructure Investment program for historically Black colleges and universities, tribally controlled colleges and universities, and minority-serving institutions (compared to $225 million proposed by the House).
Like the House bill, the Senate bill also included a new general provision making students with Deferred Action for Childhood Arrival status, as well as students with temporary protected status or a grant of deferred enforced departure, eligible for federal student loans.