2009 budget boosts research, health access

Washington -- Medical researchers, community health centers and other recipients of federal health spending received a second major boost in as many months with President Obama's approval of a fiscal 2009 spending measure on March 11.

The Senate adopted the $410 billion measure unanimously on March 10 after spending a week debating two dozen Republican amendments, none of which were adopted. The House passed the bill 245-178 on Feb. 26.

The bill funds nine of 12 federal agencies through Sept. 30, including the Dept. of Health and Human Services. Congressional Democrats last year extended spending at 2008 levels until March 6 to avoid negotiating with President Bush, then extended it again through March 11 to give Republicans in the Senate more time to offer amendments and Democrats more time to round up votes.

The measure increases the National Institutes of Health budget by $938 million to reach $30.3 billion, a 3.2% increase. "It's fairly significant to NIH," said Jennifer Zeitzer, director of legislative relations for the Federation of American Societies for Experimental Biology. "It begins to reverse the negative trend that we've been seeing ... for six years."

NIH budgets since 2003 have not kept pace with increases in the costs of medical research, and the number of grant requests has climbed over that period. The House Appropriations Committee estimated that the 2009 spending bill will allow NIH to approve about 10,600 new research grants. The institutes also received $10 billion in the stimulus package adopted in February, $1.3 billion of which is designated for renovation and expansion of university research facilities.

"The stimulus package is a huge boon to science," said FASEB President Richard Marchase, PhD. "It will [fund] a lot of work that had already been peer reviewed and found to be meritorious."

More federal support for community health centers in 2009 will let them treat a half million more uninsured people, according to the House Appropriations Committee. Health center spending is expanding by $125 million over 2008 levels to reach $2.2 billion. The increase is also important because it gives health centers an idea of what level of annual increases they will get, allowing them to plan for the future better, said Craig Kennedy, MPH, associate vice president for federal and state affairs for the National Assn. of Community Health Centers.

Kennedy said he also was thankful for the $2 billion for community health centers in the stimulus bill, $1.5 billion of which is to be used for clinic construction and renovation.

The onset of the recession and the drying up of bank lending has hurt health centers' ability to raise money for capital projects, he said. "That capital money is just critical to getting health centers back up on their feet structurally."

Health centers also are seeing higher demand for their services, Kennedy said.

Community Health Center of Lubbock in northwest Texas, for example, saw 27,000 patients in 2008, an increase of about 5,600 over the previous year, said Michael Sullivan, the center's CEO.

"That was the largest increase that we have experienced since we've been in business" starting in 1993, Sullivan said. New funding should allow the nonprofit's five health facilities to more than keep pace with new patients, he added.

The 2009 spending act also includes $222 million to train physicians and $300 million for childhood immunizations through the Centers for Disease Control and Prevention. David T. Tayloe Jr., MD, president of the American Academy of Pediatrics, said these and other provisions are "vital to the health and well-being of all children and adolescents."

Earmarks stay in

Upon signing the appropriations measure on March 11, Obama called the bill "imperfect." He pointed out that the more than 9,000 earmarks in the bill were from lawmakers from both parties and that not all of them represent wasteful spending. "Done right, earmarks give legislators the opportunity to direct federal money to worthy projects that benefit people in their district, and that's why I have opposed their outright elimination."

But Obama said earmarks must have a legitimate public purpose. If they don't, the White House will work with Congress to eliminate them. The president also called for earmark sponsors to post the projects on their Web sites in advance of votes.

Sen. John McCain (R, Ariz.), who offered an amendment to strip the earmarks from the bill, criticized Obama's action. "The president could have resolved this issue in one statement -- no more unauthorized pork-barrel projects -- and pledged to use his veto pen to stop them."