APA worked with its coalition partners to ensure Congressional appropriators maintain robust funding for the National Institutes of Health (NIH) and increase funding for the Agency for Healthcare Research and Quality (AHRQ). On July 31, the House passed H.R. 7617, the six-bill Fiscal Year (FY) 2021 “minibus” spending package that includes the Labor-Health and Human Services and Education (L-HHS) appropriations bill.
The bill provides $47 billion for NIH in FY 2021, an increase of $5.5 billion above the FY 2020 funding level. This sum includes $42 billion in annual appropriations, an increase of $500 million and $8.6 billion above the president’s budget request, and $5 billion in emergency appropriations. Each of the NIH institutes is provided “no less than 7 percent” in funding. Further, the House bill contains targeted, high-priority NIH investments, including:
- $5 billion in emergency funding to improve capacity at research institutions
- $25 million for firearm injury and mortality prevention research, an increase of $12.5 million
- $2.9 billion for Alzheimer’s disease and related dementias research, an increase of $35 million
- $80 million for Research Centers in Minority Institutions, an increase of $5 million
- $397 million for Institutional Development Awards, an increase of $10 million
The legislation also continues investments in trans-institute initiatives such as the Brain Research through Advancing Innovative Neurotechnologies® (BRAIN) Initiative, opioids research, the Cancer Moonshot initiative, the All of Us Precision Medicine Initiative, and the Clinical and Translational Science Awards.
The accompanying report to the Labor-HHS Bill included language recognizing the NIH Office of Behavioral and Social Sciences Research within the Office of the NIH Director. “The Committee supports OBSSR’s activities aimed at strengthening these sciences by enhancing trans-NIH investments in longitudinal datasets, technology in support of behavior change, innovative research methodologies, and promoting the inclusion of behavioral and social sciences in initiatives at the NIH Institutes and Centers. In partnership with other Institutes and Centers, OBSSR co-funds highly rated grants that these Institutions and Centers cannot fund alone, and coordinates NIH’s high priority program on gun violence prevention research.”
The House report noted the committee’s review of the Eunice Kennedy Shriver National Institute of Child Health and Human Development’s (NICHD) Strategic Plan. Responding to the plan, the committee notes there is “insufficient focus on behavioral health, cognition, development of young children, language, learning differences, and school readiness. NICHD has long history of funding critical and meritorious work in these areas.” NICHD is encouraged “to consider otherwise qualified grants in these areas on the same basis as any other areas of focus as it works to implement its strategic plan.” APA provided comments to the draft strategic plan in February 2019 prior the publication of the final plan in September 2019.
The report commended the National Institute of Mental Health (NIMH) for its support for youth mental health, including mental health disparities among underrepresented and underserved youth. Congress requests that the NIMH provide a 10-year strategic plan “with a goal of eliminating racial mental health disparities by 2030” within 180 days of passage of the legislation.
The House report highlighted Congress’ concern regarding “the continued lack of diversity at NIH among staff and grantees.” NIH is asked to provide Congress a strategic plan within 180 days of enactment of the bill including long- and short-term goals addressing racial, ethnic, and gender disparities at NIH. The agency is further requested to identify barriers to accessing NIH funding “by investigators researching health disparities,” along with “corrective solutions” NIH can implement. A report detailing “information about the composition of the NIH workforce, advisory committees, and grantees over the last five fiscal years” is also requested. The information should include disaggregated race and ethnicity data, gender, disability status, and veteran status.”
For the Agency for Healthcare Research and Quality (AHRQ), the bill provides $343 million in funding in FY 2021, an increase of $5 million. The bill specified the following budget recommendations: Prevention/Care Management ($11.6 million), Health Information Technology ($16.5 million), Patient Safety Research (74.2 million), Health Services Research, Data, and Dissemination ($97.5 million), and Medical Expenditure Panel Survey ($71.3 million).
Accompanying report language encourages AHRQ to consider establishing a Center for Primary Care Research to support clinical primary care research. AHRQ is urged to examine “how racism and bias is built into algorithms, machine learning, and clinical decision support tools that impact patient outcomes and lead to disparities.”
The Senate has yet to begin working on its versions of the appropriations bills.