Fight over NIH funding puts Senate medical innovation bills in jeopardy
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WASHINGTON — A Senate package of biomedical innovation bills got bogged down in a partisan fight Wednesday over funding for the National Institutes of Health, foreshadowing more trouble ahead that could threaten the effort to accelerate the search for medical cures.

Although a Senate committee eventually approved the seven innovation bills, Democrats warned that they won’t support a final package when it reaches the Senate floor unless they get an agreement with Republicans that guarantees a big funding increase for biomedical research.

The argument, which has been building over the past several months, happened when Republicans swatted down a Democratic effort to get a Senate committee to approve $5 billion a year in “mandatory” medical research funding, meaning a guaranteed source of funds that wouldn’t have to be approved by Congress every year.

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Senator Elizabeth Warren of Massachusetts tried to push for a vote on the legislation, which she introduced last week along with her Democratic colleagues on the Health, Education, Labor, and Pensions committee.

Warren tried to attach the proposal to the first biomedical bill that the committee considered, a measure that would allow the Food and Drug Administration to expand its “priority review” program for treatments for rare pediatric illnesses. After a short discussion, Warren withdrew the amendment, saying that she wanted to give the committee a chance to discuss ways to increase money for both NIH and the FDA before calling for a vote.

That won’t be easy.

Despite the polite tone of Wednesday’s hearing, the divide over how much to fund the federal medical research agencies, and where to get the money, is huge.

Democrats want to pump up the NIH budget, which went through years of decline before receiving a $2 billion increase in December, by giving it an automatic source of funds. Republicans, however, don’t like the “mandatory” funding approach because they want to pay for any increase by cutting other programs.

Warren’s bill would guarantee annual funding for three White House medical research programs — Vice President Joe Biden’s cancer “moonshot” effort, the Precision Medicine Initiative, and the BRAIN Initiative — as well as work on therapies for Alzheimer’s disease, Parkinson’s, and other neurological illnesses.

“For more than a decade, Congress has been strangling research,” Warren said. “We need real medical innovation and that starts with putting up the money for basic research.”

But Republican Senator Lamar Alexander of Tennessee, the committee chairman, said repeatedly that he won’t support mandatory funding without knowing where the money will come from.

Instead, Alexander advocates what he calls “surge” funding, which would provide NIH with additional support on a yearly basis, for a limited time. As an example, he said after the hearing, he might support $2 billion annually for the Precision Medicine Initiative, but with a specific end date.

Unlike the House — which passed its medical innovation proposals last year in one big package, the 21st Century Cures Act — the Senate is working on its proposals in smaller pieces. Alexander’s goal in breaking up the initial biomedical innovation bills into numerous parts was to try to get the parties to approve issues they agree on first, then move into the thornier issues, such as funding.

This “step by step” approach, as Alexander calls it, has angered some Democrats, particularly Warren. She said she would not support any of the seven bills considered Wednesday — or the next set of biomedical bills the committee will take up April 6 — until Democrats and Republicans reach an agreement on mandatory funding.

The bills approved by the committee Wednesday included measures to improve pediatric research, speed up the review of certain medical devices, and add the Zika virus to the Priority Review Voucher program, which guarantees faster FDA review for new medical products that are developed to treat “neglected” diseases.

Although Senator Patty Murray of Washington, the top Democrat on the committee, voted with the majority to approve the seven bills that came up Wednesday, Warren did not.

“Republicans are moving a set of disjointed policies without agreement,” Warren said. “I will not support any of these bills until we have a bipartisan agreement,” she added, noting that NIH has lost much of its purchasing power over the past 10 years.

Murray reiterated her warning that the Democrats will not support a final package that leaves out mandatory funding for biomedical research.

Alexander defended his step-by-step approach, and said, “We all know that for nine years we’ve wanted to raise money for NIH. … We don’t have the money.”

In one of the testier exchanges, Wyoming Senator Michael Enzi, a Republican, balked at Warren’s characterization of the panel’s GOP lawmakers members as indifferent to the need to put more money into research.

“You’ve got to have revenue to give money out,” Enzi said. He said he has pushed for a review of current programs to see which might be outdated, and therefore could be targets for funding cuts.

Alexander, however, struck a conciliatory note.

“This is an area that we are going to do some work on, that’s why we are here,” he said.

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