A spending bill that cleared a House subcommittee eliminates the Agency for Healthcare Research and Quality, and moves the U.S. Preventive Services Task Force to the office of the Health and Human Services Assistant Secretary for Health.
The legislation—which passed through the Appropriations subcommittee on Labor, HHS, Education and Related Agencies July 18—is intended to halt the implementation of the Affordable Care Act, by rescinding previously allocated funds and prohibiting the use of any additional money to implement the law.
Besides eliminating AHRQ, the agency that monitors the manner in which medicine is practiced in the U.S., the legislation stops all new hires under the Title 42 program at NIH.
The spending bill also eliminates all funding for Planned Parenthood, with the caveat that these funds could be restored should the organization agree to stop providing abortions.
The bill provides $30.6 billion to NIH and $5.066 billion to NCI for the next fiscal year—a flat budget for NIH and a $1.25 million cut for NCI. Overall, the House version of the $150 billion HHS spending bill is $8.8 billion below the President’s budget request.
The House appropriations measure for NIH falls $100 million below the Senate Committee’s recommendations, and NCI was given nearly $20 million less in comparison, but the House specifically allocated $8 million for repairs and improvements to the NCI facility in Frederick, Md.
The legislation includes $175 million for the National Children’s Study, $488 million for Clinical and Translational Sciences Awards, and $376 million for Institutional Development Awards programs.
The bill provides $5.75 billion to the Centers for Disease Control and Prevention—a $66 million increase of the current budget—and frees up an additional $126.5 million for the CDC by reducing the ability of HHS to divert funds away from CDC programs.
The measure authorizes NIH to collect third-party payments for the cost of clinical services that are incurred in NIH research facilities and that such payments shall be credited to the NIH Management Fund.
The NIH director is instructed to maintain an allocation of 90 percent of the appropriated funds to extramural activities, and at least 55 percent of the total toward basic science activities. No funds from institutes, centers, or Office of the Director accounts may be used for any economic research programs, projects or activities.
The subcommittee members voted 8-6 to approve the spending bill. The measure will now advance to the appropriations committee.
House Bill: Title 42 Not to Be Used
At NIH, a large number of top officials, including all institute directors, are paid under the Title 42 program, which NCI Director Harold Varmus describes as an important component of his efforts to recruit staff (The Cancer Letter, July 6).
The bill’s section on Title 42 follows: “Hereafter, the provisions of title II of the [Public Health Service] Act shall not be used as authority for appointment and compensation of continuing, full-time employees, including special consultant employees, of HHS, except with respect to direct scientific employees already receiving compensation under such provisions as of the date of the enactment of this Act.
“This section applies to both definite and indefinite appointments. The rate of base compensation to any direct scientific employee under such provisions is limited to no more than the rate of such compensation received by such employee in fiscal year 2012.
“This section does not apply to personnel of the Commissioned Corps or the National Health Service Corps of the Public Health Service.”
In another highlight, the bill reads: “None of the funds made available in this title may be used, in whole or in part, to advocate or promote gun control.”
Patient-centered outcomes research is verboten: “Notwithstanding any other provision of law, none of the discretionary funds appropriated by this Act may be used to support any patient-centered outcomes research.”
The bill rescinds $150 million in funds made available through the Patient-Centered Outcomes Research Trust Fund in fiscal 2013. Similarly, $1 billion made available for the Prevention and Public Health Fund is rescinded.
The Vote to Eliminate AHRQ
If the House subcommittee measure becomes law, AHRQ would cease to exist as of Oct. 1 of this year.
After the bill advanced to the full committee, Republicans said they sought to eliminate AHRQ purely in order to save money.
In addition to funding outcomes and disparities research, AHRQ operates the U.S. Preventive Services Task Force, a panel of independent experts who produce recommendations on screening tests.
Recent USPSTF recommendations on screenings for breast and prostate cancers caused some patient groups and subspecialties to call for a revamping of the task force to include specialists (see a related story on page 1).
AHRQ and its research programs are an important component of the Obama administration’s health care plan, as it seeks to delineate the health practices that work from those that do not.
The agency’s budget grew from $372 million to $611 million in 2011. Approximately 80 percent of the AHRQ’s budget is invested in grants and contracts focused on improving health care. This isn’t the first near-death experience in AHRQ’s 20-year history.
In 1993, the agency, then called Agency for Health Care Policy and Research, focused on writing guidelines for the clinical management of acute lower-back pain, which was interpreted by back surgeons as an attack on back fusion surgery, one of the most productive cash machines in American medicine. Almost immediately, spine surgeons started to lobby Congress to eliminate the agency, and, in fact, a House bill sought to eliminate it.
The agency survived that time, although with sharply reduced funds.
History has been hard on science-based agencies in Washington.
In 1995, under the banner of Newt Gingrich’s “Contract with America,” Congress eliminated the funds for the Office of Technology Assessment. Critics on the Hill said that OTA had been duplicating the work of other agencies.
Others pointed out that OTA had spent over two decades making enemies by studying the scientific feasibility (or lack thereof) of the Star Wars missile defense system, the dangers of climate change, and a variety of hot-button medical topics.
The House bill is available at: http://appropriations.house.gov/uploadedfiles/bills-112hr-sc-ap-fy13-laborhhsed.pdf.