The budget process sometimes feels like elaborate theater with its procedures, budget battles, and standstills. Nevertheless, these decisions have to be made – and as fiscal constraints become ever more real, so do the threats. Over the years, we've fought to preserve funding for health services research, and in particular the Agency for Healthcare Research and Quality (AHRQ). Act One ended well; the agency survived. But for how long? As the curtain opens on Act Two, a season with its own challenges and threats, there's an important page to be taken from the history books: a case study of the demise of the Office of Technology Assessment (OTA).

The Office of Technology Assessment (OTA), a former nonpartisan analytical support agency of the United States government, closed its doors on September 29, 1995, after Republican leadership in Congress sought to cut costs and, more generally, reduce the size and scope of the federal government. During its more than 20-year history, OTA provided Congress and the public with comprehensive analyses on science and technology issues, producing nearly 800 reports on everything from agriculture, education, and telecommunications to bioengineering, medicine, space, and energy.

This agency’s elimination came as a shock to many. After all, OTA was producing work that seemed befitting of bipartisan support and was operating under a modest $22 million budget, a fraction of the $2.4 billion legislative branch appropriation at the time. In spite of these considerations, then chairman of the Senate Appropriations Subcommittee on the Legislative Branch, Senator Connie Mack (R-FL), couldn’t be dissuaded of zeroing out the agency’s fiscal year 1996 funding. According to a June 1995 article from the American Institute of Physics, Senator Mack’s concerns about OTA centered on two points (note the first): “The first was that some of OTA’s research is performed elsewhere. He also criticized OTA for doing research on topics that did not have a strictly technological orientation.”

OTA’s proponents, which included Representative Rush Holt (D-NJ), Senator Orrin Hatch (R-UT), Senator Charles Grassley (R-IA), late Senator Edward Kennedy (D-MA), and a number of advocacy groups, such as the Union of Concerned Scientists, contended OTA enabled “members of Congress and the public to better understand the advantages and implications of the science and technologies in which they are asked to invest.” Some, including Representative Holt, who is a former physicist, argued the office was a fiscally sound investment; in a press release he called eliminating OTA to cut costs "foolish," as "OTA had always saved taxpayers far more money than it had cost."

Despite Representative Holt’s protests, OTA was dissolved, and although House Speaker Newt Gingrich claimed Congress could get help elsewhere, Representative Holt said those claims didn’t work. According to Representative Holt, what happened instead was that OTA’s elimination took a scientific toll on Capitol Hill:

“When OTA shut down, technological topics did not become less relevant to the work of Congress. They just became less understood. And scientific thinking lost its toehold on Capitol Hill, with troubling consequences for the ways Congress approaches all issues – not just those that are explicitly scientific.”

During its tenure, OTA produced a considerable amount of scientific and technological-related evidence and had support (albeit limited) from legislators on both sides of the aisle – so what led to its downfall?

Dr. Bruce Bimber, assistant professor in the Department of Political Science at the University of California, Santa Barbara, wrote an enlightening piece on the agency, titled “The Death of an Agency: Office of Technology Assessment & Budget Politics in the 104th Congress” (1996). In it, he highlights three characteristics that are central to understanding OTA’s eventual fate (again, pay attention):

“The first was its small internal constituency within the legislature. Unlike CRS, which provides services to virtually every legislator and committee, or GAO which produces dozens of studies annually for many legislators, OTA's regular constituency numbered only a few dozen senior legislators at most…

Just as important was the fact that OTA had no regular role in the policy-making process…The influence of the agency's work on policy was difficult for many to see…Legislators rarely drew the agency into the more publicly visible processes of debating bills, voting, and publicly explaining decisions. This fact contributed to OTA's low profile inside Congress and especially outside of it.

The third important characteristic of the agency was its strategy toward publicity and visibility. OTA fostered its own low profile and committed itself to the avoidance of controversy. It never attempted significant institutional expansion or, made a priority of establishing a secondary constituency for its work among rank-and-file legislators, the leadership, or the media. Instead, it focused a tremendous amount of organizational effort on balancing the often conflicting interests of its small, primary clientele.”

For those working in health policy, does this sound at all familiar? If not, it should.

The Agency for Healthcare Research and Quality (AHRQ) finds itself in eerily similar circumstances to those of OTA in 1994 and in the lead-up to 1995. Not only is the political context virtually identical—a Republican controlled Congress looking to cut costs in a tight and competitive fiscal environment—but AHRQ is also fighting the same uphill battle to demonstrate its value on Capitol Hill.

Since fiscal year 2012 (and really since its first near-death experience during this same period in 1994) AHRQ and its supporters have been fighting to prove that its mission is unique and fundamentally different from that of other research agencies – and therefore won’t be performed effectively elsewhere without clear authority.

To that point, AHRQ has a low profile inside—but especially outside—of Congress. AHRQ is rarely mentioned during hearings and testimonies, is habitually absent from constituents’ meetings with congressional staff, and notably, is rarely mentioned by name or function (health services research) in the media. Yet AHRQ, as the only agency with a congressional mandate to conduct health services research, has made momentous contributions to health care, including groundbreaking work around central line infections, and is home to highly relevant and widely utilized tools and datasets, including MEPS (Medical Expenditure Panel Survey), the most complete source of data on the cost of use of health care and health insurance coverage.

Nevertheless, despite AHRQ’s charge to generate the evidence to make health care safer, of higher quality, and more accessible, equitable, and affordable, the work of AHRQ and its researchers goes largely unnoticed. Being unnoticed is in many ways its own threat. Revisiting Bimber's piece, he argues that OTA was essentially collateral damage of a larger legislative budget strategy:

“OTA was terminated precisely because it was a small and uncontroversial part of the federal budget, not in spite of this fact…Congress terminated the agency…not because it offered substantive financial savings to legislators hard pressed to wring dollars out of the budget, but because it offered a politically inexpensive way for legislators to signal their willingness to lead the way in making sacrifices in the name of budget reduction. Ultimately that strategy failed, leaving legislators without the symbol they sought or the services of the agency.”

Today, AHRQ is real danger of meeting this same fate.

The House is expected to propose zeroing out the agency’s budget once again in FY17.

It continues to be more important than ever before for the health research and policy communities demonstrate why terminating AHRQ isn’t politically salient or in the best interest of the American people. Looking at history, we know that every threat of elimination requires a robust response. We cannot sit quietly, unnoticed, on the sidelines. Don't let history repeat itself.

For further reading, visit the following:

Blog comments are restricted to AcademyHealth members only. To add comments, please sign-in.