Emily Holubowich, Senior Vice President at CRD Associates, is AcademyHealth's Washington representative and leads the organization's advocacy efforts in the nation's capital.
On December 16, President Obama signed the bipartisan Consolidated and Further Continuing Appropriations Act, 2015, or "CRomnibus"--part continuing resolution (CR), part omnibus legislation. The massive spending bill includes a CR through February 27, 2015 for the Department of Homeland Security and 11 separate spending bills for the remaining months of the fiscal year, including the Departments of Labor, Health and Human Services, Education and Related Agencies Appropriations Act (Labor-HHS).
This typically controversial bill, which includes spending for the National Institutes of Health (NIH), the Agency for Healthcare Research and Quality (AHRQ), and other health agencies, generally holds funding 'flat' for public health and health research activities. Specifically, the CRomnibus provides NIH a $150 million increase to chip away at funding lost due to sequestration in 2013. AHRQ's budget is held flat when taking into account the approximately $100 million automatic transfer of funding from the Patient-Centered Outcomes Research Trust Fund. The National Center for Health Statistics (NCHS) is also held flat at $155 million; NCHS has not recouped its 2014 loss of mandatory Prevention and Public Health Fund dollars that were used to expand several surveys.
Flat funding roughly represents the best we can hope for in this austere fiscal environment. However, if you look closely at the details of the legislation and its accompanying report, the CRomnibus does include important 'wins' for the field of health services research--wins that may not have been if not for AcademyHealth:
- Budget Authority for AHRQ and NCHS. The base budgets of AHRQ and NCHS have historically been funded through what is essentially a “tap” on other health agencies’ budgets, making the agencies vulnerable as the fiscal belt has tightened and as lawmakers have sought to fund other pressing priorities (see our blog about one such threat, here). The CRomnibus, for the first time in decades, funds the base budgets of AHRQ and NCHS with full budget authority. Direct budget authority with funds from the U.S. Treasury—rather than relying on other agencies’ budgets—will provide significant stability for the agencies going forward.Earlier this year AcademyHealth, through the leadership of our Friends of AHRQ and the Friends of NCHS 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 and NCHS, as well as the Assistant Secretary for Planning and Evaluation or “ASPE” and the Office of the National Coordinator for Health Information Technology, among others.
- Investigator-Initiated Research. AcademyHealth has long advocated for balance in AHRQ-funded research–both what is funded, and how. At our recommendation, lawmakers have for many years targeted funding for investigator-initiated research (IIR) grants at AHRQ to balance investments in intramural research and contracts. Again this year, the CRomnibus includes targeted funding of $45 million for IIR and notes the importance of true IIR while urging AHRQ to avoid being too prescriptive in awarding these funds:
“Investigator-Initiated Research 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.”
The bill’s report language continues:
“For this reason, the agreement rejects the administration’s request to target $15 million of the investigator-initiated grants to health economics. No funds are included for this purpose.”It’s important to note that this sentence does not represent a prohibition on AHRQ-funded health economics research, merely, the targeting of IIR grant funding specifically for health economics. AHRQ may still fund health economics through an open IIR solicitation and/or through other areas of its budget. In this regard, this language maintains the true spirit of IIR—competition in the free market of ideas.
AcademyHealth welcomes the CRomnibus for not only what it includes, but what it does not:
- The CRomnibus includes no bans on patient-centered outcomes research; troubling language that has popped up in draft spending bills of years past.
- The bill does not prohibit health economics research at NIH, as previous draft spending proposals have. It is important to note that the CRomnibus does not include funding for research “within the [Office of the Director’s] Common Fund specifically related to health care financing reform and insurance incentive activities related to the Affordable Care Act.” This is not an outright prohibition agency-wide; Institutes themselves may continue to fund health economics.
- The CRomnibus does not include language to restrict behavioral and social sciences at the National Science Foundation. Funding for NSF’s Directorate of Social, Behavioral, and Economics Sciences or “SBE” is an important barometer of policymakers’ attitudes about scientific disciplines other than the basic, clinical, and physical sciences, including health services research (for more on the ongoing “War on Social Science” click here and here).
AcademyHealth worked diligently with our partners in the social and behavioral science community to educate Members of Congress about the value of such research and the federal role in funding it, and the CRomnibus represents the fruits of these efforts.
With the 113th Congress now adjourned, all eyes turn toward January 6 when the new Congress returns and we embark on a new appropriations season in earnest. We will continue our efforts to educate policymakers about the value of health services research and its important place in the federal health research continuum. We were successful in winning the FY 2015 battle and protecting our priorities, but the CRomnibus does include clear signs—particularly around health economics—that we have not yet won the war. We will be calling on you, our members, to help us make an effective case for funding health services research and health data collection.
For more information about funding levels for your specific priorities, please click here for a copy of the legislation, and click here for a copy of the explanatory statement or “report language” (health is in Division G) that includes more specificity about the funding levels.