Healthy Funding: Ensuring a Growing and Predictable Budget for National Institutes of Health

The current budget and appropriations process coupled with a lack of consensus among policymakers on how to address our long-term fiscal challenges makes it seemingly impossible to deliver the level of funding for biomedical research that the American public overwhelmingly supports. This report reviews the implications of a reduced federal commitment to research funded by the National Institutes of Health (including a look beyond our shores) and then examines possible options for altering the budget process so that Congress can continue to invest in the nation’s biomedical leadership even as it makes progress on addressing broader fiscal challenges.

Members on both sides of the aisle understand that the federal government has an essential role in funding biomedical research and often point with pride to the advances made and lives saved or improved on account of research undertaken by scientists in their home states. Government funding for biomedical research brings large health benefits. It also reduces the burden of fiscal debt both by reducing the long-term cost of medical care and by boosting economic growth.

There also seems to be a growing awareness that the failure to provide both growing resources and increased predictability has negative effects on the pace of medical breakthroughs and the strength of the U.S. biomedical industry. Several other nations have succeeded in making long-term public commitments to biomedical research, partly because of its importance in attracting private research.

Unfortunately, political battles over the broader federal budget have prevented legislators from translating this support into rising, or even stable, budgets. This has resulted in tremendous uncertainty about what NIH’s budget will be from year to year. Although there is a general willingness to increase the agency’s budget, members differ over whether any increases should be offset by cuts to other programs. As a result, policymakers should consider separating NIH’s budget from the broader deficit battles and implement a number of budget reforms that could provide NIH with greater resources and flexibility. These include:

• Increase discretionary spending caps and ensure additional funding flows to NIH;
• Provide NIH with permanent appropriations, limiting the agency’s exposure to annual budget battles;
• Establish a biomedical research fund to supplement annual appropriations;
• Remove NIH from the discretionary budget, making the program mandatory; or
• Streamline regulatory processes to ensure efficient use of existing funding.