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National Institutes of Health (NIH) Funding: FY1996-FY2025

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National Institutes of Health (NIH) Funding: FY1994-FY2020

FY1995-FY2021
Updated January 22May 12, 2020 (R43341)
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NIH Funding: FY1994-FY2020

The National Institutes of Health (NIH)

Summary

This report details the National Institutes of Health (NIH) budget and appropriations process with a focus on FY2020 and FY2021, and on coronavirus supplemental funding for NIH. The report also provides an overview of funding trends in regular appropriations to the agency from FY1995 to FY2021. Appendix A includes funding tables by account and program-specific funding levels for FY2020 and FY2021.

The NIH is the primary federal agency charged with conducting and supporting medical, health, and behavioral research, and it is made up of 27 Institutes and Centers and the Office of the Director (OD). About 80% of the NIH budget funds extramural research through grants, contracts, and other awards. About 10% of NIH funding goes to intramural researchers at NIH-operated facilities. Almost all of NIH's funding is provided in the annual Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act. NIH also receives smaller amounts of funding from Interior/Environmental appropriations and a mandatory budget authority for type 1 diabetes research.

NIH has an FY2020 program level of $41.685 billion and has received emergency supplemental appropriations in three coronavirus supplemental appropriations acts, totaling over $3.59 billion—an 8.6% funding increase over regular enacted FY2020 appropriations. The administration's FY2021 budget request, as amended by a March 2020 letter, proposes an FY2021 program level of $39.133 billion—a 6.1% decrease from the FY2020 program level (regular appropriations).

NIH has seen periods of high and low funding growth during the period covered by this report, as illustrated in Figure 1. 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. In some years (FY2006, FY2011, and FY2013), funding for the agency decreased in nominal dollars. From FY2016 through FY2020, 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.

When looking at NIH funding adjusted for inflation (in projected constant FY2021 dollars using the Biomedical Research and Development Price Index; BRDPI), the purchasing power of NIH funding peaked in FY2003—the last year of the five-year doubling period—and then declined fairly steadily for more than a decade until back-to-back funding increases were provided in each of FY2016 through FY2020. The FY2021 budget request would provide a program level that is 13.0% below the peak FY2003 program level.

NIH Funding: FY1995-FY2021

This report provides a historical overview of federal funding provided to the National Institutes of Health (NIH) between FY1995 and FY2021. It also provides a brief explanation of the discretionary spending funding sources for NIH associated with the annual appropriations process (via the Labor, HHS, and Education and Interior/Environment Appropriations Acts) and the mandatory funding for special program on type 1 diabetes research.1

NIH is the primary federal agency for medical, health, and behavioral research. It is the largest of the eight health-related agencies that make up the Public Health Service (PHS) within the Department of Health and Human Services (HHS).12 NIH consists of the Office of the Director (OD) and 27 Institutes and Centers (ICs) that focus on aspects of health, human development, and biomedical science. The OD sets overall policy for NIH and coordinates the programs and activities of all NIH components, particularly in areas of research that involve multiple institutes.

Supplemental Funding for NIH

In FY2020 and prior years, NIH received supplemental appropriations provided as an emergency requirement. Given that this report examines trends in regular annual appropriations to NIH enacted by Congress and the President for the normal operations of the agency, amounts provided to NIH pursuant to an emergency requirement are generally excluded from this report. In some years, supplemental funding to NIH was substantial, such as the over $10 billion in appropriations provided in the American Recovery and Reinvestment Act of 2009 (ARRA; P.L. 111-5), which was a 33% increase to the regular FY2009 appropriations NIH received. NIH has also received supplemental appropriations during several infectious disease emergencies, such as for the Ebola and Zika outbreaks. Given current interest, a summary of the FY2020 amounts for the COVID-19 pandemic is provided in Table 1. NIH activities cover a wide range of basic, clinical, and translational research, focused on particular diseases, areas of human health and development, or more fundamental aspects of biology and behavior. Its mission also includes research training and health information collection and dissemination.23 More than 80% of the NIH budget funds extramural research (i.e., external) through grants, contracts, and other awards.3 This funding supports research performed by more than 300,000 individuals who work at over 2,500 hospitals, medical schools, universities, and other research institutions around the country.4 About 10% of the agency's budget supports intramural research (i.e., internal) conducted by nearly 6,000 NIH physicians and scientists, most of whom are located on the NIH campus in Bethesda, MDMaryland.5

Funding Sources

Funding for NIH comes primarily from annual Labor, HHS, and Education (LHHS) appropriationsAppropriations Acts, with an additional smaller amount for the Superfund Research Program from the Interior/Environment appropriationsAppropriations Act.6 Those two bills provide NIH discretionary budget authority. Through LHHS appropriations, some.6 Those two bills provide NIH discretionary budget authority.7

In addition, NIH has received mandatory funding of $150 million annually that is provided in Public Health Service Act (PHSA) Section 330B, for a special program on type 1 diabetes research. 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" Transfertransfer authority.97 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 actsAppropriations 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

FY2020 Budget and Appropriations

President Trump's FY2020 budget request would have provided NIH a total program level of $34.368 billion, a decrease of $4.945 billion (-12.6%) compared with FY2019-enacted levels (see Table A-1 for further details).12 In addition, the FY2020 budget request proposed consolidating the Agency for Healthcare Research and Quality (AHRQ) into NIH, forming a 28th IC—the National Institute for Research on Safety and Quality (NIRSQ). The creation of a new NIH institute would require an amendment to PHSA Section 401(d), which specifies that "[i]n the National Institutes of Health, the number of national research institutes and national centers may not exceed a total of 27."

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

In June 2019, the House passed two consolidated appropriations bills with proposed discretionary funding levels for NIH accounts: H.R. 2740, with proposed LHHS appropriations,15 and H.R. 3055, with proposed Interior/Environment appropriations.16 In summary, the House-passed legislation would have provided NIH with an FY2020 estimated program level of $41.314 billion (see Table A-1 for further details) and would have provided an increase for all ICs. The House did not accept the Administration's proposals to consolidate AHRQ into NIH or to cap the percentage of an investigator's salary that could be paid with NIH grant funds.

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.

The enacted FY2020 NIH program level represents a $2.6 billion increase (+6.6%) above the FY2019-enacted program level. The FY2020 enacted total for NIH is also $7.5 billion (+22.0%) above the program level proposed by the Administration and $601 million (+1.5%) above the program level proposed by the House-passed bills. In FY2020, all IC accounts receive an increase above FY2019 funding levels (see Table A-1). The Building and Facilities account has an unchanged funding level of $200 million. For the Innovation Account, the full amount authorized by the 21st Century Cures Act was appropriated (see textbox below).

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

Trends

Table 1 outlines NIH program level funding over the previous 25 years, and Figure 1 illustrates funding trends in both current (also called nominal dollars) and projected constant (i.e., inflation-adjusted) FY2020 dollars.

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]).

The 21st Century Cures Act and the NIH Innovation Account

The 21st Century Cures Act ("the Cures Act," P.L. 114-255) created a new NIH Innovation account for funding programs authorized by the act. For appropriated amounts to the account—up the limit authorized for each fiscal year—the amounts are subtracted from any cost estimate for enforcing the discretionary spending limit for each fiscal year (i.e., the budget caps). In effect, appropriations to the NIH Innovation Account as authorized by the Cures Act are not subject to discretionary spending limits.

The NIH Director may transfer these amounts from the NIH Innovation account to other NIH accounts but only for the purposes specified in the Cures Act. If the NIH Director determines that the funds for any of the four Innovation Projects are not necessary, the amounts may be transferred back to the NIH Innovation account.

The Cures Act specified that the following amounts shall be transferred to the NIH Innovation account: $352 million for FY2017; $496 million for FY2018; $711 million for FY2019; $492 million for FY2020; $404 million for FY2021; $496 million for FY2022; $1,085 million for FY2023; $407 million for FY2024; $127 million for FY2025; and $226 million for FY2026. All amounts authorized by the Cures Act have been fully appropriated from FY2017 to FY2020.22

For further information, see CRS Report R44720, The 21st Century Cures Act (Division A of P.L. 114-255), and CRS Report R45778, Exceptions to the Budget Control Act's Discretionary Spending Limits.

The lower half of Figure 1 shows NIH funding adjusted for inflation (in projected constant FY2020 dollars) using the Biomedical Research and Development Price Index (BRDPI).23 It shows that the purchasing power of NIH funding (non-ARRA) peaked in FY2003 (the last year of the five-year doubling period) and then declined fairly steadily for more than a decade (excluding ARRA) until back-to-back funding increases were provided in each of FY2016 through FY2020. The projected constant FY2020 program level is 5.4% below the peak FY2003 program level.

Paycheck Protection Program and Health Care Enhancement Act (P.L. 116-139),a Amount $706b             NLT transfer of $500c              

Source: Supplemental appropriations acts, as cited.

Notes: All funding is designated as being provided as an emergency requirement. All funding in the first and third supplemental appropriations acts is available until September 30, 2024. Funding in the fourth appropriations act is available until expended. The three acts include HHS transfer authorities. Per the first supplemental, HHS may transfer funds between the Centers for Disease Control and Prevention (CDC), Public Health and Social Services Emergency Fund (PHSSEF), and NIH accounts, as specified. Pursuant to the third supplemental, HHS may transfer funds between the Administration for Children and Families (ACF), Administration for Community Living (ACL), CDC, NIH, and PHSSEF accounts, as specified. In addition, the CDC Director may transfer funds appropriated to the Infectious Disease Rapid Response Fund (IRRRDF) to NIH. Per the fourth supplemental, HHS may transfer certain funds among the CDC, NIH, PHSSEF, and the Food and Drug Administration accounts, as specified.

a. Amounts provided in P.L. 116-139 are provided as transfers from the Public Health and Social Services Emergency Fund (PHSSEF) and are provided specifically for research and development related to COVID-19 tests, as specified for each transfer. b. Of this total, not less than $156 million shall be provided for "the study of, construction of, demolition of, renovation of, and acquisition of equipment for, vaccine and infectious diseases research facilities of or used by NIH, including the acquisition of real property." c. NLT stands for "not less than."

By convention, CRS does not add amounts provided as an emergency requirement to the NIH program levels in the remainder of this report. The FY2020 regular and emergency appropriations amounts are presented separately.

FY2021 Budget and Appropriations

President Trump's FY2021 initial budget request (February 10, 2020) proposed that NIH be provided with a total program level of $38.694 billion, a decrease of $2.99 billion (-7.2%) from FY2020-enacted levels. The proposed FY2020 program level would have been made up of15

  • $37.630 billion in LHHS appropriations, including the $404 million for the Cures Act Innovation Account (the full amount authorized for FY2021);
  • $741 million in transfers to NIH pursuant to the PHS Evaluation Tap authority;
  • $74 million for the Superfund Research Program in Interior/Environment appropriations; and
  • $150 million in proposed annual funding for the mandatory type 1 diabetes program.
Under the request, all existing IC accounts would receive a decrease compared to FY2020-enacted levels (see Appendix A). The Building and Facilities account would receive an increase in LHHS budget authority, from $200 million in FY2020 to $300 million in FY2021.16

Subsequently, on March 17, 2020, the Office of Management and Budget submitted an amendment to President Trump's original request that would increase funding for the National Institute of Allergy and Infectious Disease (NIAID) by $440 million relative to the original request. 17 The purpose of this additional requested funding was "to ensure [NIAID] has the resources beginning October 1, 2020, to continue critical basic and applied research on coronaviruses and other infectious diseases." This amendment to the original proposal, if enacted, would result in NIAID receiving an increase of $9.3 million above the FY2020 level. Taking into account this amendment, as of the date of this report, the FY2021 budget request would provide NIH with a total program level of $39.133 billion, a decrease of $2.55 billion (-6.1%) from FY2020-enacted levels, with a total of $38.811 billion by provided by LHHS appropriations.

In addition, the FY2021 budget request proposes consolidating the Agency for Healthcare Research and Quality (AHRQ) into NIH, forming a 28th IC—the National Institute for Research on Safety and Quality (NIRSQ). The creation of a new NIH institute would require amendments to the PHSA, especially Section 401(d), which specifies that "[i]n the National Institutes of Health, the number of national research institutes and national centers may not exceed a total of 27." Under the FY2021 request, NISRQ would receive a total appropriation of $355.112 million, including $256.66 million in discretionary LHHS budget authority and $98.452 million in mandatory appropriations from the Patient-Centered Outcomes Research Trust Fund (PCORTF) in Social Security Act Section 1181.18 Congress did not adopt the Administration's similar proposals to consolidate AHRQ into NIH as NIRSQ in FY2018 through FY2020.19

The budget request proposes select specified FY2021 funding levels for programs and activities within and across the NIH accounts based on the Administration's research priorities, as summarized in Table A-3. If adopted, these funding levels would likely be specified in report and/or explanatory statement language accompanying LHHS appropriations bills. For the most part, Congress does not specify NIH funding for particular diseases or areas of research, instead allowing the ICs to award funding within their mission areas. Funding awards are generally made on a competitive basis through various funding mechanisms intended to balance scientific opportunity with health priorities.20 Trends Table 2 outlines NIH program level funding over the previous 25 years; Figure 1 illustrates funding trends in both current (also called nominal dollars) and projected constant (i.e., inflation-adjusted) FY2021 dollars (funding shown is total budget authority).

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.21 In some years, (FY2006, FY2011, and FY2013) funding for the agency decreased in nominal dollars.22 From FY2016 through FY2020, 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.

The lower half of Figure 1 shows NIH funding adjusted for inflation (in projected constant FY2021 dollars) using the Biomedical Research and Development Price Index (BRDPI).23 It shows that the purchasing power of NIH funding peaked in FY2003 (the last year of the five-year doubling period) and then declined fairly steadily for more than a decade until back-to-back funding increases were provided in each of FY2016 through FY2020. The FY2021 budget request would provide a program level that is 13.0% below the peak FY2003 program level.

Figure 1. National Institutes of Health (NIH) Funding, FY1995-FY2021 Program Level Funding in Current and Projected Constant (FY2021) Dollars.

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

Program Level Funding in Current and Projected Constant (FY20208 Readers should note that totals in this report and NIH source documents include amounts "transferred in" pursuant to PHS tap but do not include any amounts "transferred out" under this same authority.

NIH also receives funding through LHHS appropriations, subject to different budget enforcement rules than the rest of the NIH funding in the act—appropriations to the NIH Innovation Account created by The 21st Century Cures Act ("the Cures Act," P.L. 114-255) to fund programs authorized by the act.9 For appropriated amounts to the account—up the limit authorized for each fiscal year—the amounts are subtracted from any cost estimate for enforcing discretionary spending limits (i.e., the budget caps). In effect, appropriations to the NIH Innovation Account as authorized by the Cures Act are not subject to discretionary spending limits.10 The NIH Director may transfer these amounts from the NIH Innovation Account to other NIH accounts, but only for the purposes specified in the Cures Act. If the NIH Director determines that the funds for any of the four Innovation Projects are not necessary, the amounts may be transferred back to the NIH Innovation Account. All amounts authorized by the Cures Act have been fully appropriated to the Innovation Account from FY2017 to FY2020, including $492 million for FY2020. For FY2021, $404 million is authorized to be appropriated.11

In addition, NIH has received mandatory funding of $150 million annually that is provided in Public Health Service Act (PHSA) Section 330B, for a special program on type 1 diabetes research, most recently extended through FY2020 by the CARES Act (P.L. 116-136), with additional partial-year FY2021 funding of $25,068,493 for October 1, 2020, through November 30, 2020.

The total funding available for NIH activities, taking account of add-ons and PHS tap transfers, is referred to as the NIH "program level."

FY2020-Enacted Funding

The enacted FY2020 NIH program level is made up of the following:12

  • $40.228 billion in discretionary LHHS appropriations, including the $492 million authorized for the Cures Act Innovation Account;
  • $1.231 billion pursuant to the PHS program evaluation transfer and a $225 million transfer from the HHS non-recurring expenses fund (NEF);13
  • $81 million for the Superfund research program in Interior/Environment appropriations; and
  • $150 million in annual funding for the mandatory type 1 diabetes research program.

Accounting for transfers and other adjustments, cited FY2021 budget documents from the Administration show the NIH FY2020 program level as $41.685 billion.14

Coronavirus Supplemental Appropriations NIH has also received emergency supplemental appropriations to several IC accounts as provided by the first and third, coronavirus supplemental appropriations acts, shown in Table 1, totaling $1.8 billion. In addition to these appropriations, the fourth coronavirus supplemental required that a total of not less than $1.8 billion of $25 billion appropriated to the Public Health and Social Services Emergency Fund be transferred to two NIH institutes and the Office of the Director. When accounting for these transfers, total funding directed to the NIH would come to not less than $3.6 billion across the three acts—an 8.6% funding increase over regular enacted FY2020 appropriations.

These acts also include various other transfer authorities that would allow for additional transfers to and from NIH accounts (explained in the table notes).

Table 1. NIH Funding in Coronavirus Supplemental Appropriations Acts

(budget authority, in millions of dollars)

Account

Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (P.L. 116-123): First Coronavirus Supplemental, Amount

Coronavirus Aid, Relief, and Economic Security Act (CARES Act; P.L. 116-136): Third Coronavirus Supplemental, Amount

National Institute of Allergy and Infectious Diseases (NIAID)

$836

Transfer to NIH National Institute of Environmental Health Sciences (NIEHS) (non-add)

($10)

National Heart, Lung, and Blood Institute (NHLBI)

$103.4

National Institute of Biomedical Imaging and Bioengineering (NIBIB)

$60

National Library of Medicine (NLM)

$10

National Center for Advancing Translational Sciences (NCATS)

$36

Office of the Director (OD)- Common Fund

$30

NLT transfer of $1,000

National Cancer Institute (NCI)

NLT transfer of $306

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 U.S. Congress, House and Senate Committees on Appropriations, Subcommittee on the Departments of Labor, Health and Human Services, Education, and Related Agencies, Division A--Department of Labor, Health and Human Services, and Education and Related Agencies [LHHS] Appropriations Act, 2020, committee print, 116th Cong., 2nd sess., December 16, 2019, pp. 187-189, with Superfund research program amounts from Title III of Division E from the Consolidated Appropriations Act, 2019 (P.L. 116-6) and from Title III of Division D from the Further Consolidated Appropriations Act, 2020 (P.L. 116-94)FY2020 and FY2021 program levels are based on NIH, "FY2021 Budget Request by IC (Summary Table)," https://officeofbudget.od.nih.gov/pdfs/FY21/br/5-SupplementaryTables.pdf), with FY2021 request amended to reflect budget request amendment in letter from Michael R. Pence, President of the Senate, to Donald Trump, President of the United States, March 17, 2020, at https://www.whitehouse.gov/wp-content/uploads/2020/03/Letter-regarding-additional-funding-to-support-the-United-States-response-to-COVID-19-3.17.2020.pdf. Inflation adjustment reflects the Biomedical Research and Development Price Index (BRDPI), updated January 2019, 2020, at https://officeofbudget.od.nih.gov/gbiPriceIndexes.html.

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 designated for emergency requirements are excluded from these totals (e.g., FY2015FY2020 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 amounts provided in the coronavirus supplemental appropriations acts, summarized in Table 1 of this report).

Table 12. NIH Funding, FY1994-FY2020

FY1995-FY2021

Program Level Funding in Current and Constant (FY2020FY2021) Dollars (billions)

-13.0%

Fiscal Year

Program Level Current $

% Change

Program Level Projected Constant FY2020FY2021 $

% Below FY2003a

1994

$10.956

  

$23.817

  

1995

11.300

3.1%

23.741

24.101 		 

1996

11.928

5.6%

24.436

806 		 

1997

12.741

6.8%

25.395

780 		 

1998

13.675

7.3%

26.363

762 		 

1999

15.629

14.3%

29.206

648 		 

2000

17.841

14.1%

32.141

628 		 

2001

20.459

14.7%

35.671

36.212 		 

2002

23.321

14.0%

39.359

955 		 

2003

27.167

16.5%

44.292

963 		 

2004

28.037

3.2%

44.069

736

-0.5%

2005

28.594

2.0%

43.262

917

-2.3%

2006

28.560

-0.1%

41.299

924

-6.8%

2007

29.179

2.2%

40.650

41.266

-8.2%

2008

29.607

1.5%

39.403

40.000

-11.0%

2009

30.545

3.2%

39.495

40.093

-10.8%

2010

31.238

2.3%

39.199

793

-11.5%

2011

30.916

-1.0%

37.716

38.288

-14.8%

2012

30.861

-0.2%

37.173

736

-16.1%

2013

29.316

-5.0%

34.662

35.187

-21.7%

2014

30.143

2.8%

34.891

35.419

-21.2%

2015

30.311

0.6%

34.386

906

-22.4%

2016

32.311

6.6%

35.875

36.418

-19.0%

2017

34.301

6.2%

37.119

681

-16.2%

2018

37.311

8.8%

39.353

990

-11.21%

2019

39.313

5.4%

40.374

41.256

-8.82%

2020b

41.915

685

6.6%

41.915

42.686

-5.41%

NIH Funding Including ARRA Supplement

2009

35.499

  

$46.02

  

2010

36.684

  

$46.15

  

2021PB

39.133

-6.1%

39.133

SourceSources: NIH Budget Office, Appropriations History by Institute/Center (1938 to Present), at httphttps://officeofbudget.od.nih.gov/approp_hist.html. The FY2019 and F2020 program levels are based on U.S. Congress, House and Senate Committees on Appropriations, Subcommittee on the Departments of Labor, Health and Human Services, Education, and Related Agencies, Division A--Department of Labor, Health and Human Services, and Education and Related Agencies [LHHS] Appropriations Act, 2020, committee print, 116th Cong., 2nd sess., December 16, 2019, pp. 187-189, with Superfund research program amounts from Title III of Division E from the Consolidated Appropriations Act, 2019 (P.L. 116-6) and from Title III of Division D from the Further Consolidated Appropriations Act, 2020 (P.L. 116-94). FY2020 and FY2021 program levels are based on NIH, "FY2021 Budget Request by IC (Summary Table)," at https://officeofbudget.od.nih.gov/pdfs/FY21/br/5-SupplementaryTables.pdf, with FY2021 request amended to reflect budget request amendment in letter from Michael R. Pence, President of the Senate, to Donald Trump, President of the United States, March 17, 2020, at https://www.whitehouse.gov/wp-content/uploads/2020/03/Letter-regarding-additional-funding-to-support-the-United-States-response-to-COVID-19-3.17.2020.pdf. Inflation adjustment reflects the Biomedical Research and Development Price Index (BRDPI), updated January 2019, 2020, at https://officeofbudget.od.nih.gov/gbiPriceIndexes.html.

Notes: By convention, budget tables, such as Table 12, 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., FY2015the FY2020 amount does not include the amounts provided in the coronavirus supplemental appropriations acts, summarized in Table 1 of this report). PB denotes "President's Budget." amount does not include $238,000,000 for the NIAID for research on Ebola that was provided in P.L. 113-235, Title VI of Division G).

a. FY2003 was the peak funding year for the NIH program level.

b. The FY2020 program level includes an estimated $150 million in annual funding for the Special Diabetes Program for Type 1 Diabetes. Full year funding for the program has not been enacted, though continuing resolutions and the consolidated appropriations act have provided partial year funding for the program. Following the budget table in the FY2020 explanatory statement, CRS uses the estimated annual funding amount of $150 million for the programThe FY2020 program level shown in table differs from enacted amounts in Further Consolidated Appropriations Act, 2020 (P.L. 116-94), accounting for a transfer of $5 million from the Office of the Director to the HHS Office of the Inspector General (OIG). In addition, FY2021 budget documents do not reflect the Nonrecurring Expenses Fund transfer of $225 million to NIH in the FY2020 program level, as directed by P.L. 116-94.

Appendix A. NIH Funding Details

Table A-1. NIH Funding, by Account/Mechanism

National Institutes of Health Funding

(budget authority, in millions of dollars)

Patient-Centered Outcomes Research Trust Fund (PCORTF)

Institutes/Centers

FY2019
Enacted

FY2020Final

FY2020FY2021
Request

FY2020
FY2021House passed

FY2020
FY2021Senate Senate Cmte.a

FY2020
Enacted

Cancer Institute (NCI)

$6,144

440

$5,247

881

$6,444

—

—

$6,440

Heart, Lung, and Blood Institute (NHLBI)

$3,488

625

$3,003

298

$3,659

—

—

$3,624

Dental/Craniofacial Research (NIDCR)

$462

$397

478

$484

435

—

$477

—

Diabetes/Digestive/Kidney (NIDDK)b

a

$2,030

115

$1,746

$2,129

924

—

$2,114

—

Neurological Disorders/Stroke (NINDS)

$2,274

447

$2,026

245

$2,386

—

—

$2,445

Allergy/Infectious Diseases (NIAID)

b

$5,523

$4,754

876

$5,808

885

—

$5,885

—

General Medical Sciences (NIGMS)c

$1,726

706

$1,732

931

$1,886

—

—

$1,706

Child Health/Human Development (NICHD)

$1,506

557

$1,297

416

$1,580

—

—

$1,557

National Eye Institute (NEI)

$797

823

$686

$835

749

—

$824

—

Environmental Health Sciences (NIEHS)d

$775

803

$667

730

$813

—

—

$803

National Institute on Aging (NIA)

$3,083

$2,654

546

$3,286

226

—

$3,544

—

Arthritis/Musculoskeletal/Skin Diseases (NIAMS)

$605

625

$521

568

$635

—

—

$625

Deafness/Communication Disorders (NIDCD)

$474

$408

491

$498

446

—

$491

—

National Institute of Mental Health (NIMH)

$1,870

$1,630

2,043

$1,962

845

—

$2,038

—

National Institute on Drug Abuse (NIDA)

$1,420

458

$1,296

432

$1,489

—

—

$1,462

Alcohol Abuse/Alcoholism (NIAAA)

$526

547

$452

497

$551

—

—

$545

Nursing Research (NINR)

$163

172

$140

157

$171

—

—

$169

Human Genome Research Institute (NHGRI)

$576

$495

604

$604

550

—

$606

—

Biomedical Imaging/Bioengineering (NIBIB)

$389

405

$336

$408

368

—

$404

—

Minority Health/Health Disparities (NIMHD)

$315

$271

336

$341

305

—

$336

—

Complementary/Integrative Health (NCCIH)

$146

152

$126

138

$154

—

—

$152

Advancing Translational Sciences (NCATS)

$806

833

$694

788

$846

—

—

$833

Fogarty International Center (FIC)

$78

81

$67

74

$85

—

—

$81

National Library of Medicine (NLM)

$442

$380

457

$464

416

—

$457

—

Office of Director (OD)e

$1,922

$1,769

2,247

$2,063

099

—

$2,252

—

Innovation Accountf

$196

$157

$157

109

—

$157

—

Buildings and Facilities (B&F)

$200

$200

300

$200

—

—

$200

National Institute for Research on Safety & Quality (NIRSQ)g

—

$256

257

—

—

—

SubtotalSubtotal, NIH (LHHS Discretionary BA)

$40,223

, NIH (LHHS Discretionary BA, non-transfer)

$37,937

$33,410

$39,937

38,811

—

$40,228

—

PHS Program Evaluation (provided to NIGMS)

$1,147

231

$741

$1,147

—

$1,231

—

Nonrecurring Expenses Fund (NEF) Transfer

Superfund (Interior approp. to NIEHS)g

—

$81

—

$74

—

—

$225

Superfund (Interior approp. to NIEHS)h

Nonrecurring Expenses Fund (NEF) Transfer (to Buildings and Facilities)h

$79

$67

($225)i

$80

—

$81

—

$81

—

Mandatory type 1 diabetes fundsi

(to NIDDK)j

$150

$150

$150

—

—

—

$150

98    

NIH Program Level

$39,313

41,685

$34,368

$41,314

39,133

—

$41,915

—

Source: U.S. Congress, House and Senate Committees on Appropriations, Subcommittee on the Departments of Labor, Health and Human Services, Education, and Related Agencies, Division A--Department of Labor, Health and Human Services, and Education and Related Agencies [LHHS] Appropriations Act, 2020, committee print, 116th Cong., 2nd sess., December 16, 2019, pp. 187-189, and H.Rept. 116-62, pp. 332-334, except as noted below.

NIH, "FY2021 Budget Request by IC (Summary Table)," at https://officeofbudget.od.nih.gov/pdfs/FY21/br/5-SupplementaryTables.pdf, except as noted below.

Notes: Totals may differ from the sum of the components due to rounding. Amounts in table may differ from actuals in many cases. By convention, budget tables such as Table A-1 do not subtract the amount of transfers to the evaluation tap from the agencies' appropriation.

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

bAmounts for the columns headed "FY2021 House," and "FY2021 Senate" will be added, if available, as each action is completed. In general, amounts provided to NIH for emergency requirements are excluded from these totals (e.g., FY2020 amount does not include the amounts provided in the coronavirus supplemental appropriations acts, summarized in Table 1 of this report). a. Amounts for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) do not include mandatory funding for type 1 diabetes research (see note h).

b. The White House amended the NIAID FY2021 budget request on March 17, 2020, in a supplemental request letter for COVID-19 funding, to $5,885,470,000, which is $439,584,000 above the original FY2021 budget request. c. Amounts for National Institute of General Medical Sciences (NIGMS) do not include funds from PHS Evaluation Set-Aside (§241 of the PHS Act). Though the budget request would have providedprovides an increase to NIGMS through discretionary LHHS budget authority (BA) compared to FY2019FY2020, the total amount for NIGMS with the PHS evaluation transfer included iswould be less than FY2019-enacted levels. The FY2020 NIGMS amount is similarly higher than the FY2019-enacted level when accounting for the PHS Evaluation Set-Aside.

FY2020-enacted levels.

d. Amounts for National Institute of Environmental Health Sciences (NIEHS) do not include Interior/Environment Appropriations amount for Superfund research (see note g).

e. Includes $12.6 million for the Gabriella Miller Kids First Research Act.

f. The amount shown for the NIH Innovation Account in each column represents only a portion ($196 million for FY2019, $157 million for FY2020) of the total appropriation to the account ($711492 million for FY2019, $492the FY2020; $404 million for FY2020FY2021). The remaining funds for this account are incorporated, where applicable, into the totals for other ICs. For the FY2020FY2021, this includes $195 to NCI for cancer research and $7050 million to each of NINDS and NIMH for the BRAIN Initiative. g. This is a separate account in the Interior/Environment appropriations for National Institute of Environmental Health Sciences (NIEHS) research activities related to Superfund research. h. 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). i. Though FY2020 LHHS enacted appropriations (P.L. 116-94) directed an NEF transfer of $225 million to the Buildings and Facilities account, this transfer was not reflected in the FY2021 budget request tables and therefore is shown as a non-add in this table. j. Mandatory funds are available to NIDDK for type 1 diabetes research are under PHSA Section 330Bm. For FY2020, this funding has been extended by the Coronavirus Aid, Relief, and Economic Security Act (P.L. 116-136) through FY2020, with a temporary FY2021 extension through November 30, 2020. Cited FY2021 budget request documents show $150 million as the FY2021 proposed funding level.

Program-Specific Funding

In recent years, Congress and the President have increasingly specified funding levels for programs or research areas within NIH accounts throughout the budget and appropriations process. Congress uses language in reports and explanatory statements accompanying appropriations bills to designate funding for specified purposes. The Administration requests NIH program-specific funding, as outlined in the HHS and NIH budget request documents. For the most part, Congress does not specify NIH funding for particular diseases or areas of research, instead allowing the ICs to award funding within their mission areas. Funding is generally awarded on a competitive basis through various funding mechanisms intended to balance scientific opportunity with health priorities.24

In FY2020, Congress used explanatory statement language to specify a certain amount of IC funding for designated purposes million to each of NINDS and NIMH for the BRAIN Initiative.

g. Amount for an NIRSQ proposed by the Trump Administration does not include the estimated $112.5 million in mandatory funding transfers from the Patient-Centered Outcomes Research Trust Fund (PCORTF) in FY2019, which were provided outside of the annual appropriations process.

h. This is a separate account in the Interior/Environment appropriations for National Institute of Environmental Health Sciences (NIEHS) research activities related to Superfund research. The FY2019-enacted amount is from Title III of Division E from the Consolidated Appropriations Act, 2019 (P.L. 116-6); the House-proposed FY2020 amount is from House-passed Department of the Interior, Environment, and Related Agencies Appropriations Act, 2020 (H.R. 3055); the Senate committee amount is from Department of the Interior, Environment, and Related Agencies Appropriations Act, 2020 (S. 2580); and the FY2020 amount is from Title III of Division D from the Further Consolidated Appropriations Act, 2020 (P.L. 116-94).

i. Mandatory funds are available to NIDDK for type 1 diabetes research under PHSA Section 330Bm were provided by Section 50902 of P.L. 115-123 for FY2018 and FY2019, specified at $150 million annually. For FY2020, several temporary extensions of the funding have been provided in FY2020 continuing resolutions (P.L. 116-59, P.L. 116-69) and most recently in Section 402 of Division N, Title I, Health and Human Services Extenders in P.L. 116-94, which provided $96.6 million in funding for the program until May 22, 2020. Several legislative proposals have been introduced to extend the program (some propose increased program funding), but none have been enacted. Cited FY2020 budget documents show $150 million as the FY2020 funding level, and therefore CRS uses this amount for budget analysis.

Program Funding from FY2020 Explanatory Statement

In recent years, Congress has increasingly used language in reports and explanatory statements accompanying appropriations bills to designate funding for specific research areas, activities, or programs at NIH. For the most part, Congress does not specify funding for designated purposes and allows the ICs to allocate program funding through various agency mechanisms.24 In some cases, Congress uses report language to specify a certain amount of IC funding for a designated purpose, as summarized in Table A-2.

, as summarized in Table A-2. Sometimes the report language specifies that "no less than" a certain amount can be designated for a certain purpose; in other cases, report language "provides" or "recommends" that an amount be spent on a certain purpose. WhileFor FY2020, while the House report (H.Rept. 116-62) also included funding levels for some of the below programs, the amounts in the explanatory statement supersede those. Both the explanatory statement and the House report include many additional statements directing the agency to prioritize certain programs or areas of research, as well as expressing the opinion or concerns of Congress regarding NIH; these broad statements are not summarized here.

Table A-2. Specified NIH Funding Levels in FY2020 Explanatory Statement

  NASEM study of NIH research on autoimmune conditions that predominately affect women.

  Firearm injury and mortality prevention research

  Best Pharmaceuticals for Children Act research

Institute

/Center

Program

Amount

Cancer Institute (NCI)

Childhood cancer data initiative

Cancer Data Initiative

$50 million
 

Additional cancer research awards

$212.5 million
 

Childhood Cancer Survivorship, Treatment Access, and Research (STAR) Act

$25 million

Neurological Disorders/Stroke (NINDS)

Opioid misuse and addiction

$250 million

Allergy/Infectious Diseases (NIAID)

AIDS2020 Conference (International AIDS Conference)

$5.1 million
 

Combating antimicrobial resistance (AMR)

$511 million, an increase of $50 million
 

NASEM study on the long-term medical and economic impacts of increased AMR in the United States

$1.7 million
 

HIV/AIDS research

an increase of no less than $25 million over FY2019 level
 

Centers for AIDS Research

$51 million
 

Universal flu vaccine

$200 million, an increase of $60 million

General Medical Sciences (NIGMS)

Institutional Development Award (IDeA) Program

$386.6, an increase of $25 million

Environmental Health Sciences (NIEHS)

Hurricane Harvey research

$3 million

Aging (NIA)

Alzheimer's disease and related dementias

Increase of $350 million; total funding no less than $2.818 billion

Drug Abuse (NIDA)

Opioid misuse and addiction

$250 million

Genome Research (NHGRI)

Emerging Centers of Excellence in Genomic Sciences

$10 million

Minority Health/Health Disparities (NIMHD)

Research Centers in Minority Institutions

$75 million

Advancing Translational Sciences (NCATS)

Clinical and Translational Science Awards (CTSAs)

$578.1 million
 

Cures Acceleration Network

up to $60 million

Office of the Director (OD)/ Multi-Institute Research Initiatives

All of Us Precision Medicine Initiative

$500 million (including $149 million from the Innovation Account)

$1.5 million
 

Big data- Chief Data Strategist's work

$30 million
 

Grants for biomedical research facilities

$50 million
 

Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative

$500 million (including $140 million from the Innovation Account)

$12.5 million
 

HHS Office of National Security allocation for foreign threats program

$5 million
 

Environmental Influences on Child Health Outcomes Program

IDeA States Pediatric Clinical Trials Network

$15 million
 

NASEM study related to organ donation and transplantation.

$1.5 million

$25 million
 

Investigation of Co-Occurring Conditions Across the Lifespan to Understand Down Syndrome (INCLUDE)

$60 million
 

NASEM study on long-term medical and economic impacts of the inclusion of women and racial minorities in clinical research.

$1.2 million

Source: U.S. Congress, House and Senate Committees on Appropriations, Subcommittee on the Departments of Labor, Health and Human Services, Education, and Related Agencies, Division A--—Department of Labor, Health and Human Services, and Education and Related Agencies [LHHS] Appropriations Act, 2020, committee print, 116th Cong., 2nd sess., December 16, 2019, pp. 49-85, 187-189.

Notes: NASEM iais the National Academies of Sciences, Engineering, and Medicine, private nonprofit institutions that advise on policy related to science, technology, and health. The predecessor organization, National Academy of Sciences, was created by congressional charter in 1863.

Table A-3. Specified NIH Funding Levels in FY2021 Budget Request

Program/Activity

Amount

Opioids and Pain Research

$1.4 billion—$533 million for the Helping End Addiction Long-Term (HEAL) Initiative and more than $900 million to support ongoing research.

Methamphetamine and Other Stimulant Use- developing medication-assisted treatment and evidence-based psychosocial treatment

$50 million

Childhood Cancer Data Initiative

$50 million

Centers for AIDS Research

$16 million

Influenza research

$423 million—$200 million for developing a universal influenza vaccine

Tick-borne diseases research

$115 million

Artificial Intelligence for Chronic Disease—utilizing artificial intelligence to deepen understanding of the underlying causes of chronic diseases and identify successful early treatments

$50 million

Gene Vector Production—creating a consortium with industry, academic, and federal stakeholders to increase the efficiency of vector production and speed up gene therapy clinical trials and treatments

$30 million

Ruth L. Kirschstein Institutional National Research Service Award Program

$848 million

IDeA States Pediatric Clinical Trials Network

$15 million

Neonatal research

$100 million

National Institute for Research on Safety and Quality (NIRSQ) Programs

Health Services Research, Data, and Dissemination Research Portfolio

$57 million

Improving Maternal Health in America Initiative

$7 million

Patient Safety Research

$60 million

Medical Expenditure Panel Survey (MEPS)

$72 million
Source: HHS, "FY2021 Budget in Brief," pp. 54-61, at https://www.hhs.gov/sites/default/files/fy-2021-budget-in-brief.pdf. For the most part, the budget request does not specify funding amounts by institute/center or account. Appendix B. Acronyms and Abbreviations Appendix B. Acronyms and Abbreviations

Acronym/
Abbreviation

Organization/Term

FIC

Fogarty International Center

FY

Fiscal Year

NASEM

National Academies of Sciences, Engineering, and Medicine

NCATS

National Center for Advancing Translational Sciences

NCCIH

National Center for Complementary and Integrative Health

NCI

National Cancer Institute

NEI

National Eye Institute

NHGRI

National Human Genome Research Institute

NHLBI

National Heart, Lung, and Blood Institute

NIA

National Institute on Aging

NIAAA

National Institute on Alcohol Abuse and Alcoholism

NIAID

National Institute of Allergy and Infectious Diseases

NIAMS

National Institute of Arthritis and Musculoskeletal and Skin Diseases

NIBIB

National Institute of Biomedical Imaging and Bioengineering

NICHD

National Institute of Child Health and Human Development

NIDA

National Institute on Drug Abuse

NIDCD

National Institute on Deafness and Other Communication Disorders

NIDCR

National Institute of Dental and Craniofacial Research

NIDDK

National Institute of Diabetes and Digestive and Kidney Diseases

NIEHS

National Institute of Environmental Health Sciences

NIGMS

National Institute of General Medical Sciences

NIMH

National Institute of Mental Health

NIMHD

National Institute on Minority Health and Health Disparities

NINDS

National Institute of Neurological Disorders and Stroke

NINR

National Institute of Nursing Research

NLM

National Library of Medicine

OD

NIH Office of the Director

Author Contact Information

Kavya Sekar, Analyst in Health Policy ([email address scrubbed], [phone number scrubbed])

Footnotes

 2. Amounts shown in Table 2 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.

1Acknowledgments

CRS Research Assistant Isaac Nicchitta provided valuable assistance in analysis and writing for this report.

Footnotes

1.

"Mandatory spending" is controlled by authorization acts; "discretionary spending" is controlled by appropriations acts. For further information, see CRS Report R44582, Overview of Funding Mechanisms in the Federal Budget Process, and Selected Examples.

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).
23.

For further information on NIHThe National Institutes of Health (NIH), see CRS Report R41705, The National Institutes of Health (NIH): Background and Congressional Issues.
34.

NIH, "What We Do- Budget," March 3, 2020, at https://www.nih.gov/about-nih/what-we-do/budget.

.

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.

4.

Ibid.
5.

Ibid.
6.

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.
7.

NIH received a total of $10.4 billion in supplemental, one-time FY2009 appropriations in the American Recovery and Reinvestment Act (ARRA) of 2009 (P.L. 111-5). ARRA funds were made available for obligation for two years; $4.95 billion was obligated in FY2009, and $5.45 billion in FY2010. CRS Report R43304, Public Health Service Agencies: Overview and Funding (FY2010-FY2016).

8.

42 U.S.C. §254c-3.
9.

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).

108.

See §Section 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 actAppropriations 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.
119.

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

12.

NIH, "Justification of Estimates for Appropriations Committees--Overview FY2020, Vol. 1," p. 78.
13.

Though the budget request provides an increase to the National Institute of General Medical Sciences (NIGMS) through discretionary LHHS budget authority, the total amount for NIGMS with the PHS evaluation transfer included is less than FY2019-enacted levels. For proposed FY2020 IC funding levels see Table A-1.

14.

NIH, "Justification of Estimates for Appropriations Committees--Overview FY2020, Vol. 1."
15.

The Labor, Health and Human Services, Education, Defense, State, Foreign Operations, and Energy and Water Development Appropriations Act, 2020.
16.

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.
17.

CRS Insight IN11114, FY2020 LHHS Appropriations: Status.

18.

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).

19.

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.

20.

Amounts shown in Table 1See section on 21st Century Cures Act in CRS Report R41705, The National Institutes of Health (NIH): Background and Congressional Issues.

10.

CRS Report R45778, Exceptions to the Budget Control Act's Discretionary Spending Limits.

11.

P.L. 114-255, §1001.

12.

Except for the full FY2020 mandatory diabetes program extension, all FY2020 NIH funding was provided by the Further Consolidated Appropriations Act, 2020 (P.L. 116-94).
13.

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

14.

This program level accounts for a transfer of $5 million from the Office of the Director to the HHS Office of the Inspector General (OIG). In addition, FY2021 budget request tables do not reflect the Nonrecurring Expenses Fund transfer of $225 million to NIH in the FY2020 program level, as directed by P.L. 116-94.

15.

NIH, Congressional Justification: FY2021, February 10, 2020, p. 75, at https://officeofbudget.od.nih.gov/pdfs/FY21/br/1-OverviewVolumeSingleFile-toPrint.pdf.
16.

P.L. 116-94 directed a transfer of $225 million from the HHS Nonreccurring Expenses Fund to the NIH Buildings and Facilities account in FY2020-enacted appropriations. However, this transfer is not reflected in the budget tables of the NIH FY2021 Congressional Justification.

17.

Letter from Michael R. Pence, President of the Senate, to Donald Trump, President of the United States, March 17, 2020, at https://www.whitehouse.gov/wp-content/uploads/2020/03/Letter-regarding-additional-funding-to-support-the-United-States-response-to-COVID-19-3.17.2020.pdf.
18.

For more information about the Patient-Centered Outcomes Research Trust Fund, see CRS Insight IN11010, Funding for ACA-Established Patient-Centered Outcomes Research Trust Fund (PCORTF) Extended Through FY2029.

19.

See NIH sections of CRS Report R44888, Federal Research and Development Funding: FY2018; CRS Report R45150, Federal Research and Development (R&D) Funding: FY2019; and CRS Report R45715, Federal Research and Development (R&D) Funding: FY2020.

20.

CRS Report R41705, The National Institutes of Health (NIH): Background and Congressional Issues.

21.
2122.

For instance, the FY2006 total was 0.1% lower than the previous year, the first time that the NIH appropriationNIH appropriations 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.
22.

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 was provided by the FY2019 Consolidated Defense, LHHS, and Continuing Resolution Appropriations Act (P.L. 115-245). The fourth round of funding is detailed in this report.

23.

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.
24.

CRS Report R41705, The National Institutes of Health (NIH): Background and Congressional Issues.