2016 Federal Budget Process Breaks Down

Grant Olan
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The clock is running out for the US Congress to pass a federal budget for 2016 before the new fiscal year begins on October 1. Confidence is low that Congress will meet the deadline. Many in Washington predict Congress will keep funding the government at last year’s funding levels until it can pass a full-year budget. But if Congress fails to achieve either a new budget for 2016 or agreement to keep government operating at 2015 funding levels, essential government services will shut down.

The last shutdown in 2013 lasted 16 days. Non-mandatory federal programs funded by Congress through the annual appropriations process such as medical research were affected. The National Institutes of Health (NIH), for instance, was unable to fund new grants and contracts during that time.

A major sticking point for many Democrats are the budget caps Congress passed in 2011 to curb the federal deficit. Democrats are refusing to support appropriation bills unless there is a broad agreement to raise the caps—and allow more spending—for both defense and non-defense discretionary (non-mandatory) programs.

As a result of the caps and other federal austerity measures, NIH has lost nearly 25% of its purchasing power since 2003. During the same time, China and other countries have been ramping up their investments in research. The consequences of the funding shortfall are apparent as grant application success rates reach an all-time low and as US scientists move oversees or leave the research field altogether.

NIH Director Francis Collins, MD, PhD, provided alarming testimony before the US House of Representative in March about the impact on student interest in research. “This is the issue that wakes me up at night when I try to contemplate the future of where biomedical research can go in the United States,” Collins said. “They are finding themselves in a situation that is the least supportive of that vision in 50 years. They look ahead of them and see the more senior scientists struggling to keep their labs going and suffering rejection after rejection of grants that would have previously been supported. And they wonder, ‘Do we really want to sign up for that?’ And many of them, regrettably, are making the decision to walk away.”

Despite the current fiscal climate, bipartisan support for increasing NIH’s budget has swelled.The proposed 2016 budgets in the House and Senate both include increases for NIH. The House and Senate bills also provide the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) with increases of $22 million and $76 million, respectively.

Due to the budget cap limits on the total dollar amount Congress can spend on discretionary programs, the NIH increases would come at the expense of other public health and research programs many members of Congress who support NIH also value. The House and Senate bills cut or eliminate funding for the Agency for Healthcare Research and Quality (AHRQ) (the only federal agency that funds health services research), Centers for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA). The House bill also bans patient-centered research.

ASN is working with the Coalition for Health Funding and other partners in protesting these proposed tradeoffs, highlighting the importance of the entire research continuum, advocating to increase the budget caps, and building support for additional investments.

“Attacks on AHRQ and patient-centered research are misguided and counterproductive,” commented ASN Research Advocacy Committee Chair Frank “Chip” Brosius, MD. “Both will yield big savings to Medicare in the long run by improving the delivery of healthcare services and treatments. ASN urges Congress to increase the budget caps and bolster research investments, which is essential for maintaining America’s position as the world leader in medical innovation.”

In July, the House passed the 21st Century Cures Act, which would also provide NIH additional funding totaling $8.75 billion over 5 years and not be subject to the budget caps. A top ASN legislative priority, the society helped the House Energy and Commerce Committee develop and pass the bill and is now working with the Senate Health, Education, Labor, and Pensions Committee to develop and pass its own version of the bill in the Senate.

“ASN is grateful and urges congressional support for the 21st Century Cures Act that would provide NIH increased funding for 5 years,” noted ASN Secretary-Treasurer and Public Policy Board Chair John R. Sedor, MD, FASN. “At the same time, we need to increase the budget caps and provide NIH steady and sustained increases year after year. That is absolutely essential for attracting the best and brightest minds to science and curing our biggest healthcare challenges, including kidney disease.”