On June 23, the House Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS) Appropriations Subcommittee approved by voice vote its fiscal year (FY) 2023 spending bill. The bill proposes increases in funding for the National Institutes of Health (NIH), health workforce programs, and public health.
According to the committee’s prepared summary, the bill would provide $124.2 billion for the HHS, an increase of $15.6 billion (24%) over FY 2022 enacted funding and $298 million below the president’s FY 2023 budget request [refer to Washington Highlights, April 1].
In her opening statement, full committee and subcommittee Chair Rosa DeLauro (D-Conn.) outlined the bill’s investments in health care and public health infrastructure, students and higher education, and the behavioral health and public health workforce. She also highlighted the bill’s proposed investments in medical research. “As NIH continues to be at the forefront of transformative medical research, this bill provides $47.5 billion to strengthen its lifesaving scientific breakthroughs in everything from the Cancer Moonshot initiative to Alzheimer’s disease and Universal Flu Vaccine research. We also provide NIH the funding to continue confronting our most urgent health care crises, including maternal health and opioid misuse,” she said.
Ranking Member Tom Cole (R-Okla.) thanked DeLauro for increased investments in their “shared priorities” including the NIH, public health infrastructure, and pandemic preparedness. He also shared appreciation for increases in “special education and programs like TRIO, and GEAR UP, which help first-generation students complete college and change the trajectory of their lives.”
However, both Cole and full committee Ranking Member Kay Granger (R-Texas) said they would oppose the bill due to the significant funding increases in the bill overall. “While these bills fund priorities of Members on both sides of the aisle, our economy cannot sustain such significant increases in government funding. As I’ve said before, record-high spending equals record-high prices for the American people,” Granger said.
The full House Appropriations Committee will mark up the FY 2023 Labor-HHS spending bill on June 30. The bill text released on June 24 included some details regarding funding priorities particularly relevant to academic medicine, highlighted below, with additional detail expected to become available through the accompanying report the committee will likely release in advance of the full committee markup.
National Institutes of Health
The draft bill would provide a total of $47.5 billion for the NIH base budget in FY 2023. The funding level represents a $2.5 billion (5.8%) increase in existing NIH institutes and centers compared to the president’s proposed $275 million increase. The AAMC, as part of nearly 400 coalition members in the Ad Hoc Group for Medical Research, has been urging lawmakers to provide $49.1 billion for NIH in FY 2023.
According to the summary, the bill provides at least a 3.2% increase for each of the NIH’s institutes and centers, with highlighted investments in research on a universal flu vaccine, HIV/AIDS, Alzheimer’s disease and related dementias, and the INCLUDE Down syndrome research initiative, among other new and continued investments in initiatives such as the Cancer Moonshot and health disparities research. The draft bill would also extend certain multiyear NIH grants if the project was disrupted due to COVID-19, and, as proposed in the president’s request, the House bill would rename the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse.
Advanced Research Projects Agency for Health (ARPA-H)
The bill would provide $2.75 billion for ARPA-H available through Sept. 30, 2025, representing a $1.75 (175%) increase over FY 2022. This funding would be provided outside of the NIH but within the HHS budget.
Gun Violence Prevention Research
The spending bill would double funding for firearm injury and mortality prevention research at the NIH from $12.5 million in FY 2022 to $25 million and would increase funding by $22.5 million to $35 million at the Centers for Disease Control and Prevention (CDC), as proposed by the president and supported by the AAMC.
Agency for Healthcare Research and Quality (AHRQ)
The bill would provide $385 million for AHRQ, which would represent an increase of $35 million (9.9%) over the comparable FY 2022 funding level but falls short of the president’s proposed $416 million for the agency.
Centers for Disease Control and Prevention
According to the summary, the bill would provide a total of $10.5 billion for the CDC, an increase of $2 billion (24%) above the FY 2022 enacted level, including funding from the Prevention and Public Health Fund. The summary notes that half of the increase for the CDC is directed to “significant investments in our nation’s public health infrastructure.”
The bill summary highlights proposed investments in modernizing public health data surveillance and analytics at the CDC and state and local health departments; in health equity, including funding to address the health impacts of climate change; community and youth violence prevention; and social determinants of health, including the Racial and Ethnic Approach to Community Health (REACH) program.
Health Resources and Services Administration (HRSA)
The bill provides $9.6 billion for HRSA, which is an increase of $683 million above the FY 2022 enacted level, and $792 million above the president’s budget request.
The bill would provide $156 million for the National Health Service Corps (NHSC), a $45 million (37.5%) increase over the FY 2022 appropriation. The NHSC also separately receives $292 million in mandatory funding for FY 2023. Additionally, the bill includes $60 million for the Medical Student Education primary care recruitment program, which is a $5 million (9.1%) increase over FY 2022. It also includes $12.7 million for Rural Residency Planning and Development grants, which is an increase of $2.2 million (21%) over FY 2022.
Though additional details on all of HRSA’s workforce programs will not become available until the committee releases its accompanying report, the bill summary outlines investments in the behavioral health, public health, and nursing workforce and clinician well-being: $132 million to grow and train the behavioral health workforce; $25 million to establish the Public Health Loan Repayment program; $324 million for the nursing workforce development program, an increase of $44 million over the FY 2022 enacted level; and $25 million for the Preventing Burnout in the Health Workforce program.
Preparedness
The summary indicates that the spending bill would provide $262 million (plus $30 million) for the Hospital Preparedness Program cooperative agreements within the Office of the Assistant Secretary for Preparedness and Response, falling below the $292 million total proposed by the president.
Additionally, the summary highlights a boost in funding for other preparedness programs, including the CDC’s Public Health Emergency Preparedness program, the Biomedical Advanced Research and Development Authority, the Strategic National Stockpile, and pandemic flu efforts.
Department of Education
The bill includes $225 million for new Research and Development Infrastructure Grants to four-year underrepresented minority serving institutions to promote transformational investments in research infrastructure.
Additionally, the bill includes new language allowing Deferred Action for Childhood Arrivals program recipients and students with temporary protected status to be eligible for Pell Grants, as well as other categories of student financial assistance, including federal student loans, TRIO, and Gaining Early Awareness and Readiness for Undergraduate Programs.