Congress ready to give NIH its biggest increase in 12 years
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This story was updated at 11:25 a.m. on Dec. 16.

WASHINGTON — The National Institutes of Health will get a $2 billion funding increase in the federal spending bill released early Wednesday, a big boost that could turn around the agency’s fortunes after years of stagnant budgets.

It’s the first time the NIH budget would get such a large raise in more than 12 years — assuming the spending bill can get enough votes to pass Congress. And it comes after a year of growing momentum in which powerful Republicans and Democrats convinced their colleagues that medical science is ready to make good use of extra money.

The extra money is included in a massive spending bill to keep the federal agencies running through the rest of the fiscal year, which lasts until Oct. 1. It has to pass the House and the Senate before President Obama can sign it into law, and those votes — expected Friday — will likely require a combination of Republican and Democratic support, since the bill is a carefully balanced compromise between both parties.

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The bill gives $200 million to the Obama administration’s Precision Medicine Initiative — an effort to find treatments that can be targeted to an individual’s genetic makeup — and a $350 million increase for research on Alzheimer’s disease, an amount that could boost efforts to find an effective treatment by 2025. It also includes an $85 million increase for the BRAIN Initiative, the project to map the human brain.

The legislation gives an extra $303 million to efforts to fight antibiotic-resistant bacteria, and steers an additional $91 million — a nearly 300 percent increase — toward programs to reduce opioid abuse.

Plus, in a related tax package, Congress will suspend Obamacare’s tax on medical devices for two years, through the end of 2017. The House is expected to vote on that bill on Thursday.

One potential policy change was missing from the final package: Congress will not lift the restrictions that have effectively prevented the Centers for Disease Control and Prevention from studying gun violence for nearly 20 years.

Top Democrats, including House Minority Leader Nancy Pelosi and Representative Nita Lowey of New York, demanded the change, and doctors’ groups campaigned for it on Capitol Hill earlier this month. Ultimately, though, they fell short.

It’s not a surprise that NIH got more money out of Congress — leading Republicans in charge of the spending bill have been hinting at an increase for months. But $2 billion was the maximum the agency could have gotten, given the range of the proposals that were being negotiated on Capitol Hill. The Senate version of the spending bill had allotted the full $2 billion, but the House version only suggested a boost of $1.1 billion.

It got more money to work with through an October budget deal with the White House that raised the spending limits in federal law, making it easier for lawmakers to give more money to NIH without having to cut something else.

So far, NIH officials aren’t commenting on what they could do with the extra money — they’re waiting to make sure the bill actually passes the House. The NIH released a strategic plan Wednesday that outlines its general goals for medical research, including greater flexibility in setting priorities and a more diverse research workforce. But it was written before the extra money was announced, and doesn’t spell out how the new funds could be used.

This was one of the rare years when Obama and lawmakers from both parties all agreed on the need for more medical research funding. Congress doubled the NIH budget between 1998 and 2003, but after that, the big increases stopped.

Since then, the funding hasn’t been enough to keep up with inflation, and the agency has lost 22 percent of its purchasing power — a point NIH Director Francis Collins has been hammering for years through congressional testimony, speeches, and op-eds. Even now, the extra money wouldn’t bring NIH back up to its 2003 peak, when adjusted for inflation.

Still, this year Collins had a more sympathetic audience than usual, including two Republicans, Representative Tom Cole of Oklahoma and Senator Roy Blunt of Missouri, the chairmen of the two subcommittees in charge of medical research funding. Cole said he wants to make this funding NIH increases keep coming so that this year isn’t a one-off.

“One of my goals would be … not just to have a good year, but how are we going to increase it again next year? Because I want to build on what we’ve done,” Cole said in an interview last week, before the spending bill was released.

The policy changes

Here’s a rundown of the policy changes that made it into the bill — and the ones that didn’t:

Medical device tax: The bill would put Obamacare’s medical device tax on hold for two years, as part of a broader package of tax breaks. The change would give medical device makers temporary relief from the 2.3 percent tax on the sales price of medical devices that has been in place since January 2013.

It’s not the full repeal that medical device manufacturers have been requesting for years, but it’s a small victory for the opponents of the tax — including most Republicans and some Democrats who represent states with strong medical device industries, like Minnesota and Massachusetts.

Gun violence research: House Democrats had made the end of the restrictions on CDC gun violence research a top priority, but the final spending package leaves the restrictions in place. “Too many times, the Republicans say we can’t make a decision on this because we don’t have the data,” Pelosi said at a press conference last week. “Well, let’s get the data. Lift the ban.”

According to a history compiled by the American Psychological Association, the ban stemmed from a 1993 study published in the New England Journal of Medicine. The study, which was funded by the CDC’s National Center for Injury Prevention, found that keeping a gun in one’s home led to an increased risk of homicide by a family member or close acquaintance.

The National Rifle Association launched a public-relations campaign in response to the study, seeking to have the injury-prevention subagency completely eliminated. That didn’t happen, but in 1996 then-Representative Jay Dickey, an Arkansas Republican, had an amendment inserted into a government spending bill that barred CDC funding from being used for research that “may be used to advocate or promote gun control.” The spending bill also redirected funding that had previously been used for firearm research.

The provision has been kept in government spending bills ever since. While it isn’t an explicit prohibition on gun violence studies, it has in effect prevented any government funding from being used for any such research. Dickey said in a letter this month that he “regrets” his role in restricting CDC studies and argued that Congress should “slowly but methodically fund such research.”

E-cigarettes: The legislation appears to have dropped a provision to rein in an upcoming FDA regulation on e-cigarettes by limiting its pre-market reviews, which are supposed to prove that potentially risky products are safe. The proposal, included in an earlier version of the bill, would have prevented the agency from requiring pre-market reviews of any e-cigarettes that are already being sold in stores.

The provision was part of the House version of the bill, and was added after Republicans complained that the pre-market review process is lengthy and bad for businesses. But it comes at a time when the public is convinced that e-cigarettes are bad for people’s health, a view that is driving strong support across party lines for new government regulations.

Genetically engineered salmon: The bill orders the Food and Drug Administration not to allow genetically engineered salmon to be sold until it develops guidelines for labeling it so consumers know what it is.

More money for research, public health

The main funding highlights of the bill:

NIH

Current funding: $30 billion
New funding: $32 billion

Precision Medicine Initiative

Current: $200 million
New: $200 million

Combating Antibiotic-Resistant Bacteria

Current: $471 million
New: $774 million

CDC

Current: $7 billion
New: $7.2 billion

FDA

Current: $2.6 billion
New: $2.7 billion

National Science Foundation

Current: $7.3 billion
New: $7.5 billion

Agency for Healthcare Research and Quality

Current: $364 million
New: $334 million

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