The House May 3, 309-118, and Senate May 4, 79-18, voted to send to the president the Consolidated Appropriations Act, 2017 (H.R. 244), an omnibus spending package funding most of the federal government through the end of fiscal year (FY) 2017.
House and Senate leaders released text of the legislation, which includes a $2 billion increase for the National Institutes of Health (NIH), May 1, after months of bicameral, bipartisan negotiations. At press time, the president was expected to sign the spending bill, based on a May 2 Statement of Administration Policy expressing the White House’s overall support.
The package adheres to the FY 2017 discretionary spending cap with a total of $1.07 trillion in discretionary funding, including $161 billion for programs at the Departments of Labor, Health and Human Services (HHS), and Education as Division H of the bill. The Senate Appropriations Committee had approved its version of the spending bill in June 2016, while the House Appropriations Committee advanced its bill in July. Further negotiations stalled after the November 2016 election, with House and Senate leaders opting to complete the FY 2017 bills after the new administration took office.
Shortly after lawmakers unveiled the omnibus, AAMC President and CEO Darrell G. Kirch, MD, issued a statement praising the bill’s investment in NIH and workforce programs at the Health Resources and Services Administration (HRSA), and its continued funding for the Agency for Healthcare Research and Quality (AHRQ), expressing the AAMC’s hope to work with Congress to restore full funding for AHRQ moving forward. Dr. Kirch also praised Senate Labor-HHS-Education Appropriations Subcommittee Chair Roy Blunt (R-Mo.) and Ranking Member Patty Murray (D-Wash.), and their House counterparts, Chair Tom Cole (R-Okla.) and Ranking Member Rosa DeLauro (D-Conn.) “for their leadership in ensuring the federal commitment to medical research remains steadfast.”
The Ad Hoc Group for Medical Research, a coalition of more than 200 NIH advocacy organizations convened by AAMC, also issued a May 1 statement applauding the bill’s NIH investment, and appropriators for “continuing the longstanding bipartisan, bicameral tradition of championing the national commitment to medical research.” Additionally, the AAMC joined a May 2 letter of 37 higher education organizations coordinated by the American Council of Education, expressing strong support for the passage of H.R. 244. The letter notes that the NIH funding included in the legislation will enhance researchers’ ability “to pursue the cutting-edge medical and scientific research that leads to new cures, promising areas of treatments and the development of new technologies that meaningfully improve the lives of every American.”
The final omnibus includes several provisions of particular interest to medical schools and teaching hospitals:
National Institutes of Health: The spending bill provides a program level of $34.084 billion for the NIH, a $2 billion (6.2 percent) increase over FY 2016 including the $352 million provided through the 21st Century Cures Act in FY 2017. The omnibus provides increases for all institutes and centers, which the committees expect to support “an increase in the number of new and competing Research Project Grants,” and highlights increases in funding for research on Alzheimer’s disease, the Precision Medicine Initiative, the Brain Research Through Advancing Innovative Neurotechnologies (BRAIN) initiative, and antibiotic resistance research. The package also increases funding for the Clinical and Translational Science Awards (CTSA) to $516.1 million “to ensure that recommendations from the 2013 Institute of Medicine report can be implemented without reducing the total number of CTSA awards” below the FY 2016 level. Additionally, the agreement increases funding for the Institutional Development Award (IDeA) to $333.4 million and continues to support the National Children’s Study follow-on program at $165 million.
The bill’s explanatory statement also indicates the committees’ expectation that NIH “continue its focus on emerging investigators and first-time renewals...with actions to significantly reduce the average age of an NIH-supported new investigator.” With respect to training awards, the package directs NIH to support awards “in proportion to at least the general IC level funding increase,” and “to provide a stipend level and inflationary increase to grantees that is at least consistent with any fiscal year 2017 Federal employee pay raise.”
Salary Cap: The package maintains the salary cap at Executive Level II of the federal pay scale.
Agency for Healthcare Research and Quality: The omnibus provides $324 million in budget authority for AHRQ, $10 million (3.0 percent) less than the comparable FY 2016 funding level, as proposed by the Senate Appropriations Committee. The FY 2017 spending bill approved by the House Appropriations Committee in July 2016 had proposed $280 million for AHRQ.
Children’s Hospitals Graduate Medical Education (CHGME): The omnibus provides $300 million for HRSA’s CHGME program in FY 2017, as recommended by both the House and Senate Appropriations Committees. The funding level represents a $5 million (1.7 percent) increase over FY 2016.
Health Professions: The omnibus provides a total of $538.7 million for HRSA’s Title VII and Title VIII Workforce Development and Diversity Pipeline Programs, a net $3.2 million (0.6 percent) decrease below the FY 2016 comparable levels. For Title VII specifically, the bill provides $309.2 million, a $3.2 million (1 percent) cut below the comparable FY 2016 funding level, which includes a $50 million transfer to HRSA for the Behavioral Health Workforce Education and Training (BHWET) program, previously funded through the Substance Abuse and Mental Health Services Administration (SAMHSA). Notably, the omnibus maintains FY 2016 funding of $14.2 million for the Health Careers Opportunity Program (HCOP), which had been proposed for elimination by both the House and Senate Appropriations Committees, and also continues FY 2016 funding for the Centers of Excellence, primary care programs, Area Health Education Centers (AHEC), and geriatric training programs. All Title VIII nursing education programs also receive FY 2016 funding levels, for a total of $229.5 million.