This month, the American Dental Association (ADA), the American Academy of Pediatric Dentistry (AAPD), the American Dental Education Association (ADEA) and the American Association for Dental Research (AADR) sent letters to the House and Senate Labor, Health and Human Services and Education Appropriations Subcommittees urging them to provide modest programmatic increases to allow more Americans to have access to better oral health. The letter included a chart of funding priorities for oral health research and programs, including a request for Congress to provide $430.5 million for the National Institute of Dental and Craniofacial Research (NIDCR) in the final appropriation bill for fiscal year 2017. These organizations also noted the significant and detrimental impact a six month or year long continuing resolution would have on these programs and the populations they serve. ADA, AAPD, ADEA and AADR therefore urged Congress to approve an omnibus appropriation bill after the election.
Late last night the House and Senate Appropriations Committee released the Consolidated
Appropriations Act of 2014, which provides proposed funding levels and report language for the remainder of fiscal year 2014. Congress still needs to approve and vote on this legislation in order for it to become law.
First of all, thank you to all our advocates who responded to the AADR Action Alerts, contacted your Members of Congress, invited them to your campuses, wrote editorials and other activities that heightened their awareness of the importance of a strong biomedical research enterprise for America. Your efforts were noted and against all odds, the Consolidated Appropriations Act contains a Labor-Health and Human Services (L-HHS) appropriations section.
Specifically, the Consolidated Appropriations Act of 2014 proposes to fund the National Institutes of Health at $29.926 billion and the National Institute of Dental and Craniofacial Research (NIDCR) at $398.7 million, which is nearly a one billion dollar increase for NIH and an $11.7 million increase from the FY13 post-sequestration level for NIDCR. However, this is still $766 million below FY12 for NIH and $11.6 million below for NIDCR. It is important to note that the approximate one billion increase provided to the NIH, “…(was) generally distributed proportionately among NIH Institutes and Centers.” The other additional amounts were added to the National Institute of Aging in recognition of Alzheimer’s research and also to other institutes in anticipation of research in connection to the Brain Research through Application of Innovative Neurotechnologies (BRAIN) initiative.
Additionally, the explanatory statement accompanying the bill includes report language
encouraging the director of the NIH to make the development of alternative dental restorative materials a high priority.
“Dental Materials Research-The United Nations (UN) Environmental Programme, International Negotiating Committee completed deliberations in January 2013 on a global legally binding treaty on mercury. The UN agreement contains provisions for the reduction in the use of dental amalgam, as a mercury- added product, and calls for increased dental research into alternative materials. Given the global commitment to reduce all uses of mercury, the NIH Director is expected to make the development of alternative dental restorative materials a high priority.” (Joint Explanatory Statement, Division H-Depts. Of Labor-HHS-Education pg. 38)
AADR also advocates and tracks funding for a number of institutions. Click here to view a detailed funding chart.
Other Important Provisions
- The agreement proposes $32 million for the Health Resources and Services Administration (HRSA) oral health training program. Within the $32 million no less than $8 million is dedicated for general dentistry programs and not less than $8 million for pediatric dentistry programs. This section also prohibits health workforce funds to be used for section 340G-1, the Alternative Dental Health Care Providers Demonstration
- The agreement includes funding for the early childhood caries initiative within the
Indian Health Services. According to the report language, “The Service is encouraged to work with the Bureau of Indian Education (BIE) and to consult with Tribes about increasing preventive dental care for children by bringing dentists and hygienists into BIE schools. The Service should continue to make significant strides towards completion of
electronic dental records. The Service is encouraged to explore establishing a centralized credentialing system to address workforce needs similar to those of the Departments of Defense and Veterans Affairs, to consider a pilot program for the credentialing of dentists, and to propose funding for fiscal year 2015.”
The Centers for Disease Control and
Prevention (CDC) programs are directed to actively coordinate with the
Institutes and Centers of the NIH to identify scientific gaps to accelerate
understanding of diseases and their prevention knowledge across NIH and CDC
- In accordance with a longstanding tradition funding is not directed to any specific disease research area. The NIH is expected to base its funding decisions only on scientific opportunities and the peer review process.
- NIH is expected to maintain funding support for basic biomedical research.
- The NIH Director shall provide a report on Core Techniques and Technologies for Advancing Big Data within 180 days of enactment to the House and Senate Appropriations Committee.
- The NIH Director and IC Directors are directed to work with the other HHS operating divisions to establish a more systematic means of disseminating research results.
- The NIH is directed to examine and produce a report on how the post peer review priority setting process, resource allocation process and the portfolio evaluation data and information to ensure that the priority setting process provides decision makers with answers to key questions such as: How the proposed activity
significantly advances the body of biomedical science; How the proposed activity could contribute to expanding knowledge to improve human health; The relationship and impact of the proposed
activity to the program goals and objectives; and how the proposed activity could impact the overall research portfolio of the NIH and the national research institute or center involved.
- The NIH Director shall produce a report regarding the implementation of strategic planning. This report will include information about the prioritization process between rare and neglected diseases while also maintaining a focus balance between translational and basic bio-medical science; and how the plan is harmonized across the NIH ICs to ensure a balanced portfolio that is free of unnecessary duplication and takes advantage of cross-cutting bio-medical research.
What is Next? Today the House will vote on a short term continuing resolution funding the federal government through Jan. 18 to give Congress more time to vote on the Consolidated Appropriations Act of 2014. AADR will keep you informed as this process moves forward.
On June 1st, the organization with over 10,000 graduate students known as Stand With Science (SWS) published an op-ed in The Journal of Science Policy & Governance, highlighting the need student engagement and advocacy for the protection of science funding. Following an explanation of the sequester and its impact to the R&D industry as a whole, SWS discusses funding cuts that impact the student community: “We as graduate students must be concerned about cuts to all science funding, as all cuts to science are cuts to our future livelihoods as much as they are cuts to our nation’s competitiveness.” They follow with a subsequent call to action to the research community as a whole: “We believe the roll of the scientist should not be limited to the laboratory, and that [we] have a responsibility to contribute to important policy debates concerning science and science funding.”
See the article here.
Senate Budget Chair, Patty Murray (D-WA), released her budget resolution for Fiscal Year 2014, which starts on October 1st. This Senate resolution is a sharp contrast to the budget resolution released by the House Budget Chairman, Paul Ryan (R-WI). While both resolutions have requested $966 billion for discretionary spending, Senator Murray requested $497 billion for defense, and $469 billion for non-defense (non-defense covers education, NIH, FDA, CDC, and others). Representative Ryan requested $522 billion for defense and $414 billion for non-defense. This means that the difference in allocations for non-defense between the two resolutions is $55 billion, or 13% more than what Ryan’s budget requested for non-defense. The House and Senate will likely proceed on with the FY14 appropriations process without agreeing on top-line budget numbers, instead opting to assign budget allocations to agencies and programs within their respective top-line caps. At the end of the process, we are likely to see appropriations bills produced with dramatically different numbers — between House and Senate versions — for agencies such as NIH and NSF.
Earlier in the week, Senator Tom Harkin, Chair of the Senate Subcommittee on Labor-HHS-Education Appropriations, put forward an amendment to the FY13 continuing resolution/omnibus spending package offered by Senate Appropriations Chair Barbara Mikulski. The spending package offered by Senator Mikulski would provide a near level-funding base (compared with FY12) for most agencies, with actual budget prioritization for a few agencies (e.g. Commerce, Justice, National Science Foundation, Defense, Homeland Security, Military Construction, Veterans Affairs) and a list of anomalies (including NIH) that would deviate slightly from the flat-funding policy applied to most areas. The roughly 5% sequestration cut to most agencies and programs would then be applied to the base, bring most considerably lower than their FY12 appropriation. Senator Harkin’s amendment adds the Labor-HHS-Education and Related Agencies spending accounts to the list of agencies that Senator Mikulski has provided actual prioritized budget figures for. According to staff on Senator Harkin’s subcommittee, the amendment has a neutral fiscal impact as it puts off anticipated increases for the implementation of the state exchanges included in the Affordable Care Act. Continue reading
Yesterday, the Senate Subcommittee on Labor-HHS-Education advanced a Fiscal Year 2013 spending bill that would provide NIH a 0.33% or $100 million increase over the FY12 level. Continue reading
On Monday, President Obama released his Fiscal Year 2013 budget proposal. As the week progressed, federal agency officials began to release details of the proposal, which is drawing criticism from many organizations in the health and research communities. The President’s budget proproses to freeze funding for NIH at the FY12 level of $30.7 billion. In a budget briefing on Wednesday (2/15), NIH Director Frances Collins stated that despite the freeze in funding, the President’s budget proposal would allow for a 7% increase in FY13 (over FY12) in new and competing research grants. Dr. Collins stated that the increase is made possible by increased turnover in grants, largely do to the fact that “science is moving more quickly” than has traditionally been the case. The decrease in the duration of grants coupled with a 1% FY13 reduction to noncompeting grants was mentioned as the primary drivers of the proposed increase in new and competing grants. Dr. Collins acknowledged that, when adjusted for inflation, purchasing power at NIH has been in decline since 2003.
Some items of note from the NIH FY13 Budget Proposal:
- The NIDCR budget is slated for a $2 million decrease to $408 million.
- Funds are sought from the Public Health Prevention Fund (part of the Affordable Care Act) to make a significant increase in Alzheimer’s research.
- The ratio of funding between basic and applied research (54% basic, 46% applied) remains constant -as has been the case for several years.
- The National Center for Advancing Translational Sciences (NCATS) would receive an 11% increase to $639 million, which includes significant funding ($50 million) for the Cures Acceleration Network.
Other noteworthy budget information:
- The overall Health and Human Services budget request is 8.5% lower than last year.
- Oral health funding within CDC, Chronic Disease Prevention and Health Promotion, is essentially the same after a $9,000 increase to $14.653 million.
- The request for the National Science Foundation is up 5% to $7.373 billion.
- The request for the Agency for Healthcare Research and Quality is up by roughly 1% to $408.8 million. However, the proposal cuts investigator-initiated researcg grants by more than 31%, and comparative effectiveness research grants by 41%.
The President’s Budget Request marks the beginning of the budget process on the Hill. It is clear that the FY13 appropriations process is off to a rocky start for health and much of the research community.
In a demonstration of “better late than never,” the House and Senate joined late last week to approve Fiscal Year 2012 spending for the nine appropriations bills that remained. The end of the FY12 appropriations process came roughly 11 weeks late, as the fiscal year began on October 1st. However, some are commending Congress for passage of all of its spending bills in mid-December, since in recent years the annual appropriations process lasted several months -well into the next calendar year. President Obama is expected to sign the package into law by December 23rd -when temporary spending expires.
Provisions of Note in Final FY12 “Omnibus/Megabus” Spending Bill:
[*Note: The Labor-HHS-Education section of the omnibus FY12 spending bill contains a 0.189% across-the-board (ATB) reduction]
National Institutes of Health– Provided $30.7 billion or $299 million (approximately 1%) above FY11. [$30.6 billion after ATB reduction]
NIH is strongly urged to ensure its policies continue to support a robust extramural community and make certain sufficient research resources are available to the more than 300,000 NIH-supported scientists at over 3,100 institutions across the country. The conferees affirm the critical importance of new and competing research project grants (RPGs) to the mission of NIH and are concerned that in the past few years, NIH has failed to support the number of new, competing RPGs that it estimated would be awarded in its annual congressional budget justifications. The conferees expect NIH to evaluate its new grant-estimating methodology to improve its accuracy and support as many scientifically meritorious new and competing RPGs as possible, at a reasonable award level, with the funding provided in this Act.
In recent years, extramural research has accounted for nearly 90 percent of NIH’s budget. The conferees strongly urge NIH to maintain at least that level in fiscal year 2012. NIH should also establish safeguards to ensure the percentage of funds used to support basic research across NIH is maintained.
National Institute of Dental and Craniofacial Research- $411.5 million or $1.9 million (0.46%) above FY11. [$410.7 million after ATB reduction]
National Center for Advancing Translational Sciences (NCATS)- $576.5 million. [$575.4 million after ATB reduction]
The conference agreement includes language to eliminate the National Center for Research Resources (NCRR) and create the National Center for Advancing Translational Sciences (NCATS).
NCATS will study steps in the therapeutics development and implementation process, consult with experts in academia and the biotechnology and pharmaceutical industries to identify bottlenecks in the processes that are amenable to re-engineering, and develop new technologies and innovative methods for streamlining the processes. In order to evaluate these innovations and new approaches, NCATS will undertake targeted therapeutics development and implementation projects. In all of these efforts, the conferees expect that NCATS will complement, not compete with, the efforts of the private sector.
While the conferees welcome the creation of NCATS, they were disappointed by the way the administration requested it. The President’s proposed budget for fiscal year 2012 included a vague description of NCATS but did not formally request funding for the restructuring or provide any details about which components of NIH would be consolidated into the new Center. The failure to do so caused unnecessary uncertainty about the proposal and contributed to the impression that it was being rushed. The conferees are also aware of concerns that the NIH process for evaluating the merits of the NCATS reorganization did not comply with the NIH Reform Act of 2006 with respect to the role of the Scientific Management Review Board (SMRB).
Lessons learned with NCATS should guide NIH as it considers another proposed restructuring, one that would involve consolidating NIDA, NIAAA and components of other Institutes and Centers (ICs) into a new Institute devoted to research on substance use, abuse and addiction. The conferees understand that NIH plans to adopt a more deliberate approach in evaluating the need for this Institute. The conferees strongly recommend that this approach should include full consideration by the SMRB and that if the administration ultimately decides to seek such a restructuring, it should provide sufficient details in a formal budget request to Congress.
Centers for Disease Control and Prevention, Oral Health- $14.7 million or $276,000 (1.8%) less than FY11. [$14.67 million after ATB reduction]
The conferees are pleased to learn that CDC has decided to retain the Division of Oral Health. This action is supported by a recent Institute of Medicine (IOM) report titled “Advancing Oral Health in America” that recommends oral health be given a high priority within HHS. This decision will allow CDC to focus on the prevention and elimination of oral disease, support state oral health infrastructure programs, and improve the coordination of oral health activities with other chronic disease prevention activities.
Agency for Healthcare Research and Quality- $369 million or $3 million (0.8%) below FY11. [$368 million after ATB reduction]
House Oral Health Caucus Co-Chairs, Mike Simpson (R-ID) and Elijah Cummins (D-MD), were joined by 44 Members from both parties in requesting legislative language to prevent the Centers of Disease Control and Prevention (CDC) from downgrading its Division of Oral Health (DOH) to branch status -as has been proposed. The letter explains that efforts to reduce costs by eliminating duplicative programs should not involve DOH, given its role in advancing general health and a recent HHS-wide push to make oral health more of a priority.
If the letter to the House Appropriations Subcommittee that has jurisdiction over CDC is successful in its initial purpose, language would be added to the FY12 spending bill… directing CDC to maintain the DOH or to report on how the downgrade could happen at a time when HHS has indicated an intention to prioritize oral health. Depending on if and how the Appropriations bodies advance the request, the CDC could still move forward with its initial proposal.
The Centers for Disease Control and Prevention (CDC) has released its 2011-2014 Oral Health Strategic Plan. A CDC proposal, from earlier this year, to downgrade its Division of Oral Health to a branch is not directly mentioned in the plan. However, mention of the Division is limited to two references to past efforts.
According to the CDC, “[The] Oral Health Program is updating its strategic plan to better allocate resources to guide the program’s work for the next three to five years.” Key areas of emphasis, going forward, are said to include: dental caries, periodontal disease, oral and pharyngeal cancers, infection control, dental public health infrastructure, elimination of health disparities, health policy and translation/dissemination of CDC products, and organizational capacity and function.