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Second Opinion

Learn about policy issues important to medical schools and teaching hospitals, with Executive Vice President Atul Grover, M.D., Ph.D.

Washington Highlights

House Appropriations Panel Explores Research, Public Health Issues

March 8, 2013—Duplication of federal research and public health efforts was a major theme at a March 5 oversight hearing before the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies.

The witnesses included:

  • Francis S. Collins, M.D., Ph.D., director, National Institutes of Health (NIH);
  • Tom Frieden, M.D., M.P.H., director, Centers for Disease Control and Prevention (CDC);
  • Carolyn M. Clancy, M.D., director, Agency for Healthcare Research and Quality (AHRQ);
  • Patrick Conway, M.D., director, Center for Clinical Standards and Quality, representing Medicare and Medicaid Innovation; and
  • Mary Wakefield, Ph. D., R.N., administrator, Health Resources and Services Administration (HRSA).

In his opening statement, committee chair Jack Kingston (R-Ga.) noted that the subcommittee was proceeding in the absence of the president’s FY 2014 budget. He said he wanted to have “good and bipartisan hearings” and to have “a good relationship with the agencies, not necessarily always agreeing, but always communicating.…” He expressed concern about agencies overusing their reprogramming authorities, and said he wanted all of the agencies to review programs and propose elimination of duplications and programs “straying from normal missions statements.”

In her opening statement, subcommittee ranking member Rosa DeLauro (D-Conn.) noted, “Despite the importance of these and other missions, the budgets for many of these programs have seriously eroded over the last decade. In many cases funding has failed to keep up with costs, and for some programs funding has been cut in actual dollar terms.” She said, “For NIH, the purchasing power of its appropriation has dropped about 16 percent since 2003, after adjustment for rising costs of biomedical research.” She added, “At HRSA, the basic health professions training programs have been cut by $37 million since FY 2010 — and that is in actual dollars, before any adjustment for costs or need.”

Rep. DeLauro cautioned, “Under the ten-year caps on discretionary spending that are already in law, it will be extremely difficult to turn this situation around. In fact, before the decade is out, the cuts we have made will take non-defense discretionary spending to the lowest level as a share of GDP [gross domestic product] on record, and records go back 50 years.”

Chairman Kingston inquired about the overlap of health services research among the agencies, noting a 58 percent increase in NIH’s funding in this area since 2008 and that AHRQ receives $400 million a year. Dr. Collins explained that NIH’s role was to support large scale clinical trials; AHRQ conducts broad scale analyses of research, which may include observational as well as interventional studies; and CDC works with state and local health agencies to implement best practices.  Reps. Andy Harris (R-Md.), a physician; Steve Womack (R-Ark); and Chuck Fleischmann (R-Tenn.) asked similar questions about duplication of efforts.

Rep. DeLauro noted that last year the subcommittee proposed to eliminate AHRQ because it duplicated the work of other agencies, and asked if the Patient-Centered Outcomes Research Institute (PCORI) is in a position to take over support of all of AHRQ’s patient-centered outcomes research. Dr. Clancy replied that health professionals want to know how to get involved in the transformation of the health care system and AHRQ has “developed and generated practical solutions for doctors, hospitals, [and] nurses….” She added that 16 percent of the Patient-Centered Outcomes Research Trust Fund funding goes to AHRQ for the dissemination of findings to the patients and the public and for capacity building.

Rep. DeLauro asked what actions the agencies would take with regard to sequestration. Dr. Collins said he was most worried about the impact on young scientists “who are looking at this circumstance and wondering whether there is a career path for them” when the ability to NIH support has deteriorated over the last 10 years to only a one in six chance of getting funded and will drop further as a result of sequestration. Dr. Frieden said, ‘We will have less money for flu, less money for HIV, less money to protect our children… This will cut our outbreak control staff by more than $12 million.” Dr. Wakefield gave the example of the AIDS Drug Assistance Program (ADAP), which she said would serve about 7,400 fewer patients, and that waiting lists would expand again.

Rep. Harris asked Dr. Collins about a recent paper from UCSF linking the tobacco industry with the emergence of the Tea Party. He said, “I find it incredible that NIH is funding this,” and asked Dr. Collins, “What does the NIH do to universities that waste tax dollars this way like this?” Dr. Collins noted that the study cites two National Cancer Institute (NCI) grants, but pointed out it includes an acknowledgment that the study was not suggested or encouraged by NCI. Rep. Harris pressed him on what NIH will do to ensure “we fund real medical research, as we go forward in a time of constrained resources?” Dr. Collins promised to get back to the congressman on how NIH is responding to this matter.

Rep. Nita Lowy (D-N.Y.), the ranking Democrat on the full committee, described the impact of sequestration on funding to New York state. She said that the heads of several major New York hospitals had expressed concern at recent meeting about cuts in research and the potential impact on jobs. She said sequestration would cost an estimated 750,000 nationwide and jeopardize economic development. She did ask Dr. Collins how we could remain the leaders in biomedical research. He replied that other countries are ramping up their investment in biomedical research “because they have read our playbook.”

Rep. David Joyce (R-Ohio) asked what NIH was doing about the scientific workforce. Dr. Collins explained NIH had completed a “fairly detailed analysis.” He said that science is at a “remarkable time of discovery,” and that there is “great interest” in science careers. He added that it also is clear that these are not easy times and that many universities have cut back on hiring. He noted NIH’s loss of purchasing power and that “a bit of a crisis is beginning to emerge.” He also said that NIH is looking at the lack of diversity in the biomedical research workforce, and that the agency is proposing a “bold new set of programs.” Although he is optimistic that the situation will change, he cautioned that it “will be a long path.”

Rep. Barbara Lee (D-Calif.) asked about the lack of minorities in gaining R-01 grants from NIH. Dr. Collins explained that the problem is not only success rates but why so few minorities are applying for grants. He said NIH “will expend substantial funds in a tough time” to address this issue, and mentioned the programs to provide undergraduate research experiences and create a national research mentoring network.

Contact:

Dave Moore
Senior Director, Government Relations
Telephone: 202-828-0559
Email: dbmoore@aamc.org

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Jason Kleinman
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Telephone: 202-903-0806
Email: jkleinman@aamc.org