NIH Gains in Appropriations Budget, but Falls Short of Need

Zachary Kribs
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On Thursday, July 13, 2017, the House Labor, Health and Human Services, Education, and Related Agencies Appropriations (LHHS) Subcommittee approved the Fiscal Year 2018 budget by a party-line vote. One of the largest of 12 annual appropriations bills, the LHHS bill provides a $5 billion reduction in funding to the Department of Health and Human Services as compared to enacted 2017 funding. However, the legislation provides for a few exemptions from the cuts, including a $1.1 billion increase for the National Institutes of Health.

Under the normal appropriations process as outlined by the Congressional Budget Act, the President presents their budget blueprint to Congress the first Monday of February. By mid-April, Congress completes action on the budget resolution, which sets topline spending levels for the government. Congress then begins to craft appropriations legislation, which specify exact funding levels for all discretionary programs. This process must be complete by the beginning of the fiscal year on October 1, otherwise the government runs out of money and shuts down.

However, this year, as in previous years, the budget process is far from on schedule. Congressional leadership in charge of determining the budget has yet to complete negotiations on topline spending levels, while appropriators, shrugging off normal order, are crafting appropriations legislation without the guidance of a budget resolution. Discrepancies between the appropriations bills and the budget resolution could further delay the budget process, and with just over a month of scheduled work days before the end of the fiscal year, many legislators are predicting the need for emergency funding measures like last year’s series of continuing resolutions.

While the LHHS appropriations bill is a far cry from the Trump administration’s budget proposal, whose drastic cuts the American Society of Nephrology (ASN) spoke out against earlier this year, the bill falls short of ASN’s asks. A $1.1 billion increase for the National Institutes of Health is much more preferable than a $6 billion cut, but the amount is basically half of the $2 billion increase necessary to keep pace with medical inflation and sustain current research levels. Kidney diseases in particular deserve special attention. The government has already pledged $33 billion annually to support dialysis; greater emphasis on funding kidney research will foster breakthrough developments that would change the lives of the nearly 700,000 Americans living with kidney failure, and greatly reduce the burden kidney diseases place on the economy.

ASN will watch the bill closely as it moves through Congress. The legislation is scheduled for a full markup by the House Appropriations Committee on Wednesday, July 18, and will then be voted on in the full House floor before being sent to the Senate. Many amendments are expected to be made, and ASN will continue to advocate for both a $2 billion increase and the establishment of a Special Kidney Program to address the outsized toll kidney diseases place on the American public.