Congress has passed and the president has signed the final group of appropriations bills, called a minibus, for FY24. Speaker Johnson found the majority of his caucus voting against this bill with Democrats providing the needed votes for passage, which may lead to repercussions for his speakership in the weeks and months ahead. The Bill text is here, the joint explanatory text is here, and a summary is here.
The FY24 appropriations process was significantly limited by discretionary budget caps negotiated as part of the Fiscal Responsibility Act of 2023 (FRA) that raised the debt limit. The overall affect was a cut in the minibus programming of approximately 1.7 percent, which was then seen throughout the appropriations bill. Even programs that were flat-funded year over year saw an effective cut as it does not account for population increases and inflation. The budget caps will remain for FY25, which will put even more pressure on programs.
Notable funding levels include:
- Agency for Healthcare Research and Quality – Funded at $369 million, down from $373.5 million. The House Appropriations Committee called for AHRQ to be abolished in their initial proposal.
- Centers for Medicare and Medicaid Services, program management – Funded at $3.7 billion, level from FY23.
- National Institutes of Health – Funded at $47.08 billion, down from $47.5 billion in FY23.
- HeaHealth Resources and Services Administration – Funded at $8.9 billion, down from $9.5 billion.
- AdAdvanced Research Projects Agency for Health (ARPA-H) – Funded at $1.5 billion, level from FY23.
President Biden released his FY25 budget request
The White House Office of Management and Budget (OMB) released the President’s Budget Request (PBR) for FY25. Many programs received significantly lower requests for FY25 than they received in FY24 due to the White House attempting to meet the tight budget caps of the FRA. HHS received a $130.7 billion proposal for FY25, a 9.4 percent decrease from the FY24 Presidential request but a 3 percent increase from the FY23 enacted level. The release of the budget is generally considered to be the starting point for the congressional budget process, and leads to hearings in Congress examining the request. The President’s Budget Request does not have the force of law behind it, but is rather a suggestion that Congress considers. Estimates in the budget are based on FY23 as FY24 had not been finalized by time of release.
Notable funding levels as proposed include:
- Agency for Healthcare Research and Quality – $387 million, a 4 percent increase over FY23
- Centers for Medicare and Medicaid Services, program management – $4.3 billion, a 17 percent increase over FY23
- National Institutes of Health – $50.1 billion, a 6 percent increase from FY23
- HeaHealth Resources and Services Administration – $8 billion, a 17 percent decrease from FY23
- AdAdvanced Research Projects Agency for Health (ARPA-H) – Funded at $1.5 billion, level from FY23.
CMS extended the RFI for their proposed limitations on data policy access
In February, CMS announced a significant reform to how researchers are able to access data. These changes would end the physical distribution of data and require all researchers to use the Virtual Research Data Center (VRDC), a costly and less sophisticated research platform. This transition would occur by August 19 of this year. On March 1, CMS expanded the questions that they were asking stakeholders about to include questions about the implications of the pay and subscription structure of the VRDC and extended the deadline to hear from stakeholders to May 15.
AcademyHealth has been actively involved in educating CMS and Congress about the importance of accessible CMS data. This has included meeting with the staff of House and Senate Committees with jurisdiction over CMS, meeting with CMS leadership, and working with our partners across the research and patient communities to encourage their engagement. You can read our letter to CMS here.
President Biden signs executive order supporting women’s health research
President Biden signed an executive order to expand the federal government’s research into women’s health, including midlife conditions like menopause, arthritis and heart disease, as well as issues specifically affecting women in the military. In what the White House described as the “most comprehensive” action by a president on women’s health research, Mr. Biden directed federal agencies to ensure that they are using federal funds to research health conditions and diseases that disproportionately affect women. Biden’s executive order will require agencies to report annually their investments in women’s health research and to study ways that artificial intelligence can be used to advance such research. The National Institutes of Health will increase by 50 percent investments in small businesses focused on women’s health. The Defense Department also plans to invest $10 million to learn more about cancers and mental health issues affecting women in active military service.
Congress considers changes to CBO scoring to support preventative health
The Congressional Budget Office (CBO) is the official scorekeeper of the costs of legislation considered by the legislative branch. A bad score can stop a bill entirely. The ten-year window of a budget score can lead to incorporating the costs of a public health measure, but not the benefits as they may happen further away. A bipartisan group of senior Members is sponsoring legislation that would allow chairs and ranking members of health and budget committees to request that CBO score preventive health measures over a longer period of time — up to 30 years. If passed, this legislation could remove a significant roadblock to the passage of legislation that prevents chronic disease.
MACPAC reported to Congress on Medicaid and CHIP recommendations
The Medicaid and CHIP Payment and Access Commission (MACPAC) released the March 2024 report to Congress. This report made recommendations on how state Medicaid agencies can improve beneficiary engagement, oversight of denials and appeals in Medicaid managed care, recommendations to improve the appeals process, and a report on Medicaid disproportionate share hospital allotments to states for payments to hospitals that serve a high proportion of Medicaid beneficiaries and other low-income patients.
OMB releases an RFI on how to support public participation with the government
Federal laws regularly require that agencies frequently consult with the public to inform regulations, policies, programs, service designs, and other actions. However, these consultations are often criticized as being inaccessible, convoluted, or disconnected from the interests and priorities of stakeholders, especially those from underserved communities. The Office of Management and Budget (OMB) released a request for information asking for input on how to better structure their guidance, here. The deadline for responses is May 17.
What we’re reading…
As we all work to support more evidence-based policymaking, it was illuminating to read in Science about research by Dietz et al that found that while there has been an increase in the citation of research by Members of Congress and their staff, Democrats and Republicans rarely reference the same papers, illustrating a more hidden form of polarization. They found that from 1995 to 2020 that there was a six times increase in the number of citations appearing in committee documents. However, they found that committees under
One of the promises of AI in research is the ability to use these new tools to find connections that humans can’t always see. Time reported on efforts by Sirota et al using a machine-learning program on a database of electronic health records to find any common features shared by people who were ultimately diagnosed with Alzheimer’s. The identification of these potential red flags could lead to providers identifying patients earlier.
Yet while AI has promises for researchers, it also has challenges. Federal policymakers are considering what to do about patients who receive false information from AI chatbots due to them being based on untrustworthy data. Providers have commented to policymakers about the challenge of patients who demand unnecessary services or try dangerous interventions due to information given to them by AI tools. Brian Anderson of the Coalition for Health AI noted that “we need appropriate safeguards because we don’t want individuals inappropriately led to believe that something is a diagnosis or a potential treatment.” For its part, Congress and the Administration are only starting to wrap their heads around AI, much less regulating it.
It was reported in Nature that more than a quarter of scholarly articles are not being properly archived and preserved, risking them disappearing completely. Eve et al checked whether almost 7.5 million works labeled with digital object identifiers (DOI) are held in archives, and found that more than two million did not appear in a major digital archive. This research should be a wake up call for our assumptions about digital preservation and the long-term sustainability of our research ecosystem.
It's not just you, Congress is passing fewer and fewer laws. As Congress this weekend navigated its 8th self-imposed funding deadline in the last six months and more bills seem destined for dusty shelves, Reuters dove into the perennial question of what is going on. They find that factors include party polarization, reliance on adding unrelated bills to must-pass legislation, decreasing facetime between Members of Congress, and Members not spending enough time in Washington.
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