General Landscape
On June 27, 2024, the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies (LHHS) conducted a markup of the LHHS Act for Fiscal Year 2025 (FY25). Full Appropriations Committee Chairman Tom Cole (R-OK-4th) and LHHS Subcommittee Chairman Robert Aderholt (R-AL-4th) remarked that the billpromotes fiscal responsibility by cutting “nice-to-have” discretionary programs while preserving funding for core departmental activities.
On July 10, the full House Appropriations Committee advanced the FY25 LHHS Act for FY25. Chairman Cole’s statementand LHHS Subcommittee Chairman Aderholt’s remarks make clear their intention to use the power of the purse to combat President Biden’s agendas that promote diversity, equity, and inclusion, and increase the regulation of the health care system. They also intend to curb the use of appropriations to fund the Biden/Harris “social agenda.” Overall, the appropriations bill allocated $185.8 billion, which is 4% less than the FY24 enacted score, 11% less than the FY24 effective spending level, and 15% below the President’s Budget Request. Here is the statement from Rosa DeLauro (D-CT-3rd) (with links to supporting documents), the Ranking Member of both the full committee and the subcommittee on LHHS.
The programs funded though the LHHS bill are extremely important to individuals with serious illness and their family caregivers. These programs include research, prevention, clinical and community-based supports and services, health care professionals training, and so much more. The bill allocated $107 billion to the Department of Health and Human Services (HHS) which is 7% below the FY24 enacted level, and 22% below the President’s Budget Request. Significant cuts were made to the Health Resources and Services Administration (HRSA), Centers for Disease Control and Prevention (CDC), and the Agency for Healthcare Research and Quality (AHRQ). Minor funding increases were provided to the National Institutes of Health (NIH), Substance Abuse and Mental Health Services Administration (SAMHSA), and Centers for Medicare and Medicaid Services (CMS).
Specific Institute, Departmental, and Agency Allocations
The NIH saw significant restructuring alongside a 7% overall budget increase to $49.711 billion. The House appropriations bill includes consolidating, renaming, and eliminating various institutes of the NIH. For example, in the bill, the National Institute on Aging is replaced by the National Institute on Dementia, limiting the scope of work to exclusively study dementia. The National Institute on Dementia is funded at $4.604 billion, a 2% increase from the National Institute on Aging’s FY24 budget. Additionally, a newly formed National Institute on Body Systems Research would absorb the work of the former National Heart Lung and Blood Institute and several other institutes. It was reported that Representative Steny Hoyer (D-MD-5th) attempted unsuccessfully to restore the $1.5 billion authorized for ARPA-H during committee mark-up.
All these changes will probably not come to pass but they do signal the directions that some appropriators are moving toward. As pointed out by ranking member Rosa DeLauro (D-CT-3rd), “And I have my doubts about the majority’s short-sighted decision to overhaul the National Institutes of Health in a partisan appropriations bill.”
The House needs to hold public hearings and engage in a thoughtful process to incorporate the best ideas to advance NIH as the crown jewel of biomedical research. Any discussion to reauthorize the NIH needs to be bipartisan and bicameral — unfortunately, the proposed reorganization in today’s partisan bill falls short.
CDC funding decreased by approximately 22% to $6.259 billion. Chronic disease prevention and health promotion funding decreased from FY24 by 13% to $912.8 million. Funding for HIV/AIDS, viral hepatitis, sexually transmitted diseases, and tuberculosis prevention decreased by 15%. Additionally, Public Health Scientific Services saw a decrease in funding of 92%.
The proposed bill decreases HRSA funding by 17% ($1.53 billion) and the Health Workforce Programs were cut by $62.3 million from their FY 2024 enacted levels. Funding for Health Systems and Rural Health increased by 3% and 10%, respectively.
CMS funding was increased by 2%. Grants to States for Medicaid and program management saw 6% budget cuts each. Payments to Health Care Trust Funds and the Health Care Fraud and Abuse Control Account saw funding increases by 9% and 3%, respectively.
The Administration for Community Living, Aging, and Disability Services Programs saw a decrease in funding of 2% to $2.407 billion. Funds for prize competition money awarding research in kidney disease prevention, diagnosis, and treatment research remained the same at $5 million. Funding for Medicare Hearings and Appeals remained the same. Additionally, the Medicare Payment Advisory Commission received a budget increase of 5% to $14.477 million.
The Agency for Healthcare Research and Quality and the National Library of Medicine were completely removed from the budget and received no funding in FY25.
The House Appropriations bill in its current state is unlikely to become law due to opposition to many of its provisions by Senate Democrats. The Senate has not yet marked-up its LHHS bill but has begun the process with other subcommittee bills. It is unlikely that Congress will pass all 12 bills prior to the elections in November, so they will likely pass a continuing resolution (CR) to keep government operating after September 30 which marks the end of the fiscal year.
