House subcommittee forwards Health, Education funding bill for fiscal year 2019

Bill provides increases to NIH, cuts CDC and HRSA

On June 15, 2018, the House Appropriations Subcommittee on Labor, Health and Human Services, and Education marked up the FY 2019 funding bill. The legislation includes funding for programs within the Departments of Labor, Health and Human Services, and Education, and other related agencies, including the Social Security Administration.n.

The bill includes $177.1 billion in discretionary funding, essentially the same as the 2018 enacted level. Because funding for the bill was not increased over last year, increases were modest for some agencies and many agencies were flat-funded or cut.

The bill allocates increased funds for the National Institutes of Health (NIH) at $1.25 billion, for a total of $38.3 billion. These funds would boost numerous medical research programs and combat opioid abuse. 

The bill provides increases for various NIH research initiatives, including:

  • $2.25 billion, a $401 million increase, for Alzheimer’s disease research
  • $400 million, a $100 million increase, for the Cancer Moonshot research initiative
  • $429 million, a $29 million increase, for the Brain Research through Application of Innovative Neurotechnologies (BRAIN) initiative
  • $437 million, a $147 million increase, for the All of Us (precision medicine) research initiative
  • $130 million, an increase of $30 million, for research to develop a universal influenza vaccine
  • $528 million, an increase of $15 million, for research on Combating Antibiotic-Resistant Bacteria
  • $366 million, an increase of $15 million, for Institutional Development Awards
  • $12.6 million for the Gabriella Miller “Kids First” pediatric cancer research initiative.

Because much of the increase to NIH is directed to special initiatives, many of the NIH institutes would receive only a 1.2 percent increase in FY 2019 if the funding levels in this bill prevail.

Centers for Disease Control and Prevention (CDC) – The legislation includes a total of $7.6 billion for CDC – $663 million below the FY 2018 enacted level and $2 billion above the President’s budget request.  The decrease is due in part to the transfer of the Strategic National Stockpile to the HHS Office of the Assistant Secretary for Planning and Response (ASPR); when accounted for, the bill provides a programmatic increase of $427 million.  This includes $848 million in transfers from the Prevention and Public Health Fund, which was established under the Affordable Care Act. The bill also continues the longstanding prohibition against using federal funds to advocate or promote gun control (without prohibiting research, per se—though no funds were included for it).

The bill includes $300 million to establish an Infectious Disease Rapid Response Reserve Fund to allow the Secretary of Health & Human Services to quickly respond to a pandemic, as well as funding for initiatives proposed in the President’s Budget to continue efforts to track children and families affected by the Zika virus and to address infectious disease in high-risk areas, especially those disproportionately affected by the opioid crisis.

Substance Abuse and Mental Health Services Administration (SAMHSA)The bill funds SAMHSA at $5.6 billion, which is $448 million above the FY 2018 enacted level and $2.1 billion above the President’s request. The legislation maintains a prohibition on federal funds for the purchase of syringes or sterile needles but allows communities with rapid increases in cases of HIV and hepatitis to access federal funds for other activities, including substance-use counseling and treatment referrals.

The bill would reduce overall funding for the Health Resources Services Administration (HRSA), although some programs within the agency, including the Maternal and Child Health Block Grant, would receive slight increases. The Agency for Healthcare Research and Quality received $334 million in funding for FY 2019, the same level of funding as FY 2018. Notably, the agency was left as a stand-alone federal agency and not folded into NIH as a new institute, as proposed in the President’s Budgets for FY18 and FY19. 

The legislation was approved in the Labor-HHS-Education Subcommittee along a party-line vote, with only Republicans voting to approve. Democrats voted no on the bill in part due to the flat funding, but also due to the presence of controversial riders, including a provision that would eliminate all Title X family planning funding and provisions that would stop the implementation of the Affordable Care Act (including prohibiting the use of any new discretionary funding to implement the program).  Democrats also objected to the so-called Monsanto rider, which would block funding for the World Health Organization’s International Agency for Research on Cancer. That agency had released a report that concluded that a chemical in Monsanto’s products—including Roundup—was a possible carcinogen.

The full Appropriations Committee will mark up the bill the week of June 18, 2018.

Federal agencies take on opioid crisis

Inter-Agency Pain Task Force and NIH HEAL Initiative move forward

Although the wheels of progress often turn slowly in Washington, two major legislative mandates related to the opioid crisis have recently come to fruition.

Pain Task Force

The Comprehensive Addiction and Recovery Act of 2016 authorized the creation of the Pain Management Best Practices Inter-Agency Task Force to update best practices and address current gaps and inconsistencies in managing chronic and acute pain.

The task force held its inaugural meeting on May 30-31, 2018.  Psychology was well represented on the panel by Mary Meagher of Texas A & M (who had been nominated by the American Psychological Association) and Cecilia Spitznas, who serves as Science Policy Advisor for the Office of National Drug Policy. Following the meeting, APA provided detailed comments for the task force to consider as it works to develop guidelines for best practices in pain management.

HEAL Initiative

In April, the National Institutes of Health (NIH) launched its Helping to End Addiction Long-term (HEAL) Initiative, supported by additional funding in fiscal year 2018 appropriations.  APA had expressed concern about the low visibility of primary prevention research in the early descriptions of HEAL, and emphasized that message in a June letter to NIH Director Francis Collins.  

Fortunately, the latest version of the HEAL Initiative Research Plan appears to accommodate many of APA’s concerns.  In addition, Nora Volkow, Director of the National Institute on Drug Abuse (NIDA), stressed the importance of prevention research, especially that focused on preventing increased opiate use in adolescents and young adults, in her plenary address at the College on Problems of Drug Dependence meeting in June. 

Still, while the priorities in the HEAL research plan related to opiate use disorders now incorporate psychological approaches, it is less clear where those approaches fit into the plan’s priorities for pain research, which remain largely biologically focused.  APA will continue to engage with NIH to develop a comprehensive approach to pain research.

NIDA psychologists to lead HEAL initiatives

Two psychologists at NIDA will serve in pivotal roles in implementing the HEAL research plan.  Redonna Chandler, who until recently served as Deputy Director of the Division of Clinical Innovation at NIH’s National Center for Advancing Translational Sciences, has returned to manage NIDA’s AIDS Research Program. In her new position, Dr. Chandler will also manage the largest of the focused HEAL initiatives, the HEALing Communities Study. A workshop (which will include several psychologists) to discuss the design and implementation of the HEALing Communities Study will be held at NIH headquarters and webcast live on June 18, 2018.

In addition, psychologist Kurt Rasmussen recently joined NIDA to manage the Division of Therapeutics and Medical Consequences. Dr. Rasmussen, who previously oversaw drug discovery and development at Lilly Pharmaceuticals, will work on new pharmaco- and behavioral therapies within HEAL’s Medication Assisted Treatment research plan.

APA will continue to monitor the progress of both the Pain Management Best Practices Inter-Agency Task Force and the NIH HEAL Initiative. For more information on APA’s work on the opioid crisis and on pain management, contact Geoff Mumford of APA’s Science Government Relations Office.

Social psychologist presents research on Capitol Hill

Kate Sweeny of UC Riverside shares her work on how waiting and worrying affect health and wellbeing.

On May 9, 2018, the American Psychological Association (APA) participated in the 24th Annual Coalition for National Science Funding (CNSF) Exhibition on Capitol Hill as part of an all-day event aimed at increasing congressional awareness of the importance of the National Science Foundation (NSF) and the research the agency supports – including basic behavioral and social science. To convey the impact and policy relevance of psychological research, APA sponsored a visit by Kate Sweeny, a professor of psychology at the University of California, Riverside, whose NSF-funded work examines the effects of waiting and uncertainty on health and wellbeing. 

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Six questions for Kate Sweeny

A psychologist shares her thoughts on a researcher’s role in advocating for science.

Kate Sweeny of the University of California, Riverside represented the American Psychological Association (APA) at the 24th Annual Coalition for National Science Funding (CNSF) Capitol Hill Exhibition on May 9, 2018.  Kate’s work focuses on the anxiety associated with waiting for big news, like medical test results or the outcome of a job interview. APA staff asked her a few questions about her research and her experience communicating her work to policymakers on Capitol Hill.

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NIH announces new initiative to address opioid epidemic

Plan dovetails with APA recommendations to president’s opioid commission.

On April 4, 2018, Francis Collins, director of the National Institutes of Health (NIH), announced an ambitious new plan to stem the tide of the opioid epidemic.  Through the HEAL Initiative (Helping to End Addiction Long-term), NIH is nearly doubling its commitment to opioid research from $600 million in 2016 to $1.1 billion in 2018.

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Science fares well in FY 2018 appropriations bill

Funding is healthy, and NIH clinical trial policy is suspended.

[updated 3/27/18]

The congressional appropriations committees have labored mightily and produced a $1.3 trillion final funding bill for Fiscal Year 2018, the current fiscal year. In February Congress raised the budget caps that had made reaching agreement on a full year’s spending legislation difficult. With a two-year budget agreement and extra money in hand, the appropriations committees produced a bill that passed both houses of Congress and was signed by the President before the temporary funding bill expired.

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