AAMC/FASEB Town Hall on NIH Reauthorization Highlights Major Issues and Concerns

Although it was planned well in advance, the AAMC and FASEB town hall on NIH Reauthorization that was held on August 25^th provided an excellent venue in which to discuss the revised discussion draft for NIH reauthorization. 

More than 100 people attended representing a broad spectrum of health advocacy organizations and professional societies.  Cheryl Jaeger (Senior Policy Advisor for the Office of the House Majority Whip) provided some introductory remarks explaining Chairman Barton’s vision for the legislation and what they were hoping to accomplish.  She then fielded a variety of specific questions from the audience, largely focused on the major placeholders in the discussion draft such as the authorization levels, the composition of the advisory council, the percentage levels for the common fund and transfer authority, and the process for determining the funding levels for individual institutes and centers. 

As Cheryl reiterated several times, Chairman Barton is not interested in maintaining the status quo in many of these areas, and he feels very strongly about improving the overall management structure of NIH.  For example, Chairman Barton believes that using “such sums as necessary” language abdicates his authority as an authorizer, and is very adverse to that type of approach.  She explained that the Chairman “has serious concerns about the current process for allocations among Institutes and Centers” and does not want to perpetuate a system that results in 27 separate line items for the NIH.  Cheryl noted that the NIH Director currently has ability to move around ~3% of NIH funds, and the Chairman intends to increase the NIH Director’s level of discretionary budgetary authority.  In closing, she did confirm that additional input from the advocacy community would be welcomed as discussions continue and additional details are worked out.

Following Cheryl’s remarks, a general discussion commenced amongst the organizations in attendance that covered the major elements of the discussion draft.  No congressional staff or representatives were present during this discussion.   

Many in the group expressed concern for why and how the decisions were made regarding the classification of the various ICs into either mission-specific or science-enabling categories.  When asked about the rationale during her remarks, Cheryl explained that these categories are intended to reflect the distinction between “vertical” centers (the mission driven, disease specific) and “horizontal” (the science-enabling) as Dr. Zerhouni has characterized them in related testimony.   She noted that NIEHS, for example, was reclassified from mission-driven to the science-enabling category in this second draft on this basis.  Based on the conversation, it seemed that a better explanation and justification for the creation and implementation of this classification system would be welcomed.

A major dilemma identified by many was the clear conflict between the desire to preserve the current system of specific line item allocations for each institute and center in the appropriations process and Cheryl’s feedback that such an approach is not be acceptable in the Chairman’s view.   The current draft would establish a new appropriations system by which Congress would allocate three lump sums: one to the NIH director’s office, one for all the mission-specific ICs, and one for all the science-enabling ICs.  The process for the distribution of these funds to the individual ICs is yet “to be determined” according to the discussion draft.  Several groups noted that not only would such a model make it difficult to lobby for a strong appropriation level for the particular institute or center that most impacts their disease, but it also would be difficult to hold Congress accountable for its level of funding in different disease areas.

There was a great deal of discussion around the current levels for appropriations in the discussion draft for 2007, 2008, and 2009 that have yet to be determined.  Some people suggested pushing for the use of “such sums as necessary” language instead of specific appropriation levels.  As an alternative, the group also discussed the whether or not the health community should be advocating for a specific appropriation level in the authorizing language.  No consensus was reached regarding the viability of any particular strategy to address these concerns.     

While those in attendance seemed to be generally comfortable with the establishment of a “common fund” as outlined in the revised discussion draft, there was a great deal of uncertainty and concern expressed for: a) the lack of identified percentages for the common fund and the transfer authority, and b) the need for an expansion of transfer authority given the establishment of a common fund.  Some groups wanted justification for why each IC should be subject to the same percentage of contribution to the common fund and to transfer authority, particularly because the ICs will vary in their core levels of trans-NIH activities.   Although no consensus was reached, there was some discussion about the idea of a formula that tied the growth of funding for the NIH Director and the common fund to “new money.” 

Regarding the establishment of an advisory council to the NIH Director to play a role in the oversight and implementation of some of the Director’s new and/or expanded authorities, there was discussion about the need for various external stakeholders to have a role on that advisory council.  Cheryl did confirm earlier in the meeting that they heard the feedback regarding the need for external input on the council, and this was under consideration.  There were also some concerns expressed by certain disease groups that their voice on the council would be squeezed out or non-existent if seats on the council were dominated by major disease areas such as cancer and heart disease.