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(from IB10018, 07-09-99)
National Institutes of Health (NIH)The Administration has requested a 2.1% increase for NIH for FY2000, $320 million above the FY1999 appropriation, for a total budget of $15.933 billion (see Table 5). Each of the institutes and centers is proposed for a 2.4% increase, while the Buildings and Facilities account drops nearly 25% because of completion of the Clinical Research Center construction funding. FY1999 funding for NIH was finalized at $15.612 billion in the omnibus appropriations act (P.L. 105-277, "Omnibus Consolidated and Emergency Supplemental Appropriations Act, 1999," October 21, 1998), which incorporated the FY1999 Labor-HHS-Education appropriations act. The final appropriation was an increase of $1.99 billion (14.6%) over FY1998; an additional $40 million advance appropriation for FY2000 was provided for the construction project. Increases received by NIH from Congress in the previous two appropriations were 6.8% for FY1997 and 7.1% for FY1998.
For the past two years, many advocates for medical research have been urging Congress to double the NIH budget (increase it by 100%) over the 5-year period from FY1998 to FY2003, an effort that would require increases of about 15% per year. Advocates hoped that the large increase given to NIH in the FY1999 appropriation would be considered a "downpayment" on this effort and would be repeated in FY2000. The Administration, however, in explaining the request for only a 2.1% increase, referred to its original FY1999 proposal to increase the NIH budget by only 48% by FY2003. HHS budget documents indicate that with the large increase from Congress in FY1999, this smaller request for FY2000 still leaves the NIH budget on track for reaching the Administration’s original goal. According to HHS, the request also responds to concerns expressed by the science community in recent years about restoring the balance between funding of health research and support of other scientific disciplines. The FY2000 Budget Resolution (H.Con.Res. 68, H.Rept. 106-91) includes "Sense of the Senate" language indicating an assumption that "there shall be a continuation of the pattern of budgetary increases for biomedical research" (sec. 328). Providing substantial increases for NIH, however, will be quite difficult if existing spending caps are maintained.
In its budget documents, NIH discusses a number of new initiatives that are underway with the FY1999 money, all of which are supposed to be continued in FY2000 and beyond. Details are available on NIH’s website at [http://www4.od.nih.gov/ofm/policies/page1.htm]. These activities, and selected new initiatives for FY2000, address four broad "research themes" across all institutes and centers: exploitation of genomic discoveries (DNA sequencing, identification of disease genes, development of animal models, bioinformatics); interdisciplinary research (engaging other scientific disciplines in medical research); reinvigoration of clinical research (strengthening clinical training, research centers, clinical trials); and elimination of health disparities (among ethnic and socioeconomic subgroups in the United States, and premature mortality and disability in developing countries). No specific funding levels are mentioned for these "theme" areas. In addition, seven cross-cutting "Areas of Research Emphasis" that offer particularly promising opportunities are identified for increases: the biology of brain disorders, including neurodegenerative disorders; new approaches to pathogenesis (disease origins and development); new preventive strategies against disease; new avenues for development of therapeutics; genetic medicine; bioengineering, computers, and advanced instrumentation; and health disparities. Increases for the seven areas, spread across many institutes, total $212 million for FY2000.
Table 5. National Institutes of Health (NIH)
($ millions)
| Institute or Center | FY 1997 compa,b |
FY1998 compa,b,c |
FY1999 compb,c |
FY2000 requestb |
| Cancer | $2,389.1 | $2,527.5 | $2,903.3 | $2,972.9 |
| Heart/Lung/Blood | 1,488.2 | 1,573.0 | 1,783.1 | 1,825.8 |
| Dental/Craniofacial Research | 197.1 | 214.1 | 238.4 | 244.1 |
| Diabetes/Digestive/Kidney Diseases | 813.1 | 873.3 | 997.2 | 1,021.1 |
| Neurological Disorders/Stroke | 729.3 | 774.9 | 899.4 | 921.0 |
| Allergy/Infectious Diseases | 1,257.8 | 1,358.9 | 1,576.6 | 1,614.4 |
| General Medical Sciences | 995.5 | 1,061.7 | 1,198.0 | 1,226.7 |
| Child Health/Human Development | 631.6 | 674.6 | 753.6 | 771.7 |
| Eye | 331.6 | 355.4 | 397.0 | 406.5 |
| Environmental Health Sciences | 307.6 | 341.2 | 388.6 | 397.9 |
| Aging | 484.3 | 520.3 | 600.3 | 614.7 |
| Arthritis/Musculoskeletal/Skin Diseases | 256.2 | 273.0 | 307.4 | 314.8 |
| Deafness/Communication Disorders | 188.3 | 201.3 | 231.6 | 237.2 |
| Nursing Research | 59.6 | 63.5 | 70.1 | 71.7 |
| Alcohol Abuse/Alcoholism | 211.3 | 225.9 | 259.3 | 265.5 |
| Drug Abuse | 490.2 | 531.9 | 608.2 | 622.8 |
| Mental Health | 700.7 | 743.1 | 855.5 | 876.0 |
| Human Genome Research | 189.0 | 220.9 | 269.2 | 275.6 |
| Research Resources | 414.0 | 452.2 | 554.8 | 568.1 |
| Complementary/Alternative Medicine | 0 | 19.5 | 50.0 | 51.2 |
| Fogarty International Center | 26.5 | 28.2 | 35.4 | 36.3 |
| Library of Medicine | 150.4 | 160.5 | 181.3 | 185.7 |
| Office of the Director | 229.7 | 221.0 | 256.6 | 262.7 |
| Buildings & Facilitiesd | 200.0 | 206.6 | 197.5 | 148.8 |
| [AIDS/Off. of AIDS Research (non-add)]e | [1,501.1] | [1,602.8] | [1,798.4] | [1,833.8] |
| Total, NIH | $12,740.9 | $13,622.4 | $15,612.4 | $15,932.8 |
Source: NIH FY2000 and FY1999 Justification of Estimates for Appropriations Committees.
aFY1997 and FY1998 comparable reflect transfer of the Women’s Health
Initiative from the Office of the Director (OD) to National Heart, Lung, and Blood
Institute (FY1997: $56.4 million; FY1998: $54.7 million). FY1998 also reflects transfer of
$25.5 million to DHHS for year 2000 conversion and other activities, and transfer of $41
thousand to National Cancer Institute from Department of State.
bAll years, transfers not included: $9.5 million to National Institute on Drug
Abuse from Office of National Drug Control Policy, and $27 million to National Institute
of Diabetes and Digestive and Kidney Diseases for diabetes research (funding from Balanced
Budget Act of 1997 for FY1998-FY2002).
cFY1998 and FY1999 only are comparable for Clinical Center formula adjustment
among institutes/centers, and for transfer from OD to National Center for Complementary
and Alternative Medicine.
dFY2000 amount includes $40 million forward funding from FY1999 appropriation.
eAll AIDS funding is shown distributed to the individual institutes and
centers, although the FY2000 request places the money in a consolidated OAR account. Total
AIDS spending, as reported by NIH, is shown in brackets. The FY1997, FY1998 and FY1999
appropriations acts did not specify amounts for AIDS.
The request continues NIH’s emphasis on support of extramural research, particularly basic research, through independent investigator-initiated research project grants. Nearly 30,000 projects would be supported — a record number — but 17% fewer new and competing awards would be made than in FY1999. The number of research training positions supported would remain approximately the same, and intramural research would increase 3.7%. AIDS funding is once again proposed for consolidation in a single account for the Office of AIDS Research (OAR). Since FY1996, Congress has preferred to appropriate AIDS funds to the institutes and centers; OAR then distributes the funds consistent with the AIDS research plan that OAR coordinates.
No comprehensive reauthorization legislation for NIH has been enacted since 1993, although several expired authorities were extended in measures that passed at the end of the 105th Congress. Hearings have been held in the last few years on NIH priority-setting and resource allocation, including disease-specific funding, on coordination of NIH research across institutes, on scientific advances, and on clinical research issues. Research priority setting, especially opportunities for public input, have been of particular interest, and NIH has a new Council of Public Representatives which serves as an advisory committee to the director. For further information on NIH, see CRS Report 95-96, The National Institutes of Health: An Overview.