President Reaches for Middle Ground in His Budget Request

President Barack Obama released his budget request for fiscal year 2014 on April 10, 2013. In a departure from his grand and ambitious budget proposals of the past, the president made some significant concessions to meet congressional Republicans halfway.

Specifically, the president proposed to replace the $1.2 trillion sequester cuts to discretionary spending with $1.8 trillion in deficit reduction achieved through entitlement reform and nearly $1 trillion in new revenue that includes a new minimum tax of 30 percent on households earning more than $1 million after charitable giving, known as the “Buffett Rule.”

The president’s proposal includes a modest increase in the National Institutes of Health’s (NIH) funding, and small increases to programs for organ donation activities.

Of the $1.8 trillion in deficit reduction, $400 billion would be achieved through health care–related savings, such as cuts to Medicare providers’ graduate medical education payments, bad debt reimbursement reductions, and increases in Medicare drug rebates. The $400 billion also includes Medicare structural reforms and new measures to reduce Medicare and Medicaid fraud.

The President’s proposal contains some new initiatives, including:

$100 billion for roads and railways

$8 billion to help community colleges prepare students for existing jobs

$1 billion to promote innovation in manufacturing

$130 million to expand mental health treatment and prevention services

The president’s proposal also includes modest increases for existing federal programs and federal research agencies. For instance, included is $26 million for coordinating organ donation activities and for state grants to develop and improve donor registries, an increase of $2 million.

The budget would increase $471 million, or 1.5 percent over 2012, to $31.3 billion. Included in that funding is a new $100 million initiative called BRAIN, short for Brain Research through Advancing Innovative Neurotechnologies, to uncover new ways to prevent, treat, and cure neurological disorders. The overall NIH budget increase would also include new funding of $18 million for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) over 2012 for a total of $1.8 billion.

“The president should be commended for his proposed investments in NIH and other federal research agencies,” said John R. Sedor, MD, ASN Research Advocacy Committee Chair. “However, ASN is calling for Congress to provide $32 billion for NIH and $2 billion for NIDDK, the minimum amounts needed to avoid loss of promising research, like a groundbreaking discovery that helps explain racial/ethnic disparities that increase risks for kidney disease. African Americans are more than 4 times as likely as Caucasians to progress to advanced kidney failure. Now we know, thanks to recent NIDDK-funded research, that African Americans with two variants of the APOL1 gene face greater risk of kidney failure. This finding could lead to new interventions to improve the kidney health of African Americans.”

ASN has been working with the Ad Hoc Group of Medical Research, Coalition for Health Funding, and the kidney community to advocate for these NIH and NIDDK requests. The society is also supporting the Friends of AHRQ’s request for $433.7 million for the Agency for Healthcare Research and Quality, which is a 7 percent increase over 2012 and in line with the president’s request.

VA funding

While the president also requested a slight increase for medical and prosthetic research for veterans in 2014 of $586 million, ASN is supporting the Friends of VA Medical Care and Health Research’s (FOVA) more robust request of $611 million. This new funding would support new research into conditions veterans returning from Iraq and Afghanistan face, including polytrauma, multiple traumatic injuries such as a serious head injury in addition to a serious burn.

ASN is on the Executive Committee of FOVA, which is also requesting at least $50 million for up to five major Department of Veterans Affairs (VA) research facility construction projects and $175 million in nonrecurring maintenance and minor construction funding to address deficiencies identified in a VA congressionally requested report last year detailing an in-depth survey and analysis of the physical condition of all VA research facilities (www.aamc.org/varpt). For more information about the VA, FOVA, and FOVA’s 2014 requests, see the March issue of ASN Kidney News (http://www.asn-online.org/publications/kidneynews/).

Despite the new initiatives and budget increases for federal research agencies the president proposed, taken together with his deficit reduction recommendations, annual federal budget deficits would dip from the current level of $937 billion to just $439 billion in 2023, or 1.7 percent of the gross domestic product. The nation’s debt would continue to grow, however, climbing from $16.8 trillion today to $25 trillion in 2023.

Of course, Congress controls the purse strings and Republican responses to the president’s budget request have been mixed. As lawmakers negotiate the 2014 budget, ASN will continue highlighting the importance of supporting innovative kidney disease research that will improve patient care, cut costs, and preserve the investigator pipeline.


May 2013 (Vol. 5, Number 5)