A Preview of This Fall’s Congressional Budget Showdown

These days, it seems that Congress lurches from one fiscal crisis to the next with another one set for this fall. The clock for passing a budget for Fiscal Year 2014, which begins on October 1, is quickly running out. If Congress fails to pass a budget or appropriations funding government services beyond that date, non-essential federal offices will be closed and non-essential employees furloughed. While the impact on health care would be minimal—Medicare and other mandatory federal programs would still operate—public health and medical research programs would be in jeopardy.

Congress faces a number of challenges. For one, the House of Representatives and Senate are unable to agree on funding levels for each of the 13 appropriation bills. The Senate budget levels are above funding caps established by the 2011 Budget Control Act passed by Congress to cut the federal deficit. The House and Senate have not had a conference to reconcile their funding levels for each of the appropriation bills. Complicating matters, the United States will again hit the “debt ceiling” this fall, the legal limit of how much debt the government can assume. Some Republicans say they will refuse to raise the debt ceiling unless there are more federal budget cuts.

If Congress does manage to pass a budget that raises funding levels beyond the existing caps, lawmakers must also amend the 2011 Budget Control Act. Otherwise there will be an across-the-board cut, known as “sequestration,” to bring federal discretionary spending program budgets in line with the caps, including budgets for the Agency for Healthcare Research and Quality (AHRQ) and National Institutes of Health (NIH).” The FDA and NIH have already sustained significant cuts. NIH’s budget in 2013 was $29.1 billion compared to $30.6 billion in 2012. The budget for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the largest source of federal funding for kidney research, was cut $99 million in 2013 (Table 1)

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“These cuts will mean fewer and smaller research projects aimed at finding treatments and cures for kidney disease, and lost jobs,” said John R. Sedor, MD, ASN Research Advocacy Committee chair. “ASN remains committed to protecting NIH, NIDDK, and the rest of the medical research enterprise from more cuts under sequestration and has teamed up with NDD United, a national coalition of 3200 organizations, to fight back.”

“We are facing a time where prominent scientists in the field of nephrology are unsure how and if they will be able to maintain their laboratories over the next several years,” added ASN Research Advocacy Committee Member Jordan A. Kreidberg, MD, PhD. “The field was already in crisis before the sequester, now it is in uncharted territory.”