Congress passed the Consolidated Appropriations Act, 2021 (H.R. 133) on Monday, Dec. 21, funding federal agencies for the remainder of fiscal year (FY) 2021, as well as providing COVID-19 emergency funding, expanding the number of graduate medical education slots, and extending a number of health care programs [see related stories].
The Senate voted 92-6 to send the package to the president, following House passage of the bill in two votes — 327-85 (including appropriations for most security agencies as Divisions B, C, E, and F) and 359-53 (the remainder of the package). Congress also passed a weeklong continuing resolution to maintain current funding for the government while Congress finalizes the logistics to prepare the bill for presentation to the president to sign into law. The president has raised questions about the legislation, and it is unclear if and when he will sign it.
The White House and Congress had been negotiating for months to determine a path forward for appropriations and COVID-19 relief [see Washington Highlights, Dec. 18]. Congressional and committee leaders released the final bicameral, bipartisan agreement on Dec. 21, and AAMC President and CEO David J. Skorton, MD, issued a statement after the bill’s passage noting, “The AAMC is grateful that negotiations have resulted in an omnibus legislative package that will fund the federal government through the end of FY 2021, including funding for critical public health, research, and health agencies.”
Department of Health and Human Services (HHS)
Within the Labor-HHS-Education section (Division H) of the final bill, the agreement provides a total of $42.934 billion for the National Institutes of Health (NIH) in FY 2021, including the full $404 million provided in FY 2021 through the Innovation Account established in the 21st Century Cures Act for specific initiatives (P.L. 114–255). This total funding level represents a $1.25 billion (3%) increase over the comparable FY 2020 funding level — the sixth consecutive increase since FY 2016.
The Ad Hoc Group, convened by the AAMC, issued a statement on Tuesday, Dec. 22, expressing appreciation that the bill includes some emergency funding for the NIH [see related story] and an FY 2021 investment for the NIH that keeps pace with inflation in light of difficult discretionary spending constraints. The coalition also urged lawmakers to work quickly to provide additional emergency funding for the NIH in the new year and to continue the trajectory of sustained growth above research inflation in FY 2022 and beyond.
The bill retains the salary cap at Executive Level II of the federal pay scale. The bill also includes increases for the NIH’s Clinical and Translational Science Awards program ($587.5 million, an increase of $9 million) and the Institutional Development Award program ($396.6 million, an increase of $10 million), among others.
The joint explanatory statement (JES) accompanying the package includes new report language on several issues, including animals used in research, foreign government influence, and training the next generation of physician-scientists. In place of language in the reports accompanying the House FY 2021 spending bill and the draft Senate bill, the JES explicitly omits report language on “Use of Human Fetal Tissue in Research and Timely Evaluation of Promising Biomedical Research Proposals” [see Washington Highlights, July 17]. The JES also states that report language in House Report 116-450 carries the same weight as the JES, unless otherwise noted.
The bill maintains funding for the Agency for Healthcare Research and Quality at its FY 2020 level of $338 million, falling short of the House-passed level of $343 million but rejecting the Senate’s proposed cut to $256 million.
The omnibus includes a program level of nearly $7.875 billion for the Centers for Disease Control and Prevention (CDC) — an increase of $125.3 million (1.6%) above the FY 2020 enacted level. Within the total, the Racial and Ethnic Approaches to Community Health program receives $63.95 million — a $4 million (6.6%) increase over FY 2020 levels. For the second year in a row, the legislation also includes dedicated funding for gun violence prevention research at the CDC and the NIH, with $12.5 million for each agency as in FY 2020.
The bill provides $3 million in first-time funding for a new CDC Social Determinants of Health Pilot Program, which will provide grants to state, local, territorial, or tribal jurisdictions to support the development of Social Determinants of Health Accelerator Plans. This pilot program was first proposed as part of the AAMC-endorsed Social Determinants Accelerator Act (H.R. 4004, S. 2986) [see Washington Highlights, March 13].
The legislation includes $754 million for the Health Resources and Services Administration (HRSA) Title VII health professions and Title VIII nursing workforce development programs — a $19.5 million (3%) increase over FY 2020 enacted levels. This total includes $43.3 million for Area Health Education Centers, a $2 million (5%) increase; $42.7 million for Geriatric Programs, a $2 million (5%) increase; $37.9 million for Mental and Behavioral Health, a $1 million (3%) increase; and $112 million for Behavioral Health Workforce Education and Training, a $10 million (10%) increase.
The legislation also includes $15 million for the HRSA Health Careers Opportunity Program (HCOP), $23.7 million for Centers of Excellence, $51.5 million for the Scholarships for Disadvantaged Students Program, and $50 million for the Medical Student Education Program — all flat-funded from FY 2020. Previously, the Senate draft Labor-HHS-Education legislation proposed to eliminate the HCOP [see Washington Highlights, Nov. 13].
Other HRSA funding includes $350 million for Children’s Hospitals Graduate Medical Education (a $10 million [3%] increase over FY 2020), $10.5 million for the Rural Residency Program (a $0.5 million [5%] increase over FY 2020), and $120 million for the National Health Service Corps discretionary appropriation [see related story].
Department of Education
Within the Department of Education, the Labor-HHS-Education legislation provides $1.2 billion for Federal Work-Study — a $10 million (1%) increase over FY 2020.
Department of Veterans Affairs (VA)
The bill provides funding for the VA within the Military Construction, VA, and Related Agencies section (Division J). This includes $815 million for the VA Medical and Prosthetic Research Program in FY 2021 — a $15 million (1.9%) increase above the FY 2020 funding level. The bill also includes a $20 million rescission of prior year funds from the VA research program. The JES accompanying Division J includes text related to canine research and an Innovative Research Partnership Demonstration to establish partnerships with public universities.
The bill provides an additional $497 million for the VA Medical Services budget in FY 2021, in addition to $56.16 billion provided in the prior year’s appropriation — a $5.24 billion (10.2%) increase in FY 2021 over the comparable FY 2020 spending level. The bill also provides $58.9 billion in FY 2022 advanced appropriations for Medical Services.
The bill also provides an additional investment of $1.4 billion for the VA Medical Community Care budget in FY 2021 funding, in addition to $17.13 billion provided in the prior year’s appropriation — a $3.23 billion (21.2%) increase in FY 2021 over the comparable FY 2020 spending level. The bill also provides $20.1 billion in FY 2022 advanced appropriations.
National Science Foundation (NSF)
Finally, within the Commerce-Justice-Science section (Division B) that funds the NSF, the bill provides a total of $8.48 billion for the NSF, with $6.91 billion (a $169 million [2.5%] increase) dedicated to research and related activities. The funding total would represent an increase of $209 million (2.5%) over the comparable FY 2020 funding level.
- Washington Highlights