Members of Congress and stakeholders in the health community expressed concern over the fiscal year (FY) 2018 budget blueprint released March 16 by the White House. The blueprint proposes a $54 billion increase in defense spending in FY 2018 with offsets in non-defense discretionary spending, including substantial cuts to agencies within the Department of Health and Human Services (HHS), such as the National Institutes of Health (NIH). The budget blueprint only provides a preliminary overview of discretionary funding proposals; proposals for mandatory programs, tax policy proposals, and comprehensive details about individual programs are expected to be released with the full budget in May.
Overall, the blueprint requests $69.0 billion for HHS, which it characterizes as $15.1 billion (17.9 percent) less than current funding levels under the continuing resolution scheduled to expire April 28. Within the HHS total, which “includes additional funds for program integrity and implementing the 21st Century Cures Act,” the budget blueprint proposes to cut funding for NIH by $5.8 billion (18 percent) to $25.9 billion, the lowest level for the agency since FY 2002.
The administration calls for a “major reorganization” within NIH, including the elimination of the Fogarty International Center and “other consolidations and structural changes across NIH organizations and activities” intended to “help focus resources on the highest priority research and training activities.” Additionally, the proposal aims to “[reduce] administrative costs and rebalance Federal contributions to research funding.”
Among the proposed structural changes to NIH, the blueprint “consolidates” the Agency for Healthcare Research and Quality (AHRQ) within NIH, but does not provide details as to whether funding for the agency would be transferred to NIH, or if NIH would be expected to absorb AHRQ’s work with its reduced budget.
The budget blueprint also proposes the elimination of $403 million in health professions and nursing training programs, stating the unspecified programs “lack evidence that they significantly improve the Nation’s health workforce.” However, the budget blueprint “continues to fund health workforce activities that provide scholarships and loan repayments in exchange for service in areas of the United States where there is a shortage of health professionals.”
For the Department of Veterans Affairs (VA), the president’s budget blueprint provides an increase for VA medical care, but does not include details regarding VA Community Care provided at non-VA facilities or VA Research.
AAMC President and CEO Darrell G. Kirch, MD, March 16 responded to the preliminary budget blueprint saying, “The unprecedented budget cuts proposed by President Trump for FY 2018 would cripple the nation’s ability to support and deliver the important biomedical research that provides hope to all, including the millions of Americans affected by life-threatening and chronic diseases. Gutting funding for NIH, the Agency for Healthcare Research and Quality (AHRQ), programs at the Health Resources and Services Administration (HRSA), and other federal agencies would have a devastating effect on America’s health security.”
The Ad Hoc Group for Medical Research, a coalition of more than 200 medical research stakeholder organizations convened by AAMC, panned the proposal as well, emphasizing, “Cuts to NIH of such unprecedented magnitude would affect every American, including patients, their families, researchers, and communities where NIH investment spurs economic growth.”
Members of Congress also reacted to the proposal. Rep. Kevin Yoder (R-Kan.) released a statement that referred to the strong bipartisan support for NIH demonstrated through support for the 21st Century Cures Act (P.L. 114-255) enacted in 2016. He noted, “More than 300 members voted to boost medical research by billions in November, we cannot turn around a few short months later and slash its budget.”
Press also reported that Senate Health, Education, Labor, and Pensions (HELP) Committee Chair Lamar Alexander (R-Tenn.) raised concerns with the proposed budget blueprint. He said, “The president has suggested a budget, but, under the Constitution, Congress passes appropriations bills. As a member of the Senate Appropriations Committee, my priorities are national defense, national laboratories, the National Institutes of Health and national parks. We will not balance the budget by cutting discretionary spending, which is only 31 percent of spending and is already under control because of earlier budget acts.”
Additionally, In a March 17 TV interview, House Labor-HHS-Education Subcommittee Chair Tom Cole (R-Okla.) stated, “I don’t favor cutting NIH or centers for disease control. You’re more likely to die in a pandemic than a terrorist attack.”
Even prior to its release, the budget framework had raised criticism from members of Congress from both sides of the aisle, including House Labor-HHS-Education Subcommittee Chairman Tom Cole (R-Okla.) and senators at a March 8 hearing on NIH [see Washington Highlights, March 10]. Senate Appropriations Committee Ranking Member Pat Leahy (D-Vt.) addressed a March 10 letter to leaders of the Senate Budget Committee highlighting the consequences of sequestration and the projected impact of cuts to nondefense discretionary spending.
NIH Director Francis Collins, M.D., Ph.D., is scheduled to testify before the House Labor-HHS-Education Appropriations Subcommittee March 21.