New federal budget brings an end to NIH growth spurt

Washington -- Congress has passed a federal budget for this fiscal year that abandons the dramatic growth in funding that the National Institutes of Health had experienced over the past five years.

After several procedural delays, the Senate signed off on an $820 billion omnibus budget package for the 11 departments that had been operating on continuing resolutions since last October, when fiscal year 2004 started.

The NIH will receive about $1 billion more in 2004 than it did in 2003. Whether it is an adequate increase, or even if it amounts to an increase, depends on who is asked.

According to the Bush administration, the final budget raises NIH research funding by 7% over 2003 levels. That calculation excludes last year's one-time cost of building infrastructure for new bioterrorism facilities.

But taking that bioterrorism money out of the fiscal year 2003 budget would mean that Congress didn't really meet the goal of doubling NIH's budget over five years.

"You can't really say, 'The NIH budget doubled over five years, oh, but by the way, we got a 7% increase this year because some of the money we spent last year didn't really go toward research,' " said David Moore, associate vice president of government relations for the Assn. of American Medical Colleges. "You can't count it both ways."

The AAMC estimates that once all factors are taken into account, the new NIH budget will be about 3.1% more than it was last year.

With inflation, that is not even really an increase, said Stacie Pabst, PhD, director of science policy for Research America, a public education and advocacy nonprofit organization in Alexandria, Va.

"It's a major problem for people doing research," she said.

Some experts speculate that the institutes might have to shorten grant durations or reduce grant amounts to deal with the new fiscal reality.

An NIH spokesman could not confirm this but said officials were making "adjustments" to some grants.

The grant process also has been held up because of the delay in Congress passing the fiscal 2004 budget.

The NIH budget still has to be adjusted downward because of a 2% across-the-board tap on the Health and Human Services Dept. budget to fund several projects and the Agency for Healthcare Research and Quality. Another $150 million will be taken out of NIH's budget as part of its contribution to funding President Bush's international initiative to combat HIV/AIDS.

Ups and downs

The fiscal 2004 budget reduces funding by 4.6% for projects known as Title VII programs, designed to encourage physicians and others to go into primary care. These programs also provide grants to promote ethnic diversity and geographic distribution within the health care work force.

This move comes at a time when the attractiveness of primary care has been waning, experts said. Relatively low pay and high exposure to liability are turning young physicians away from primary care residencies. Without specific incentives, primary care physicians will become increasingly scarce in the future, experts said.

"There has been a constant process of the administration trying to cut the programs," said the AAMC's Moore. In the past, Congress has restored the funding but failed to do so this year.

By contrast, community health centers received a $122.3 million increase in funding in the budget package. As part of a strategy to strengthen the country's health care safety net, the Bush administration has been pushing to expand the capacity of community health centers. The goal ultimately is to double the number of people served by the centers.

For the third year in a row, the increase in funding was substantial but fell short of the $225 million the National Assn. of Community Health Centers had requested. It also has not kept pace with the dramatic rise in patients coming to the centers, said a spokeswoman for NACHC.

The patient population has grown by more than 800,000 over the past three years, largely fueled by the growing number of uninsured Americans, she explained.

Also under the fiscal 2004 budget:

• The Food and Drug Administration received $1.4 billion, which is about the same as last year.
• The Agency for Healthcare Research and Quality avoided a substantial budget cut and ended up with $303.7 million, virtually the same amount of funding as last year. ARHQ supporters had asked for an increase to $390 million.
• The Global HIV/AIDS, tuberculosis and malaria program got $2.4 billion. Bush requested $2 billion but had promised to give a total of $15 billion over five years.
• Homeland security biodefense programs received $3.26 billion in funding -- $1.63 billion for the NIH, $1.12 billion for the Centers for Disease Control and Prevention, and $518 million for hospital preparedness.
• A substance abuse voucher initiative being launched by the administration received $100 million. The vouchers might make it easier for patients to choose among recovery programs, including faith-based ones.
• Abstinence education programs received $75 million in funding, an increase of $20 million over last year.