Republican control of both the US House of Representatives and the US Senate for the first time in 40 years presents opportunities as well as challenges for federal funding of biomedical research.
Although leadership of committees has been transferred from the Democrats to the Republicans, bipartisan support for the National Institutes of Health (NIH) will continue to flourish. Such support for the NIH was heightened and expanded during lobbying efforts for the proposed National Fund for Health Research during the last Congress. The brainchild of Senators Mark O. Hatfield (R-OR) and Tom Harkin (D-IA), this concept, introduced during the ill-fated health care reform debate in the last Congress, would establish a voluntary income tax checkoff and a 1% set-aside from all health insurance premiums to go to the NIH to supplement the annual congressional appropriation. Republicans pledged to overhaul the tax code during the 104th Congress, so the income tax checkoff component may become a reality, whereas the 1% set-aside will probably not be resurrected under the expected incremental approach to health care reform. Reportedly, Senator Hatfield plans to soon introduce a free-standing bill to establish a National Fund for Health Research during this new Congress. Funds for this purpose may be deposited in the prospective NIH National Foundation for Biomedical Research, which was created under the 1993 NIH Revitalization Act. In addition, the envisioned Fund has been retained in legislation to inspire state-executed health care reform, S. 308, the Health Partnership Act, reintroduced by Senator Hatfield and Senator Bob Graham (D-FL). If S.308 becomes law, it would provide at least $6 billion to the NIH over a period of 5 years to supplement the NIH annual congressional appropriation. The bill contains a voluntary income tax checkoff and a $1 per pack increase in the tobacco excise tax.
The American Heart Association (AHA) will continue to take a leadership role in seeking alternative funding sources for the NIH. To cut the deficit, Congress remains under the constraints of a 5-year freeze on discretionary programs. This means that increases in one program must be made at the expense of another. For the next several years, funding for the NIH is not expected to be above the inflation rate for biomedical research.
The Senate and the House Appropriations Committees have historically provided bipartisan support for the NIH. If there are any additional resources, the Senate Appropriations Committee Chairman Senator Hatfield and the House Appropriations Subcommittee on Labor, Health and Human Services (HHS), Education, and Related Agencies Chairman John Edward Porter (R-IL-10) will be helpful to the NIH. Senator Hatfield also serves on the Senate Appropriations Subcommittee on Labor-HHS-Education. Both men are ardent champions of increased funding for biomedical research at the NIH.
Representative Porter has consistently sought additional resources for the NIH. In 1994, the AHA honored Senator Hatfield and Congressman Porter with the AHA National Public Service Award. The Chairman of the Senate Appropriations Subcommittee on Labor-HHS-Education, Senator Arlen Specter (R-PA), and the ranking minority member of the comparable House Subcommittee, David Obey (D-WS-7), are both strong supporters of the NIH. Senator Harkin, an ardent NIH supporter, is the Senate subcommittee’s ranking minority member.
However, the “Contract With America” document, which spells out the broad policy goals of the House Republican Members of Congress, presents potential challenges for biomedical research. It proposes a constitutional amendment to balance the budget, a permanent line-item veto, a middle-class tax cut, and an increase in spending for defense. The House Republicans have pledged to act on these and other elements in the “Contract” during the first 100 days of the 104th Congress, or by April 14, 1995. According to most budget analysts, to achieve a balanced budget—which must be approved by both houses of Congress and ultimately ratified by three fourths of the states in 7 years, or by 2002—$700 billion to $800 billion in spending cuts and/or tax increases over 5 years would be required. According to the chairman of the Senate Government Affairs Committee, William V. Roth, Jr (R-DE), “radical reform” would be required to arrive at the more than $1 trillion in deficit reduction required to balance the budget in 7 years. The House passed a balanced budget amendment on January 26, but the amendment was rejected by the Senate on March 2. However, both houses of Congress remain committed to a balanced budget. They can institute the necessary budget cuts to achieve a balanced budget without the amendment. The Senate will probably vote on the amendment again before the 1996 elections. It is expected to be adopted in the Senate by a narrow margin.
The House, on February 6, passed legislation giving the president permanent authority to veto specific items in an appropriation bill without rejecting the entire measure. Although this “line-item veto” has long been supported by many legislators in both houses of Congress to eliminate “pork-barrel projects” from appropriations bills, advocates speculate that it will probably die in the Senate.
The Contract’s proposal to provide a middle-class tax cut could jeopardize funding for biomedical research because tax cuts will be offset by spending cuts to avoid increasing the federal deficit. The President and the Democrats are now also calling for a tax cut.
In addition, the Contract’s element to beef up defense spending to strengthen the military could also threaten biomedical research. Within this element, there would be a reinstitution of the so-called “fire walls” that prevent the transfer of proposed money for the Department of Defense to enhance spending for disassociated social spending programs like the NIH. Moreover, this element mandates that any prospective cuts in defense spending must be applied exclusively to reducing the deficit. The president has subsequently proposed a $25 billion increase in spending for defense over the next 6 years.
To demonstrate that the Republicans are serious about deficit reduction, the Chairman of the House Appropriations Committee, Robert L. Livingston (R-LA-1), has started off the 104th Congress with an unprecedented rescission legislation to cut spending from the current Fiscal Year (FY) 1995 funds enacted last year. Insiders anticipate that the savings from this legislation will be used to pay for the proposed tax cuts and benefit increases in the Contract. According to Representative Livingston, “Republicans will be reevaluating every program, every rice bowl that Democrats have built up over 50, 60 years.” Livingston asked each of the 13 House Appropriations Subcommittee chairmen to develop a list of possible reductions. Livingston stressed that “. . . we are not fooling around. We are committed to cutting back the role of government.” He emphasized that federal agencies must vindicate their existence. Livingston would like to have rescission legislation on the House floor by late February or early March 1995. However, these rescission efforts could be in vain because the Senate may not act on similar legislation.
Generally speaking, during the FY 1996 appropriations process, in the Labor-HHS-Education Appropriation bill, the NIH will probably fare as well as if not better than some of the other programs under this massive spending bill. For instance, historically, Republicans have been more favorably inclined toward providing increased money for biomedical research than for providing more funds for Head Start and other educational programs that the Democrats have traditionally championed. Although the Republicans are serious about drastic spending cuts, if history is any guide, the reductions will probably not be as draconian as proposed.
AHA President Suzanne Oparil, MD, testified before the House Appropriations Subcommittee on Labor-HHS-Education on January 25. Dr Oparil reminded the members of the subcommittee that cardiovascular diseases remain America’s No. 1 killer of men and women and stressed that heart attack and stroke still occur in epidemic proportions. She emphasized that fewer federal research dollars are spent on heart disease and stroke than other major diseases. Advocating the Ad Hoc Group for Medical Research Funding’s FY 1996 proposal of $13 billion for the NIH, Dr Oparil focused on the National Heart, Lung, and Blood Institute (NHLBI) and the National Institute of Neurological Disorders and Stroke (NINDS).
Expressing concern about the steady decline in relative support for the NHLBI compared with the other institutes, she told the panel that the FY 1995 appropriation has reduced NHLBI buying power below its FY 1985 level, restricting the Institute’s ability to fund many promising areas of research. She recommended an FY 1996 appropriation of $1.5 billion for the NHLBI. Oparil cited promising NHLBI research opportunities for innovative, cost-effective approaches to the diagnosis, treatment, and prevention of heart disease and stroke that could be exploited with more resources. In advocating more money for stroke research, Oparil told the Subcommittee that despite the seriousness and expense of stroke, FY 1995 NINDS-supported stroke research is only $71 million. She warned the subcommittee that with the paucity of resources devoted to stroke research, the promise of the Decade of the Brain rings hollow. Pointing out that the NINDS must receive sufficient funds to exploit research opportunities in stroke prevention and treatment, Oparil recommended an FY 1996 appropriation of $95.5 million for stroke to allow NINDS to pursue expanded public education and more rapid progress toward the goal of “prevention of 80% of all strokes and protection of the brain during the acute stroke within the Decade of the Brain.” The AHA is a member of the executive committee of the Ad Hoc Group for Medical Research Funding, “a diverse coalition of more than 130 medical and scientific societies, voluntary health groups, and academic and research organizations dedicated to the future of biomedical and biobehavioral research.” After her testimony, Oparil and former AHA President W. Virgil Brown, MD, met with Speaker of the House Newt Gingrich (R-GA-6). They discussed the importance of funding for biomedical research.
Shortly after Dr Oparil presented the AHA testimony, the president submitted to Congress a budget outlining his administration’s proposed spending priorities for FY 1996, which will begin October 1. The budget reflects the third year of a five-year freeze on discretionary spending with no adjustment for inflation. Under this “zero-sum game,” a program receives an increase only if the amount of the increase is taken from another program. Also, in the budget, the president proposes to extend discretionary spending caps that were lowered in FY 1995 through FY 2000.
Under the president’s FY 1996 budget, the NIH would receive an overall 4.1% increase over FY 1995, or a total of $11.773 billion, slightly less than biomedical research inflation of 4.3%. However, about one third of the increase is targeted toward the president’s priority areas, including HIV/AIDS research, breast cancer and other women’s health research, minority health research (including high blood pressure), high-performance computing, and tuberculosis. Another one quarter of the increase is targeted for biomedical research in brain and brain disorders, gene therapy, musculoskeletal diseases, disorders of developmental and reproductive biology, DNA sequencing technology, structural biology and drug design, and prevention research. Most of the rest of the increase will be targeted for basic research.
For the second year in a row, as required under the NIH Revitalization Act, each of the individual institutes’ AIDS research funds is placed in the Office of AIDS Research. Subsequently, the resources will be transferred to the respective institutes. The president’s FY 1996 budget calls for a 5.4% increase over FY 1995 for NIH AIDS research, for a total of $1.4 billion.
Within the total proposed budget for the NIH, including money for AIDS research, the President recommends an allocation of $1.337 billion for the NHLBI, $672 million for the NINDS, $448 million for the National Institute on Aging (NIA), and $385 million for the National Center for Research Resources (NCRR). If this budget were enacted, the NHLBI, NINDS, NIA, and NCRR would receive 3.1%, 3.0%, 3.0%, and 7.4% increases, respectively, over the FY 1995 levels. These proposed increases, except for the NCRR increase, fall short of the rate of inflation for biomedical research of 4.3%.
The AHA will activate its 56 affiliates nationwide, Grassroots Science Network and Legislative Grassroots Network, and the Stroke Connection and Mended Hearts to contact their members of Congress, particularly the members of the House and the Senate Appropriations Subcommittees on Labor-HHS-Education, to ask the adoption of FY 1996 funding levels of $1.5 billion for the NHLBI and $95.5 million for NINDS-supported stroke research. The AHA will take a leadership role in the NHLBI Constituency Group–designated district lobby week during the congressional district work period of April 8 through April 24 or 30 and the NHLBI-sponsored lobby day on Capitol Hill scheduled for April 27. The NHLBI Constituency Group consists of a variety of national organizations that advocate increased funding for the NHLBI, including the AHA, American College of Cardiology, American Lung Association, the American College of Chest Physicians, and the American Society of Hematology.
The AHA urges volunteers to redouble efforts to communicate with members of Congress and take advantage of the congressional district work periods (see attached schedule in the Table⇓) to meet with their US representatives or senators in the home state to educate them about the seriousness of cardiovascular diseases, including heart attack and stroke, and the need for a significant increase in federal funding for innovative, cost-effective approaches to disease diagnosis, treatment, and prevention. Remind them that heart attack remains America’s No. 1 killer of men and women and that stroke is the third largest killer in the United States and the chief cause of permanent disability. Emphasize the tremendous cost that these diseases have in the nation’s economy, an estimated $138 billion in medical costs and lost productivity in 1995. Working through the local AHA affiliate, invite federal legislators and/or their staff to tour a research facility, showing them what has been accomplished with federal funds and what promising opportunities cannot be pursued because of lack of resources.
- Received February 16, 1995.
- Accepted February 19, 1995.
- Copyright © 1995 by American Heart Association