The White House has proposed cutting $7.2 billion from the NIH budget, with $1.2 billion coming out of NCI—a proposal that, if supported by Congress, would eviscerate the cancer research enterprise in the United States, critics say.
NIH stands to lose 21 percent in the Trump administration’s updated fiscal 2018 budget proposal, which would reduce the NIH budget to $26.92 billion. Also, the White House proposes to cut $1.2 billion from NCI’s budget—a 20 percent loss.
The budget proposal, which was released May 23, comes on the heels of the FY17 omnibus spending bill, in which Congress approved a $2 billion increase for NIH (The Cancer Letter, May 5).
In a budget blueprint published in March, the administration proposed cutting NIH by 18.3 percent. At the time, the blueprint, titled “America First,” provoked immediate backlash from research organizations and luminaries in oncology. The final budget proposal seeks slash even more money from NIH.
In recent weeks, The Cancer Letter spoke with former NCI directors, scientists, advocates and legislators. A summary of these conversations appear at the end of this page.
Other federal health agencies also stand to lose significant resources, or risk being completely defunded in the White House’s budget proposal, which aims to cut federal spending by $3.6 trillion over 10 years. The following agencies are slated to have their total discretionary budget authority reduced by:
FDA: $854 million
Centers for Disease Control and Prevention: $1.315 billion
Health Resources and Services Administration: $602 million
The Agency for Healthcare Research and Quality is, once again, on the cutting block: the $425 million agency that plays a central role in the implementation of the Affordable Care Act would be eliminated in President Donald Trump’s budget proposal. Trump may succeed—for at least three times over the past eight years, the House has tried to defund the 27-year-old federal agency, which pays for patient-centered outcomes research and monitors the manner in which medicine is practiced in the U.S. (The Cancer Letter, June, 26, 2015, July 20, 2012).
The proposal would also reduce Medicaid funding by more than $600 billion.
“The President’s proposed budget is extremely disappointing, but we remain encouraged by bipartisan support from Congress that resulted in increased NIH and NCI funding in both FY 2016 and FY 2017,” said Daniel Hayes, president of the American Society of Clinical Oncology. “ASCO strongly opposes the Administration’s proposed cuts to federal agencies that support biomedical research and Medicaid for Fiscal Year 2018.
“Such extreme reductions to programs that are critical to research will fundamentally damage our nation’s progress in treating patients and will irreversibly harm our nation’s already fragile biomedical research infrastructure. Gutting critical federal support at this time will jeopardize Americans’ health and our country’s scientific leadership and economic growth.”
The federal government should be doubling its commitment to cancer research, instead of taking steps backward, said Jonathan Hirsch, president and founder of Syapse, a precision medicine company.
“Even if the Trump budget proposal never fully comes to fruition, as is likely, it will still make an impact—forcing NIH to stall programs that physicians and patients rely on,” Hirsch said to The Cancer Letter. “We stand at the precipice of major breakthroughs in areas like cancer research, and NIH is critical to moving those forward.”
Proposal would limit reimbursements for NIH grants
The president’s budget proposal also seeks to limit reimbursements from the federal government for auxiliary expenses associated with NIH research grants. At current rates, these indirect costs, also known as “facilities and administrative costs,” can be reimbursed at up to 50 or 60 percent of the
“The NIH and NCI cuts would be achieved largely by capping overhead costs associated with federal research funding,” according to the American Society for Radiation Oncology. “Implementing an unrealistic cap on these administrative dollars would result in fewer jobs for researchers, especially for early career scientists, and less support for clinical trials. More dangerously, it could cause entire research programs to shut down.”
NIH reimburses institutions, based on that rate for each grant that the institution receives, to help cover some of those associated expenses of research, said Tannaz Rasouli, senior director of public policy at the Association of American Medical Colleges.
“Cutting F&A funding would mean that you’re cutting critical support for things like building and maintaining high-tech labs, the high-speed data processing and storage that’s associated with research, cutting security for sensitive and dangerous chemicals and microbes, or radiation safety, or hazardous waste disposal,” Rasouli said to The Cancer Letter. “I mean, which of those things would you want to cut; right? You cannot cut those things and still be able to conduct the research.”
Every three or four years, the federal government regularly audits and assesses reimbursement rates negotiated between institutions and the HHS or the Office of Naval Research to determine the appropriate federal share of the cost, Rasouli said.
“Cutting F&A would result in institutions being unable to afford continuing research at the same capacity that they have up until this point,” Rasouli said. “Unfortunately, we think the consequence would simple be that less research would happen.”
The White House proposal would limit the reimbursement rate for grants to a cap of 10 percent of total research, Rasouli said.
“It’s actually a little ambiguous in the language in terms of how they actually plan to go about this,” Rasouli said. “What they have said is that they would like to essentially limit the reimbursement that institutions receive for these facilities and administrative expenses. It’s still unclear to us what exactly that means, and how exactly they plan to move forward with that.
“Regardless, the notion itself that they’re planning to limit the reimbursement that institutions receive is something that is very troubling to our community and, quite frankly, to the overall research enterprise, because it is premised on the assumption that you can separate out the facilities and administrative expenses and still be able to move forward with research in the same way as before.
“That’s simply not true. The reality is, if you’re going to cut facilities and administrative expenses, you’re simply cutting the research. You’re going to make it more difficult for research to move forward. A cut to F&A is a cut to the research itself.”
Health care, research groups: Trump’s budget is tone-deaf
The proposed cuts are shocking, especially the reduction to the NCI budget, said Michael Caligiuri, president of the American Association for Cancer Research, director of The Ohio State University Comprehensive Cancer Center, and chief executive officer of the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.
“This is extremely concerning, especially when factoring in all of the efforts that took place last year to establish the important goals and objectives of the transformative Beau Biden Cancer Moonshot initiative,” Caligiuri said. “If we are to accelerate the pace of research so that new, more effective therapies become available to patients, and also improve our ability to prevent cancer and detect it at an early stage, robust, sustained, and predictable annual funding increases for the NIH will be required.
“We are appalled that the Trump administration would include in its budget a proposal that would risk irreversibly harming our nation’s ability to further understand the complexity of cancer and postpone the development of lifesaving therapies for patients.”
The White House’s proposed budget is an imbalanced, heavy-handed approach to bolstering national defense at the expence of other American priorities, including the research and innovation crucial to national security, said Research!American President and CEO Mary Woolley.
“Instead of weakening our nation with this approach, we urge the 115th Congress to negotiate a bipartisan budget deal that will ensure that both defense and non-defense priorities are sufficiently funded,” Woolley said. “Consistently, surveys show how highly Americans rank securing better health and quality of life; the President’s blueprint is tone-deaf to that reality.
“Congress recognizes the urgency in keeping research for health at the forefront of national priorities, as it has signaled with back-to-back, significant increases for the NIH in FY16 and FY17. Strong bipartisan support for research must continue in FY18, and at the same time, Congress should act to lift the budget caps that threaten to hamstring non-defense discretionary appropriations.”
According to a study conducted by United for Medical Research, the cuts proposed in the first “Skinny Budget” draft in March would, if enacted, lead to a loss of nearly 90,000 jobs and $15 billion in economic activity compared to 2016.
“Simply put, less funding for NIH means fewer Americans leading healthy, productive lives,” said UMR President Lizbet Boroughs. “These cuts also will slow an engine for U.S. economic growth. NIH-funded research, conducted at academic and medical institutions in communities in every state, directly and indirectly supported almost 380,000 jobs and $65 billion in economic activity across the United States in 2016 alone.”
The proposed cuts to CDC would affect the following programs: immunization, public health preparedness, infectious and chronic disease, and disease monitoring and outbreak response, according to the National Association of County and City Health Officials, which represents nearly 3,000 local health departments.
“The President’s budget cuts, if enacted, would negatively impact the health and safety of communities across the country,” said Laura Hanen, interim executive director and chief of government affairs at NACCHO. “This is a document that in theory embodies the values and priorities of the nation. Unfortunately, the emphasis is not on preventing disease and ensuring long and healthy lives of Americans, particularly those most vulnerable.”
The massive proposed reduction in Medicaid funding would limit patient access to health coverage and care, ASTRO officials said.
“Multiple studies have demonstrated a link between inadequate health insurance and delayed cancer diagnosis and treatment, ultimately resulting in higher mortality rates,” ASTRO officials said in a statement. “New limits on coverage for cancer patients will restrict their access to the treatments they need and deserve. Inadequate coverage also leads to higher costs that are felt throughout the economy.
“These substantial reductions in support for medical research and care would destabilize the progress toward finding cures and negatively impact cancer patients across the country.”
I just don’t see this as having any legs whatsoever. I think there is no support for it in Congress. It illustrates to me this president’s ignorance of government, and his lack of discipline to even begin to study how things work. It’s just more campaigning.
Former House appropriator who oversaw the doubling of the NIH budget
This is a very anti-science budget that I think surprised a lot of us to go way beyond issues about energy, climate, to the NIH, which has always been something that, luckily, seemed to be very bipartisan in its support.
Biotechnology entrepreneur and former NCI director
Congress can fight over this, but the bottom line is the leader of our country has communicated his priorities, and those priorities set us back
CEO of CancerCare
When we went to Congress 25 years ago and began asking for more money for breast cancer, it wasn’t just throwing more money at the problem. Our message was, this is exactly how much we you need to appropriate, this is why. We did our homework, we had a plan.
President of the National Breast Cancer Coalition
Research, we know, saves money ultimately. The great advocate Mary Lasker once said, ‘If you think research is expensive, try disease.’
Chair and founder of Friends of Cancer Research
You’re going to devastate future cures, and you’re going to devastate our talent pool of young researchers that do that science. That will make us a second-rate scientific country. That shouldn’t be acceptable to anybody.
Chair of the American Society of Clinical Oncology Government Relations Committee
This would inevitably have negative effects on patients. I don’t think that we can expect that the private sector or the philanthropic sector are going to be able to fill in these gaps.
President of the American Association for Cancer Research
It’s also going to be the cancer center directors saying to their members of Congress, ‘What the hell, do you understand what this is going to do to the economy of our local district?’
Vice president of public affairs at Friends of Cancer Research
Whether it’s a Democratic administration or a Republican administration, I would have tried to be pretty agnostic to the party in control and merely focus my vision on doing the best that we can to be sure we have managed well and done our best to communicate the good news of what we have accomplished and the opportunities at our doorstep.
Former NCI director, Executive vice president & CEO, Inova Translational Medicine Institute