Figure 1. National Institutes of Health (NIH) Funding, FY1994-FY2020

Sources: NIH Budget Office, Appropriations History by Institute/Center (1938 to Present), at http://officeofbudget.od.nih.gov/approp_hist.html. The FY2019 and F2020 program levels are based on budget data from NIH, "Justification of Estimates for Appropriations Committees FY2020--Overview, Vol. 1," p. 78, except for FY2019 appropriations to NIEHS through the Consolidated Appropriations Act, 2019 (P.L. 116-6. Funding for the type 1 diabetes program for FY2018 and FY2019 was provided by Section 50902 of P.L. 115-123.⁸ For FY2020, temporary extensions of the funding have been provided in FY2020 continuing resolutions (P.L. 116-59, P.L. 116-69) and most recently in P.L. 116-94, which provided $96.6 million in funding for the program until May 22, 2020. Funding for the type 1 diabetes program will expire on May 22, 2020, though previously appropriated funds will be available until expended.

Some funding is also transferred to NIH pursuant to the PHS Evaluation Set-Aside or the "PHS Evaluation Tap" Transfer authority.⁹ Authorized by Section 241 of the Public Health Service Act, the evaluation tap allows the Secretary of HHS, with the approval of appropriators, to redistribute a portion of eligible PHS agency appropriations across HHS for program evaluation and implementation purposes. The PHSA section limits the set-aside to not less than 0.2% and not more than 1% of eligible program appropriations. However, LHHS appropriations acts have commonly established a higher maximum percentage for the set-aside and have distributed specific amounts of "tap" funding to selected HHS programs. Since FY2010, and including in FY2020, this higher maximum set-aside level has been 2.5% of eligible appropriations.¹⁰ The total funding available for NIH activities, taking account of add-ons and PHS tap transfers, is referred to as the NIH program level.¹¹

Under the Administration's FY2020 budget proposal, all the existing ICs and budget activity lines, except for Buildings and Facilities, would have received a decrease compared with FY2019-enacted levels.¹³ The Buildings and Facilities appropriation of $200 million would not have changed from FY2019 to FY2020. The proposed NIRSQ would have received $256 million in funding for FY2020. The budget request also aimed to reduce the direct cost of research by proposing a cap on the percentage of an investigator's salary that can be paid with NIH grant funds at 90%.¹⁴

The Senate did not complete committee or floor consideration of FY2020 LHHS appropriations. The majority of the Senate Appropriations Committee, however, released a draft bill and a draft committee report.¹⁷ Separately, the Senate Appropriations Committee passed an FY2020 Interior/Environment bill with funding for the Superfund Research Program (S. 2580).

On December 20, 2019, Congress and the President mostly finalized the FY2020 NIH program level (except for full-year type 1 diabetes funding) by enacting the Further Consolidated Appropriations Act, 2020 (P.L. 116-94), which included final FY2020 LHHS appropriations in Division A, Interior/Environment appropriations in Division D, and a temporary extension for the special diabetes program for type 1 diabetes through May 22, 2020. The enacted FY2020 NIH program level is made up of the following:

• $40.228 billion in discretionary LHHS budget authority (nontransfer),
• $1.231 billion pursuant to the PHS program evaluation transfer and a $225 million transfer from the HHS nonrecurring expenses fund (NEF),¹⁸
• $81 million for the Superfund research program,
• $150 million in estimated annual funding for the mandatory type 1 diabetes research program. P.L. 116-94 provided temporary program funding for the program until May 22, 2020.

Congress did not adopt the Administration's proposals to consolidate AHRQ into NIH or to cap the percentage of an investigator's salary that can be paid with NIH grant funds at 90%. Congress did not adopt similar proposals by the Administration in FY2017 through FY2019.¹⁹

NIH has seen periods of high and low funding growth. Between FY1994 and FY1998, funding for NIH grew from $11.0 billion to $13.7 billion (nominal dollars). Over the next five years, Congress and the President doubled the NIH budget to $27.2 billion in FY2003. In each of FY1999 through FY2003, NIH received annual funding increases of 14% to 16%. From FY2003 to FY2015, NIH funding increased more gradually in nominal dollars.²⁰ In some years, (FY2006, FY2011, and FY2013) funding for the agency decreased in nominal dollars.²¹ From FY2016 through FY2020, the NIH has seen funding increases of over 5% each year. The largest increase was from FY2017 to FY2018, where the program level increased by $3.0 billion (+8.7%), making this the largest single-year nominal dollar increase since FY2003 (excluding one-time funds provided by the American Recovery and Reinvestment Act of 2009 [ARRA, P.L. 111-5]).

Program Level Funding in Current and Projected Constant (FY2020) Dollars.

Notes: By convention, program level totals include amounts "transferred in" pursuant to PHS tap, but do not include any amounts "transferred out" under this same authority. Program level includes all budget authority, including appropriations for the Global Fund to Fight AIDS, TB, and Malaria (FY2002-FY2011) that were subject to transfer-out. As of FY2012, NIH no longer receives appropriations for the National Institute of Allergy and Infectious Diseases (NIAID) identifying resources for the Global Fund; this responsibility was transferred to another federal agency. ARRA supplementary funding is from the American Recovery and Reinvestment Act of 2009, P.L. 111-5. In general, amounts provided to NIH for emergency requirements are excluded from these totals (e.g., FY2015 amount does not include $238 million for the NIAID for research on Ebola that was provided in P.L. 113-235, Title VI of Division G).

The Public Health Service also includes the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Agency for Healthcare Research and Quality (AHRQ), the Health Resources and Services Administration (HRSA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Indian Health Service (IHS), and the Agency for Toxic Substances and Disease Registry (ATSDR).

For further information on NIH, see CRS Report R41705, The National Institutes of Health (NIH): Background and Congressional Issues.

Department of Health and Human Services, Fiscal Year 2018 Budget in Brief, Washington, DC, May 2017, p. 38. Updated numbers were not available in the FY2019 or FY2020 HHS Budget in Brief.

Ibid.

Ibid.

The Hazardous Substance Basic Research and Training Program (Superfund Research Program) funds research on the health effects of exposures to hazardous substances and related solutions at the National Institute of Environmental Health Sciences. It is authorized by 311(a) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (42 U.S.C. 9660(a)) and Section 126(g) of the Superfund Amendments and Reauthorization Act of 1986.

42 U.S.C. §254c-3.

For more information on the PHS Evaluation Tap, or PHS Evaluation Set-Aside, see discussion in CRS Report R44916, Public Health Service Agencies: Overview and Funding (FY2016-FY2018).

Totals include amounts "transferred in" pursuant to PHS tap, but do not include any amounts "transferred out" under this same authority.

See §204 of Division A of P.L. 116-94 for the FY2020 maximum set-aside level. The last time that an appropriations act set the PHS tap percentage at a level other than 2.5% was in FY2009, when it was 2.4% (see P.L. 111-8). The FY2020 omnibus also retained a change to this provision, first included in the FY2014 omnibus, allowing tap transfers to be used for the "evaluation and the implementation" of programs funded in the HHS title of the LHHS appropriations act. Prior to FY2014, such provisions had restricted tap funds to the "evaluation of the implementation" of programs authorized under the Public Health Service Act.

Totals include amounts "transferred in" pursuant to PHS tap, but do not include any amounts "transferred out" under this same authority.

NIH, "Justification of Estimates for Appropriations Committees--Overview FY2020, Vol. 1," p. 78.

NIH, "Justification of Estimates for Appropriations Committees--Overview FY2020, Vol. 1."

The Labor, Health and Human Services, Education, Defense, State, Foreign Operations, and Energy and Water Development Appropriations Act, 2020.

Commerce, Justice, Science, Agriculture, Rural Development, Food and Drug Administration, Interior, Environment, Military Construction, Veterans Affairs, Transportation, and Housing and Urban Development Appropriations Act, 2020.

CRS Insight IN11114, FY2020 LHHS Appropriations: Status.

The nonrecurring expenses fund (NEF) permits HHS to transfer unobligated balances of expired discretionary funds from FY2008 and subsequent years into the NEF account. Congress authorized use of the funds for capital acquisitions including information technology (IT) and facilities infrastructure (42 U.S.C. §3514a).

For further background, see NIH sections of CRS Report R44516, Federal Research and Development Funding: FY2017; CRS Report R44888, Federal Research and Development Funding: FY2018; and CRS Report R45150, Federal Research and Development (R&D) Funding: FY2019.

Amounts shown in Table 1 include appropriations for the Global Fund to Fight AIDS, TB, and Malaria (FY2002-FY2011) that were subject to transfer-out. As of FY2012, NIH no longer receives appropriations for the National Institute of Allergy and Infectious Diseases (NIAID) identifying resources for the Global Fund; this responsibility was transferred to another federal agency. For further details on the amounts transferred out by fiscal year, see the "Supplemental Appropriation Data Table" for "History of Congressional Appropriations, Fiscal Years 2000-2012" at http://officeofbudget.od.nih.gov/approp_hist.html.

For instance, the FY2006 total was 0.1% lower than the previous year, the first time that the NIH appropriation had decreased since FY1970; the FY2011 total, provided in the Full-Year Continuing Appropriations Act, 2011 (P.L. 112-10), was 1.0% below the previous fiscal year; and the FY2013 total, provided in the Consolidated and Further Continuing Appropriations Act, 2013 (P.L. 113-6), was reduced by the March 2013 sequestration and a transfer of funding under the authority of the HHS Secretary ($1.553 billion and $173 million, respectively), resulting in a budget that was 5.0% lower than the prior year.

The first round of funding was provided by Section 194 of the Further Continuing and Security Assistance Appropriations Act, 2017 (CR, P.L. 114-254). The CR appropriated $352 million in the NIH Innovation account for necessary expenses to carry out the four NIH Innovation Projects as described in Section 1001(b)(4) of the Cures Act. The second round of funding was provided by the FY2018 omnibus (P.L. 115-141). The third round of funding iswas provided by the FY2019 Consolidated Defense, LHHS, and Continuing Resolution Appropriations Act (P.L. 115-245).

NIH, "Justification of Estimates for Appropriations Committees- Overview FY2020, Vol. 1," p. 78.

Provided by P.L. 116-6, Consolidated Appropriations Act, 2019.

The House appropriations committee recommendations provide for an NIH program level total of $38.564 billion, calculated from figures in H.Rept. 115-952, pp. 573-575, and using the House Superfund appropriations recommendation of $80 million to NIEHS from H.Rept. 115-765, p. 82.

The Senate appropriations committee recommendations provide for an NIH program level total of $39.312 billion, calculated from figures in H.Rept. 115-952, pp. 573-575, and using the Senate Superfund appropriations recommendation of $78 million to NIEHS from S.Rept. 115-276, p. 95.

The index is developed for NIH by the Bureau of Economic Analysis of the Department of Commerce. It reflects the increase in prices of the resources needed to conduct biomedical research, including personnel services, supplies, and equipment. It indicates how much the NIH budget must change to maintain purchasing power. See "NIH Price Indexes," at https://officeofbudget.od.nih.gov/gbiPriceIndexes.html.

NIH, "Justification of Estimates for Appropriations Committees--Overview FY2020, Vol. 1," p. 78.