On Tuesday, President Barack Obama released the proposed budget for fiscal year (FY) 2015, including the "Budget-in-Brief" for the Department of Health and Human Services (HHS). While the president's budget request is widely viewed by Washington insiders as "dead-on-arrival," a "non-starter," and "on the road to nowhere" on Capitol Hill, it does provide important clues into the administration's thinking and how it would prioritize health and health research if the constitutional "power of the purse" were in the hands of the Executive Branch.
As with any budget document, the devil is in the details. And to fully understand the administration's vision for health services research we'll need to wait until later this week when agencies publicly release their budget justifications to appropriators in Congress (more on that to come). Nevertheless, the Budget-in-Brief indicates a major win for the field of health services research--even if just the first step in a winding process of negotiation between the executive and legislative branches.
Beginning more than a decade ago, the Agency for Healthcare Research and Quality (AHRQ) started changing the way it did business, moving away from competitive research grants toward contracts as the funding mechanism of choice. By 2013, new and competing grants comprised only 5 percent of AHRQ's total budget. In fact, the ratio of total grants to total contracts in the budget has gone from 1.35:1 in 2002 to 0.51:1 in 2013.
AcademyHealth members have been vocal in their concerns, and AcademyHealth responded by making a concerted advocacy effort to restore balance to both what AHRQ funds, and how it funds that work. Beginning five years ago, AcademyHealth was successful in convincing Congress to create a small set-aside in AHRQ's budget for "investigator initiated research" (IIR). This is ironic given that IIR is the centerpiece of research funding at the National Institutes of Health and has been seen as a key strategy to have the best and brightest scientists compete for funding based on the strength of their science and the potential impact of their work. But beginning with the earliest of President Obama's budgets, the administration has each year proposed cutting funding for IIR, or eliminating it altogether.
AcademyHealth fought back by educating policymakers on the Hill and in the administration about the value of research competition and innovation afforded by R01s. Congress has listened, and consistently supported the funding for IIR. Over time, this set-aside has grown slowly to a new high watermark of nearly $46 million in the FY 2014 spending bill passed by Congress and signed by President Obama in January.
Based on the president's FY 2015 budget request, it seems AcademyHealth's message has finally reached the administration as well. The president explicitly requests $40 million for AHRQ's IIR portfolio. The request includes $20 million for new and competing grants, and of this, $15 million for health economics research. A first!
The administration's budget request is just that, a request. It will be up to congressional appropriators to decide how much, if any, funding to dedicate to AHRQ's IIR portfolio. However, the administration's acknowledgement of the value of IIR by prioritizing it in the FY 2015 budget remains a small but significant victory for the field of health services research, and demonstrates importance of persistence in advocacy.