On March 22 and 23, Congress approved the omnibus fiscal year 2018 spending bill. The House voted 256 – 167 to pass the bill – with 145 Republicans and 111 Democrats voting “aye” and 90 Republicans and 77 Democrats voting “nay” (view the roll call here). The Senate approved the measure by a vote of 65 – 32 (roll call here) with 23 Republicans and 9 Democrats voting against the 2,232 page bill (full text, report). President Donald Trump, signed the measure into law on March 23.
The omnibus legislation funded all of ASPPH’s appropriation priorities and provided significant increases to the National Institutes of Health, the Centers for Disease Control and Prevention, and the Health Resources and Services Administration. The following provisions in the FY 2018 omnibus are of particular interest to academic public health. [Contact Mr. Tony Mazzaschi at firstname.lastname@example.org for information on accounts not mentioned below.]
National Institutes of Health (NIH)
The bill includes just over $37 billion in fiscal year 2018 for the NIH, a $3 billion — or 8.8 percent — increase from the previous year. This amount includes $496 million from the 21st Century Cures Act. Opioid activities will get $500 million for research on addiction as well as the development of alternatives to opioids for treatment of pain and for new addiction treatments. The bill contains a $414 million increase for Alzheimer’s disease research, and $149 million in new funding for the BRAIN Initiative. Clinical and Translational Science Awards (CTSAs) will receive $543 million, an increase of almost $27 million.
- Fogarty: The bill provides an appropriation of $75.733 million for the Fogarty International Center, an increase of $2.38 million over the FY 2017 level. The Trump Administration’s proposal to abolish Fogarty never gained traction.
- Facilities and Administrative (or Indirect) Costs: The bill continues to contain language to block any Administration attempt to impose an indirect cost cap unilaterally.
- Salary Cap: The bill maintains the current salary cap at Executive Level II (currently $189,600).
- The report accompanying the omnibus put at least a temporary halt to NIH’s use of an expanded definition of clinical trials that would sweep in many research studies with humans that don’t test treatments. The report said, “There is concern that policy changes could have long-term, unintended consequences for this research, add unnecessary regulatory burdens, and substantially increase the number of studies in the ClinicalTrials.gov database that are not clinical trials.” The bill directs NIH to apply the new reporting rules only to studies that were already considered clinical trials and to delay adding additional studies while NIH consults with the community. NIH was ordered to report to Congress on its plans by June 22.
Centers for Disease Control and Prevention (CDC)
The omnibus includes $7.2 billion in discretionary budget authority for CDC, or about a $1.1 billion increase over fiscal 2017 enacted spending levels. Total spending at CDC would be $8.3 billion. The proposal would boost CDC’s Public Health Preparedness and Response programs by $45 million and provides $480 million for construction of a new biosafety lab to support biodefense research. It also gives CDC $475 million for prescription overdose prevention activities — and an increase of $350 million to help fight the opioid epidemic, with $10 million of those funds dedicated to an opioid abuse awareness campaign. Trump’s 2019 budget proposal had called for a $900 million cut to the agency. Programs of special interest to ASPPH:
- The bill provides $25,461,000 for the Prevention Research Centers Program, the same as in FY 2017.
- Within the NIOSH accounts, the bill provides $25,500,000 for the Agriculture, Forestry, Fishing Centers and $29,000,000 for the Education and Research Centers, the same as in FY 2017.
- The Academic Centers for Public Health Preparedness are provided $8,200,000, again the same as in FY 2017.
- The bill provides an additional $50,000,000 with three-year availability to help CDC sustain its Global Health Security work in other countries.
- Gun Violence Research: The statement of managers attempts to clarify that the Dickey amendment only affects gun control advocacy and does not ban CDC research on gun violence. The report contains language stating, “While appropriations language prohibits the CDC and other agencies from using appropriated funding to advocate or promote gun control, the Secretary of Health and Human Services has stated the CDC has the authority to conduct research on the causes of gun violence.” No explicit gun violence research funding was provided in the bill.
- CDC’s Office on Smoking and Health will be funded at $210 million (a $5 million increase from the FY 2017 level and $50 million higher than the House-passed bill). In addition, the House-passed policy riders concerning the U.S. Food and Drug Administration’s (FDA’s) tobacco regulations were dropped from the final bill. The House would have exempted “large and premium cigars” from FDA oversight and change the grandfather date in order to exempt e-cigarettes, cigars, and other tobacco products from an FDA product review requirement.
Health Resources and Services Administration (HRSA)
Congress provided the Health Resources and Services Administration with $7.014 billion, an increase of $553 million over the FY 2017 level. Within the HRSA account, $17 million is provided for the Public Health and Preventive Medicine line, which includes the Public Health Training Centers Program and the Preventive Medicine Residency Program. Both programs are level funded compared to FY 2017.
Agency for Healthcare Research and Quality (AHRQ)
The bill rejects the Trump Administration’s proposal to move AHRQ to NIH as a new institute. The bill provides AHRQ with an appropriation of $334 million, an increase of $10 million from the FY 2017 level.
Opioid Response Funding
The HHS section of the bill provides $3.6 billion to address the opioid crisis, an increase of 244 percent and $2.55 billion over the FY 2017 level. Specific allocations include:
- A new $1 billion State Opioid Response grant program under SAMHSA.
- $500 million for research on addiction at NIH, and for-profit grant recipients would be subject to a 50 percent match. The explanatory statement would also encourage the National Institute on Drug Abuse to allocate more of its budget to opioid research.
- $500 million for the State Response to the Opioid Abuse Crisis Account created under the 21st Century Cures Act (Public Law 114-255), the same as in fiscal year 2017.
- $475.6 million for prescription drug overdose prevention activities at the CDC, $350 million more than in fiscal year 2017.
- $130 million for a new Rural Communities Opioids Response program.
- $2 million under the Substance Abuse and Mental Health Services Administration (SAHMHSA) to charter a National Academies of Sciences (NAS) review within 90 days of enactment. The review will report on the effectiveness of activities authorized by the Comprehensive Addiction and Recovery Act, specifically their effectiveness “in achieving their respective goals for preventing, treating and supporting recovery from substance abuse disorders.” An interim report is expected in three years and a final report in five years.
Other Accounts Of Interest:
- Student financial assistance: $24.445 billion (an increase of $247.1 million over the FY 2017 level and $1.513 billion more than requested by the Administration)
- Higher education: $2.247 billion (an increase of $191.1 million over the FY 2017 level and $701.2 million more than requested by the Administration)
- The bill contains several technical fixes to the Public Service Loan Forgiveness (PSLF) Program, including $350 million for the Secretary to provide loan cancellation for certain borrowers who would otherwise qualify for PSLF but are in extended or graduated repayment plans. The bill also provides $2.3 million for the Secretary to conduct outreach to borrowers who intend to apply for PSLF to ensure they meet the terms and conditions of the program, as well as improve the certification process.
U.S. Department of Agriculture (USDA):
- Agricultural Research Service: $1.343 billion (an increase of $73.5 million over FY 2017 and $350.2 million more than requested by the Administration)
- Food Safety and Inspection Service: $1.057 billion (an increase of $24.8 million over FY 2017 and $18.8 million more than requested by the Administration)
- Food for Peace Grants: $1.600 billion (an increase of $134 million over FY 2017 and $1.6 billion more than requested by the Administration)
- McGovern-Dole International Food for Education and Child Nutrition Program: $207.6 million (an increase of $6.0 million over FY 2017 and $207.6 million more than requested by the Administration)
Environmental Protection Agency (EPA):
Overall, the EPA receives $8.06 billion in fiscal 2018, equal to the FY 2017 amount and $2.4 billion more than the Administration requested. Included in this funding:
- Environmental programs and management: $2.598 billion (the same level as in FY 2017 and $880.5 million more than requested by the Administration)
- Science and technology: $706.5 million (the same level as in FY 2017 and $255.7 million more than requested by the Administration)
State Department and Foreign Operations
The State Department and foreign operations programs receive $54.2 billion for fiscal 2018, $13.5 billion more than the administration requested and $3.35 billion less than the programs received in FY 2017. Within the bill:
- Global health programs: $8.690 billion (a decrease of $35 million over the FY 2017 level and $2.209 billion more than requested by the Administration)
- International organizations: $1.786 billion (a decrease of $30.1 million from the FY 2017 level and an increase of $616.7 million over the Administration’s request).
- The bill would block all global health assistance funds — not just those earmarked for family planning — from going to nongovernmental organizations that promote or perform abortions, except in cases of rape or incest, or when the mother’s life is endangered. The measure also would allow contributions to the U.N. Population Fund, which supports reproductive health care and other rights for women and youth, only if the fund doesn’t support abortion and U.S. support isn’t used for programs in China.
- National Science Foundation: $7.767 billion (an increase of $295 million over FY 2017 and $1.115 billion more than requested by the Administration)
- National Highway Traffic Safety Administration (NHTSA): A total budget of $911.247 million (including both appropriations and trust fund) (an increase of $35 million over the FY 2017 amount and $48.065 million more than requested by the Administration).