Proposed NIH Budget Includes Mandatory Funding

President Obama recently unveiled his proposed budget for fiscal year (FY) 2017, which would increase the NIH's total budget by $825 million to roughly $33.1 billion. To fund the increase, he suggested relying on mandatory dollars instead of discretionary funding, which is controlled by Congress. In addition, he proposed trimming the NIH's base budget, funded through discretionary spending, by $1 billion, which would then be offset by $1 billion in mandatory funding.

The modest overall increase of $825 million would prioritize just three NIH programs: $680 million for the NCI's recently announced cancer “moonshot” initiative; $100 million for the Precision Medicine Initiative cohort program; and $45 million for the BRAIN initiative.

Many in the medical research advocacy community have greeted the proposed budget with considerable skepticism. “It's unrealistic, generally speaking,” says Lynn Marquis, director of the Coalition for the Life Sciences. “Thinking in terms of your household budget, you'd never add to your mandatory expenses—picking up a more expensive mortgage, for instance—without knowing you could pay for it.” The same concept applies to what the president has proposed, she says, because a funding source for a mandatory budget increase for the NIH has yet to be identified. Additionally, competition for such funding sources is fierce.

Discretionary dollars are more favorably regarded, Marquis explains, because “the appropriations process allows for flexibility to add new programs or modify existing initiatives.” On the other hand, mandatory spending—once a federal revenue stream has been established—includes no such flexibility, which “could be problematic for a constantly evolving agency like the NIH.” Nonetheless, she acknowledges that this was the president's workaround “to ensure that important programs continue to receive sufficient support,” given that spending caps agreed to last year by Congress and the administration “left things very tight, fiscally.”

Mandatory funding is “not a totally foreign concept,” says NIH Director Francis Collins, MD, PhD. Last year, the House of Representatives passed the 21st Century Cures Act, aimed at accelerating drug discovery and development, which if implemented would provide nearly $9 billion in mandatory funding over 5 years for the NIH. Representatives proposed funding the bill by selling some of the nation's petroleum reserves. The Senate is now considering its own version of this legislation.

Against that backdrop, “it's not surprising that mandatory funding appeared in the budget proposal,” says Mary Woolley, president of Research!America. “It's still a high-risk strategy, albeit not the first time a tactic of this kind has played out between a president and Congress when they're of different parties, over something as inherently popular as medical research.” She points out that during the Clinton administration, “budgets with very modest increases for the NIH were put forward. President Clinton knew full well that Congress would add considerably to what he proposed—which they did.”

Representative Tom Cole (R–OK) and Senator Roy Blunt (R–MO), who lead the appropriations subcommittees overseeing the NIH and other health and education programs, have already announced their intention to boost the NIH's budget, even “at the expense of other agencies within [our] jurisdiction.”

Plus, with public enthusiasm for medical research running high, those seeking reelection in November “will pay exquisite attention to what their constituents want,” Woolley adds.

“We're of the view that where there's a will, there's a way,” she continues. “Congress will find a way to put money behind its priorities. I do think they'll do much more for the NIH, specifically, than the president did in his budget proposal.” –Alissa Poh

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