On Thursday, July 24, the Senate appropriations subcommittee with jurisdiction over health research funding released its draft appropriations legislation for fiscal year (FY) 2015. Health services research fared well in the draft bill, in which the subcommittee proposed increases for the National Institutes of Health (NIH), the Agency for Healthcare Research and Quality (AHRQ), and the Centers for Disease Control and Prevention (CDC). Yet, though the legislation looks promising--all things considered--its potential to ever see the light of a vote does not.
Within the bill, the Labor, Health and Human Services, Education and Related Agencies Subcommittee provides details on what should be funded, at what level, and how. Some important notes that are relevant to health services research include:
- AHRQ Budget Authority. AHRQ has historically been funded through what is essentially a "tap" on other health agencies' budgets, making the agency vulnerable as the fiscal belt has tightened and as lawmakers have sought to fund other pressing priorities. The Senate subcommittee would, for the first time in decades, provide AHRQ with its own budget authority, providing significant stability for the agency. AcademyHealth, through the leadership of the Friends of AHRQ and the Friends of NCHS (the National Center for Health Statistics) coalitions, initiated the "Mind the Tap" campaign to educate lawmakers and staff about the evaluation tap and the important work funded by it, including AHRQ, NCHS, the Assistant Secretary for Planning and Evaluation (ASPE), and the Office of the National Coordinator for Health Information Technology.
- Investigator-Initiated Research. AcademyHealth has long advocated for balance in AHRQ-funded research (IIR)--both what is funded, and how. At our recommendation, lawmakers have for many years targeted funding for investigator-initiated research grants at AHRQ to balance investments in intramural research and contracts. Again this year, the subcommittee proposes maintaining this targeted funding of $45 million and notes the importance of true IIR while urging AHRQ to avoid being too prescriptive in awarding these funds:
"The Committee believes that IIR should not be targeted to any specific area of health services research in order to generate the best unsolicited ideas from the research community about a wide variety of topics."
- Commission on Scientific Standing. The subcommittee proposes $1 million for the National Academy of Sciences to establish a "Blue Ribbon Commission on Scientific Standing." The Commission would discern American public opinion on, understanding of, and faith in scientific research and make recommendations for how to improve scientific literacy and enhance Americans' views about science.
Just as important as what is in the bill is what is not. The bill does not include restrictions on the use of research, or prohibitions on comparative effectiveness research and health economics. AcademyHealth has been watching for such troubling language closely, since it first appeared in a draft House appropriations spending bill two years ago.
The release of the draft spending bill provides some transparency into the priorities of the Senate subcommittee with jurisdiction over health spending. However, it's about all we can expect to see for the remainder of this Congress. The Senate Appropriations Committee cancelled its full committee markup of this spending bill among concerns about Affordable Care Act (ACA)-related amendments. The House has not--and likely will not--scheduled a markup of its health spending bill given the political sensitivities surrounding it (e.g., ACA, Title X funding, etc.).
With the month-long August recess upon us, lawmakers will not take any further action on the FY 2015 spending bills until they return in September, at which point they are expected to pass a stop-gap continuing resolution to keep the government running at current levels until December. Whether or not Congress will be able to negotiate an actual spending bill for the Department of Health and Human Services (HHS)--or will take the easy way out with a year-long continuing resolution--will largely depend on which party retains control of the Senate after the mid-term elections.