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Thursday, March 24, 2011

The National Institutes of Health (NIH): Organization, Funding, and Congressional Issues

Judith A. Johnson
Specialist in Biomedical Policy

Pamela W. Smith
Analyst in Biomedical Policy

The National Institutes of Health (NIH) is the focal point for federal health research. An agency of the Department of Health and Human Services (HHS), it uses its $31 billion budget to support more than 325,000 scientists and research personnel working at over 3,000 institutions across the U.S. and abroad, as well as to conduct biomedical and behavioral research and research training at its own facilities. The agency consists of the Office of the Director, in charge of overall policy and program coordination, and 27 institutes and centers, each of which focuses on particular diseases or research areas in human health. A range of basic and clinical research is funded through a highly competitive system of peer-reviewed grants and contracts.

Congress doubled the NIH budget over a five-year period from its FY1998 base of $13.7 billion to the FY2003 level of $27.1 billion. Since then, the growth rate of the NIH budget has been below the rate of inflation, which for biomedical research in FY2011 is estimated to be 2.9%. The American Recovery and Reinvestment Act (ARRA ) provided NIH with an additional $10.4 billion to be spent over the two-year period of FY2009 through FY2010. The Continuing Appropriations Act, 2011 (P.L. 111-242), as amended, provides temporary FY2011 funding through March 18, 2011, at the FY2010 rate of operations. H.R. 1, the Full Year Continuing Appropriations Act, 2011, would provide funding for NIH for the remainder of the fiscal year. According to the House Appropriations Committee, the bill would reduce the NIH budget by $1.63 billion compared to the FY2010 level and by $1.57 billion compared with the FY2011 request. For FY2012, the Obama Administration has requested $32 billion for NIH, an increase of $745 million (2.4%) over FY2010.

Appropriators and authorizers face many issues in working with NIH to set research priorities in the face of tight budgets. Congress accepts, for the most part, the priorities established through the agency’s complex process of weighing scientific opportunity and public health needs. While the Public Health Service Act (PHSA) provides the statutory basis for NIH programs, it is primarily through appropriations report language, not budget line items or earmarks, that Congress gives direction to NIH and allows a voice for advocacy groups. Challenges facing the agency and the research enterprise, all aggravated by restrained budgets, include attracting and keeping young scientists in research careers; improving the translation of research results into useful medical interventions through more efficient clinical research; creating opportunities for transdisciplinary research that cuts across institute boundaries to exploit the newest scientific discoveries; and managing the portfolio of extramural and intramural research with strategic planning, openness, and public accountability.

The last time Congress addressed NIH with comprehensive legislation was in December 2006 when it passed the NIH Reform Act (P.L. 109-482). Congressional oversight of NIH activities may focus on pending financial conflicts of interest regulations and proposals to reorganize the institutes and centers, such as the new National Center for Advancing Translational Sciences (NCATS). Also, health reform legislation (P.L. 111-148) requires NIH to implement the Cures Acceleration Network (CAN). The purpose of CAN is to support revolutionary advances in basic research and facilitate FDA review of CAN-funded cures. However, although P.L. 111-148 authorizes $500 million for CAN in FY2010, CAN would be funded via a specific appropriation—not through the general NIH appropriation. If CAN receives an appropriation, NIH would determine which medical products are “high need cures,” and then make awards to research entities or companies in order to accelerate the development of such high need cures.

Date of Report: March 16, 2011
Number of Pages: 47
Order Number: R41705
Price: $29.95

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