House’s HHS budget defies Trump on NIH funding, keeps ONC cuts

President Donald Trump had proposed a 16 percent cut across HHS in his budget blueprint for fiscal year 2018, but the Republican majority on the House Appropriations Committee added $14.5 billion over his request in its own budget proposal released July 12.

More than half of the additional funding in the House version would go to the National Institutes of Health (NIH). Trump’s budget would have reduced funding to the agency by more than $7 billion, but the committee would instead increase it by more than $1.1 billion. Research initiatives which would see a boost in funding include Alzheimer’s research ($400 million increase) and the Precision Medicine Initiative ($80 million increase).

The committee’s NIH budget also went against a Trump proposal to cap how much NIH grant money can be spent on administrative and IT costs, instead requiring the agency to reimburse research institutions for those overhead expenses.

“This bill reflects Republican priorities to cut spending and focus investments in programs our people need the most,” said committee chairman Rodney Frelinghuysen, R-New Jersey.

Unlike Trump’s proposal, the House budget wouldn’t fold the Agency for Healthcare Research and Quality (AHRQ) into NIH, but would cut its funding by $24 million.

Several other HHS agencies would be funded above what Trump requested under the House bill, including the Centers for Disease Control and Prevention (CDC), Substance Abuse and Mental Health Administration (SAMHSA) and the Health Resources and Services Administration (HRSA). In those cases, however, agencies would still see funding levels reduced compared to the fiscal year 2017 budget.

In the case of CMS, the House budget allocates a total of $3.5 billion, $137 million below what Trump requested and $219 million below fiscal year 2017. The committee said the reduced funding would be “sufficient to maintain core operations and services.” It excluded any additional funding for programs tied to the Affordable Care Act, including paying for navigators to help customers buy health insurance on the ACA exchanges.

One area where the House and Trump budgets aligned was on the Office of the National Coordinator for Health IT. Both would reduce the agency’s funding by $22 million—a 36 percent cut. The committee’s version doesn’t go into specifics, only allocating the $38 million for “grants, contracts, and cooperative agreements for the development and advancement of interoperable health information technology” at ONC.

To make due with the cuts, ONC has planned on eliminating functions like the Health IT Adoption programs and the agency’s chief privacy officer. Health IT groups opposed the reducing funding level, arguing it would hinder efforts to implement the 21^st Century Cures Act.