The National Institutes of Health (NIH): Background and Congressional Issues

Summary

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 $30 billion budget to support more than 300,000 scientists and research personnel working at over 2,500 institutions across the United States 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.

The congressional authorization committees and appropriation committees face many issues in working with NIH to set research priorities in the face of tight budgets. The last time Congress addressed NIH with comprehensive legislation was in December 2006, when it passed the NIH Reform Act (P.L. 109-482). 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. Congress accepts, for the most part, the priorities established through the agency’s complex process of weighing scientific opportunity and public health needs.

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 FY2015 is estimated to be 2.2%. An exception occurred when the American Recovery and Reinvestment Act (ARRA) of 2009 provided NIH with an additional $10.4 billion to be spent over the two-year period of FY2009 through FY2010.

The FY2013 appropriation provided an increase of almost $70 million for the NIH Office of the Director, but it also required an across-the-board rescission of 0.2% for all accounts. In addition, a March 1, 2013, sequestration order and a transfer of funding under the authority of the HHS Secretary further reduced FY2013 amounts for NIH by $1.553 billion and $173 million, respectively, leaving the agency with an FY2013 program level budget of $29.151 billion. The Consolidated Appropriations Act, 2014 (P.L. 113-76), provided an NIH program level total of $30.151 billion, a $1 billion increase over the FY2013 post-sequester level. The NIH program level in FY2015 is $30.311 billion. The President’s FY2016 budget requests an NIH program level total of $31.311 billion, an increase of $1 billion (3.3%) over the FY2015 level.

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.

Also of concern is the position of U.S. biomedical research compared with the investments being made by other countries. A January 2015 study found that the total U.S. (public and private) share of global biomedical research funding declined from 57% in 2004 to 44% in 2012 while Asia, particularly China, tripled its investment from $2.6 billion (2004) to $9.7 billion (2012). Globally, the United States continues to be the top supporter of both public and industry medical research.