Highlights from the President's FY 2018 Budget Request: Dept. of Health and Human Services

Unless otherwise noted, all FY 2018 figures are from the department’s budget justification, and all FY 2017 figures are from committee reports for the Consolidated Appropriations Act of 2017.

The administration’s FY 2018 budget request for the Department of Health and Human Services (HHS) is $69.8 billion in discretionary spending, reflecting a $14.6 billion (17.3 percent) decrease from FY 2017 estimated funding levels. Discretionary spending accounts for approximately 7 percent of the total proposed HHS budget. Mandatory spending for programs like Medicare, Medicaid and the Children’s Health Insurance Program account for the balance. Total FY 2018 budget authority for HHS would be $1.1 trillion (0.03 percent increase over FY 2017 estimates).  

National Institutes of Health (NIH)

In FY 2018, NIH would receive $26.9 billion, a decrease of $5.7 billion (17.4 percent).

As part of the 21^st Century Cures Act, the Congressionally authorized 10-year $4.8 billion funding commitment, NIH will commit $496 million in FY 2018 for four key initiatives including:

• The Precision Medicine Initiative;
• The Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative;
• The Beau Biden Cancer Moonshot; and,
• The Regenerative Medicine Program. 

In the president’s budget, NIH would be subject to several structural changes including:

• Applying a uniform indirect cost rate to all grants;
• Eliminating the Fogarty International Center, but retaining allfederal staff and maintaining key activities in other NIH Institutes and Centers;
• Consolidating the Agency for Healthcare Research and Quality into NIH while maintaining $272 million in discretionary funding for these activities; and,
• Conducting a review of health services research across NIH and developing a strategy to ensure that the highest priority health services research is conducted and made available across the federal government.

The proposal highlights that on average, from FY 1994 to FY 2014, NIH spent approximately 30 percent of its research resources on indirect costs. The Trump administration proposes reforms to release grantees from the “costly and time-consuming” indirect rate setting process and reporting requirements. By applying a uniform indirect cost rate to all grants, the administration contends that the risk for fraud and abuse will be mitigated because it can be simply and uniformly applied to all grantees.

The proposed FY 2018 NIH funding would support a total of 33,403 research project grants, including 7,326 new and competing awards (18.4 percent decrease from FY 2017 estimates) with 1,578 new SBIR/STTR awards (11.3  percent decrease). Approximately 9.2 percent of the budget would support intramural programs consisting of basic and clinical research activities with the majority of NIH’s available funding used to support the extramural research community including universities, medical schools, hospitals and other research facilities. The total request for the 24 institutes of NIH and the Office of the Director breaks down as follows:

Agency for Healthcare Research and Quality (AHRQ)

While the Agency for Healthcare Research and Quality (AHRQ) would be eliminated, the FY 2018 budget request includes $272 million within NIH to preserve key research activities previously carried out by the Agency for Healthcare Research and Quality (AHRQ). Under the proposed plan, NIH would structure AHRQ as an institute and “preserve links between many of the closely-related continuing activities; simplify administrative responsibilities for consolidating and continuing the programs; and, maintain an entity that can serve as a center of excellence for improving the quality and safety of health care services.”

Centers for Disease Control and Prevention (CDC)

The FY 2018 budget requests $6.4 billion, a $25 million (0.4 percent) increase, for the Centers for Disease Control and Prevention (CDC) to support activities including funding for basic and applied research in areas of interest to the CDC.