INSIGHTi

National Institutes of Health (NIH) Provisions
Expiring in 2023
June 8, 2023
The National Institutes of Health (NIH), based in the Department of Health and Human Services (HHS),
is the primary federal agency responsible for medical and health research. NIH is made up of 27 Institutes
and Centers and the Office of the Director (OD). In addition, Congress established a new agency in
FY2022—the Advanced Research Projects Agency for Health (ARPA-H)—that is housed within NIH. In
FY2023, NIH has a total program level of $49.2 billion, which includes $1.5 billion for ARPA-H and
$47.7 billion for NIH Institutes and Centers and OD.
NIH programs are mostly authorized through the Public Health Service Act (PHSA), specifically PHSA
Section 301 and Title IV. Some of NIH’s authorizations are expiring in 2023 or have previously expired.
For the most part, NIH is funded by annual discretionary appropriations and has continued to receive
annual appropriations, including where authorizations of appropriations have expired. However, NIH
receives some mandatory appropriations and some funding subject to unique budgetary rules scheduled to
expire in 2023.
Authorizations of Discretionary Appropriations
NIH-Wide Authorization
There is an authorization of appropriations for all of NIH (“PHSA Title IV”) in PHSA Section
402A(a)(1), which expired in FY2020 (42 U.S.C. §282a(a)(1)). This NIH-wide authorization of
appropriations was established through the NIH Reform Act of 2006 (P.L. 109-482), which consolidated
all of the authorizations of appropriations for specific NIH programs into one single authorization of
appropriations for the entire agency. This provision was most recently reauthorized through the 21st
Century Cures Act (P.L. 114-255) from FY2018 through FY2020. Congress has continued to appropriate
NIH funding through annual appropriations laws.
FY2024 Request: The Biden Administration proposed a total FY2024 appropriation of $47.9 billion
under PHSA Section 402A(a)(1).
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https://crsreports.congress.gov
IN12173
CRS INSIGHT
Prepared for Members and
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Gabriella Miller Kids First Research Program
In 2014, the Gabriella Miller Kids First Research Act (P.L. 113-94) established a new mechanism to fund
a 10-year pediatric research initiative as a part of the NIH Common Fund, a fund managed by the Office
of Director intended to support short-term and multidisciplinary research projects. Specifically, the Kids
First Act established a 10-year Pediatric Research Initiative Fund (PRIF), which receives transfers from
the Presidential Nominating Convention Account within the Presidential Election Campaign Fund (PECF;
26 U.S.C. §9008(i)). Although the PRIF includes “10-year” in its name, transfers into the PRIF are not
time-limited. Separately, the Kids First Act added a new authorization of appropriations of $12.6 million
annually from the PRIF to fund pediatric research grants supported by the Common Fund (PHSA Section
402A(a)(2), 42 U.S.C. §282a(a)(2)). The authorization of appropriations is set to expire in FY2023.
Since FY2015, appropriations laws have provided the $12.6 million annually to support the Kids First
research program. In most years, these appropriations were made from the PRIF, as established by the
Kids First Act. However, in two years—FY2018 and FY2022—PRIF balances were too low to fund the
full $12.6 million for the program. In both years, Congress provided appropriations from the Treasury
General Fund to finance the full $12.6 million (see the FY2022 NIH budget request).
FY2024 Request: The Biden Administration proposed an FY2024 appropriation of $12.6 million from
the PRIF for the Kids First program, the same funding level and source as FY2023.
Congressional Action: In 2022, the House passed H.R. 623, which would have extended the program
with an increased authorization of appropriations of $25 million annually available from the PRIF for
FY2023 through FY2027. In the 118th Congress, introduced bills (H.R. 3391, H.R. 546 and S. 1624)
would address the program. H.R. 3391 is largely the same as the 2022 House-passed bill. S. 1624 would
add a new funding source for the PRIF—Securities and Exchange Commission penalties on certain
companies. H.R. 546 would terminate the PECF and transfer all remaining funds to the PRIF.
Mandatory and Other Unique Funding Authorities
Special Diabetes Program for Type 1 Diabetes
Provided through PHSA Section 330B (42 U.S.C. 254c-2), the Special Diabetes Program (SDP) for Type
1 Diabetes Research receives annual mandatory appropriations to fund research on type 1 diabetes at the
National Institutes of Diabetes and Digestive and Kidney Diseases. SDP was first established in 1998.
From FY2004 to FY2023, PHSA Section 330B has provided $150 million annually—most recently
extended in Consolidated Appropriations Act, 2021 (P.L. 116-260). However, due to Budget Control Act
sequestration, the program received $141.5 million in each of FY2022 and FY2023.
FY2024 Request: The Biden Administration has proposed SDP appropriations of $250 million for
FY2024, $260 million for FY2025, and $270 million for FY2026.
Congressional Action: In May 2023, the House Energy and Commerce Health Subcommittee marked up
an SDP extension through an amendment in the nature of a substitute to H.R. 3281 (Section 202). The
legislation would provide $170 million in mandatory spending for each of FY2024 and FY2025.
21st Century Cures Act Innovation Account—Cancer Moonshot Initiative
The 21st Century Cures Act of 2016 (P.L. 114-255; Division A) established a new NIH Innovation
Account to fund, on a discretionary basis, four innovation projects, including the Cancer Moonshot. This
account is subject to different budget enforcement rules than the rest of NIH’s discretionary
appropriations. Amounts appropriated to the account—up to the limit authorized for each fiscal year—are
subtracted from any cost estimate for enforcing discretionary spending limits (i.e., the budget caps). In

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effect, appropriations to the NIH Innovation Account as authorized by the Cures Act are not subject to
discretionary spending limits.
The Cures Act authorized appropriations for the Cancer Moonshot effort until FY2023 (Cures Act Section
1001). Congress could still continue to fund the Cancer Moonshot Initiative in FY2024 without
reauthorizing the Cures Act provision; these appropriations would be subject to the same budget
enforcement rules as other discretionary appropriations.
FY2024 Request: The Biden Administration has proposed to reauthorize the Cancer Moonshot Initiative
and to provide $2.9 billion in mandatory appropriations for the program in FY2025 and FY2026. This is
part of the Administration’s “reignited” Cancer Moonshot initiative announced in 2022. In addition, the
Biden Administration has proposed a broader Cancer Moonshot initiative with investments across HHS in
cancer research, prevention, and control in its FY2024 budget.


Author Information

Kavya Sekar

Analyst in Health Policy




Disclaimer
This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan shared staff
to congressional committees and Members of Congress. It operates solely at the behest of and under the direction of
Congress. Information in a CRS Report should not be relied upon for purposes other than public understanding of
information that has been provided by CRS to Members of Congress in connection with CRS’s institutional role.
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