For months, AcademyHealth has documented the disruption at the Agency for Healthcare Research and Quality (AHRQ), the small federal agency dedicated to making health care safer, more affordable, and more effective. This week, the story took a serious turn.
On September 16, Senators Patty Murray and Tammy Baldwin sent the Department of Health and Human Services a public letter demanding, within 24 hours, full documentation of the interagency agreements AHRQ has used to move its funding. Their concern, and ours, is straightforward: with two weeks left in the fiscal year, is AHRQ actually spending the money Congress gave it for health services research, or is it moving that money out the back door?
Here is what prompted the question.
Congress appropriated about $345 million for AHRQ this year to fund research on patient safety, health care quality, and the cost of care. HHS has said the agency has spent nearly all of it. At his confirmation hearing on September 16, Chris Klomp, the nominee for HHS deputy secretary, testified that AHRQ is "on track to expend 97 percent of its appropriated funds by the end of the fiscal year," though he acknowledged he did not have the detail behind that figure. According to the senators' letter, that near-complete figure does not reflect research grants going out to scientists and institutions. Instead, it reflects a series of interagency agreements that shift AHRQ's dollars to other agencies and other purposes: work on school meals at the National Institutes of Health, "quality improvement" activities on menopause, and other efforts for which, the letter notes, no actual funding opportunities have been posted. Nor does the vague statements of allocations add up to the amount Congress appropriated raising new questions about where the money went.
This distinction matters more than it might seem. There is a difference between spending money on the work Congress funded and promising to move money elsewhere before the clock runs out. When appropriated dollars are shifted out of an agency rather than used for their intended purpose, and when there is no visible way for the intended recipients to apply for them or for the dollars to be spent in time, the funds are not reaching the research Congress intended and taxpayers paid for. That is the heart of the concern the senators raise, and it is why the GAO is already examining whether AHRQ has unlawfully withheld funds.
This maneuver is the mechanism underneath the story we have been tracking all summer. Beginning in July, AHRQ canceled 150 research grants across 32 states that included work on reducing hospital infections, catching diagnoses earlier, supporting families of hospitalized children, improving maternal care, and training the next generation of health services researchers. Our own analysis raised serious questions about whether those cancellations followed the federal rules and laws that govern research grants, including whether the required individual determination was communicated to the grantee – which did not happen for any of these cancelations. Many of the canceled projects fell squarely within the priorities AHRQ itself said it wanted to protect in the cancelation.
Now the picture is clearer. The grants were canceled, the funding stalled, and as the fiscal year closes, the money appears to be moving anywhere but to the health services research it was meant for. In fact, as it does not appear that the appropriated dollars are actually being spent and HHS has not informed the public or Congress about what it is being spent on, this might be an illusion of compliance – a shell game of obscuring federal spending. Without the dollars being spent on the priorities that the law requires, the funding remains unlawfully impounded.
The demand for transparency and the funding of this research is bipartisan. Last week, Senators Dave McCormick (R-PA) and John Fetterman (D-PA) sent a letter to Secretary Kennedy calling on AHRQ to explain how the collapse of grantmaking at the Agency came together, why they canceled so many grants, and why researchers did not get any recourse or appeal. The letter also asks what AHRQ is planning on doing with their appropriated funds. This follows a similar letter sent by 30 Democratic Senators demanding answers about the grant cancelations that AHRQ did not respond to.
Why does this matter beyond one agency's budget?
AHRQ studies not whether a treatment exists, but whether patients receive it safely, affordably, and without preventable harm. That work pays for itself many times over. AHRQ-funded research on reducing hospital-acquired conditions helped prevent an estimated 20,500 deaths and saved $7.7 billion in health care costs between 2014 and 2017. Against a base appropriation of roughly $300 million a year, that is a return of more than $25 for every dollar invested. When that evidence stops being produced, the loss is not abstract. It shows up as infections that could have been prevented, diagnoses that come too late, and costs that keep climbing because no one funded the work to bring them down.
It also sets a precedent. If appropriated funds can be redirected through last-minute interagency agreements, with little transparency and no clear accounting, then Congress's constitutional power to direct federal spending, and the public's ability to know how their tax dollars are used, is weakened well beyond AHRQ.
We want to be clear about what this is and is not about. AcademyHealth is nonpartisan, and this concern has nothing to do with which party holds power or who leads the agency. It rests on a principle that should outlast any administration: when Congress appropriates funds for a purpose, those funds should be used for that purpose. We would raise the same concern regardless of who was in office, because health services research serves patients in every state, and whether the government spends what Congress directed is a matter of good governance, not politics.
We share the senators' call for transparency. But the deeper question is not only whether the money was spent. It is whether it was spent on what the law actually requires. AHRQ's authorizing statute directs it to establish a broad base of scientific research, to provide training grants in health services research, and to support research on health care delivery in rural and underserved communities. Shifting funds into last-minute interagency agreements does none of those things. From everything we and Congress can see, the grants that would fulfill those obligations were canceled, and the training and delivery research the statute calls for is not being funded. That is the heart of the concern: not a matter of accounting, but of a federal agency failing to do what Congress created it, and paid it, to do. AcademyHealth will continue to document what has happened and to give the research community, policymakers, and the public the clearest possible account. Our tracker of the canceled grants is available at researchinterrupted.academyhealth.org.