Trump’s budget proposes slashing NIH, NCI

The White House Feb. 10 released its FY21 budget proposal that, once again, includes drastic cuts to NIH and NCI.

This time, the White House proposed $38 billion for NIH in FY21, nearly $4 billion less than the amount appropriated for the current year. The cuts would also include a 9% decrease to NCI’s budget, NCI Director Ned Sharpless said at the Feb. 11 virtual meeting of the National Cancer Advisory Board.

President Trump’s efforts to slash NIH have been an annual occurrence since 2017 (The Cancer Letter, March 17, 2017), but Congress, in a bipartisan manner, has pushed back against these efforts, instead increasing funding for biomedical research, including cancer research (The Cancer Letter, Feb. 15, 2019).

If anything, Trump has been taming his visions of drastic cuts. For example, in FY20, the White House proposed funding NIH at $33 billion—a cool $5 billion less than what’s on the table for FY21.

By the time it passed the House and Senate and ended up on the president’s desk, the FY20 appropriation included $41.7 billion for NIH. NCI received $6.3 billion, over $200 million above the 2019 appropriated level.

Also in the bill was a $212.5 million increase for NCI to cope with an avalanche of grant applications and improve the institute’s declining success rates for grants(The Cancer Letter, Dec. 20, Dec. 6, June 14, Jan. 25, 2019). The NCI appropriation for FY20 also included $195 million in Moonshot funds.

In another highlight, the FY20 bill included a mandate that raised the federal tobacco-purchasing age to 21. The mandate applies to e-cigarettes, combustible cigarettes, and all other tobacco products.

Now, what happens is it goes over to Congress, where they will work on it for a while, and we expect a very lively, interesting year of appropriations, and we’ll find out what is in store for us in ‘21 later. 

Ned Sharpless

“The president released his budget yesterday, which included a 9% cut for the NCI,” Sharpless said at the NCAB meeting. “Many of you will remember that prior year budgets, this administration had even larger cuts for the NCI. Now, what happens is it goes over to Congress, where they will work on it for a while, and we expect a very lively, interesting year of appropriations, and we’ll find out what is in store for us in ’21 later.”

The FY21 proposal would fund the second year of the NCI Childhood Cancer Data Initiative, which has a proposed investment of $50 million per year over a period of 10 years.

The White House proposal for FY21 calls for moving the Center for Tobacco Products out of FDA and creating a new agency within HHS to focus on tobacco regulation. This new agency would be led by a Senate-confirmed director, according to the proposed budget.

Reactions to the White House proposal for FY21 follow:

“During the past five years, Congress has prioritized funding medical research due to the extraordinary pace of basic scientific discovery and innovations that are contributing to save the lives of cancer patients through improved therapies and early detection strategies. We strongly believe that maintaining this significant positive momentum against cancer is of the utmost importance, as is supporting the new generation of cancer researchers through robust annual funding increases for NCI.”

“The administration’s FY2021 budget request is an example of bad faith negotiation, as the president is proposing to nullify last year’s two-year budget deal by cutting $40 billion in overall non-defense, non-discretionary spending, when in fact, last year’s budget deal provides for a small increase in FY2021 for these vital programs. The president’s proposal to cut the NIH and NCI budgets in FY2021 by 7 percent and 9 percent, respectively, is irresponsible, and is a 180-degree turn from just this past December when Congress provided NIH with a $2.6 billion or 6.7 percent increase above FY2019, which also was the fifth consecutive year that Congress has provided NIH and NCI with robust funding increases.”

“ASCO believes it’s critical that the U.S. continues to have a robust research enterprise, a commitment to cancer prevention, and a strong cancer care delivery system so that every patient with cancer receives the best care possible. While we’re disappointed that the FY2021 budget request proposes funding cuts and program restrictions not aligned with this goal, we are committed to working with Congress and the administration to ensure our nation continues to build on the tremendous progress already made in improving treatment and reducing mortality from cancer.”

“The president’s FY2021 budget proposal is a nonstarter. A $2.6 billion cut to NIH and a $559 million cut to NCI would be disastrous to the cancer community and could reverse recent significant progress against cancer. We are confident that congressional champions on both sides of the aisle recognize the need to continue robust annual budget increases for both the NIH and NCI.”

“If implemented, the administration’s budget would leave millions more Americans unable to access comprehensive health care coverage whether that be through the private market with health care subsidies or through essential public programs such as Medicaid.

“Medicaid serves as a safety-net for more than 2.3 million Americans with a history of cancer. Ensuring it is appropriately funded is critical for reducing the country’s cancer burden and saving lives through prevention, early detection and treatment.

“The budget does offer some relief for seniors by capping out-of-pocket prescription costs for those on Medicare Part D and allowing some low-income enrollees to be spared cost-sharing on generic drugs. These would be welcome changes and could help enrollees better afford their care.

“The proposed cuts to NIH and NCI funding included in this budget would squander years of renewed momentum and progress in advancing discovery in cancer and other chronic diseases.

“These investments have long enjoyed strong bipartisan support and have led to incredible understanding in how to detect, diagnose and treat cancer that still claims the lives of more than 600,000 Americans each year.

“The president has signaled his interest and desire for continued progress reducing cancer incidence and deaths. Increasing research investment—not cutting it—is indispensable to that effort.

“We know colorectal cancer can be prevented with regularly-scheduled screenings which is why we are pleased to see the budget includes a provision that would eliminate cost-sharing for seniors on Medicare who are hit with a surprise bill during a routine screening colonoscopy when a polyp is discovered and removed during the same procedure. However, those not yet on Medicare also need access to colonoscopies and other proven cancer screenings. Increased investment in CDC cancer control programs would accelerate our progress against the disease for everyone, while eliminating these programs and cutting funding will hurt low-income, underinsured Americans.

The president’s proposal to cut the NIH and NCI budgets in FY2021 by 7 percent and 9 percent, respectively, is irresponsible, and is a 180-degree turn from just this past December when Congress provided NIH with a $2.6 billion or 6.7 percent increase above FY2019. 

Jon Retzlaff

“Cutting the CDC’s chronic disease budget by 34% and eliminating specific funding for tobacco control programs threatens to substantially weaken, if not eliminate, vital efforts to reduce the number one preventable cause of cancer: tobacco. And the proposal to strip the FDA of its ability to regulate the tobacco industry amid an ongoing youth e-cigarette epidemic is shortsighted. Creating a new agency with politically-appointed leadership would give the tobacco industry far too much influence over future tobacco regulation.

“Budgets reflect priorities. Preserving millions of peoples’ access to affordable, comprehensive health care coverage and continuing to invest in medical research to save the most lives from cancer as possible should always be a top priority. On behalf all Americans expected to be diagnosed with cancer this year and their families, we urge Congress to reject these cuts and ensure access to health care and cancer research remains among our nation’s top priorities.”

“As with his previous budgets, this one is going nowhere. Instead, House Democrats will continue working for the people on an agenda that recognizes our biggest economic challenge: that people are working in jobs with wages that do not keep up with the rising cost of healthcare, child care, housing, and education. As Chair of the House Appropriations Subcommittee on Labor, Health and Human Services, and Education, we are going to continue investing in working people, the middle class, and the most vulnerable—not millionaires, billionaires, corporations, and special interests.”

“Each fiscal year, receipt of the president’s budget request marks an important step in the budget and appropriations process. It’s the president’s opportunity to provide Congress with an aspirational list of priorities as lawmakers chart the path forward on government funding. And to President Trump’s credit, at least he met the legal requirement to send a budget request to Congress for the upcoming fiscal year. By stark contrast, the House Democratic majority did not even attempt to write a budget last year, and it has already been made clear that will be the case again this year – even though Congress is legally required to pass a budget. Sooner rather than later, all sides must come to the table with realistic propositions and have serious discussions on how to address the nation’s exploding debt and rising deficits. Without a budget though, progress isn’t likely to be made.”

“The president’s request marks the start of the budget process and clearly outlines the administration’s priorities. Those of us in Congress will take those requests under consideration as we work to determine what programs to fund and at what levels. As an appropriator, I look forward to moving through the Fiscal Year 2021 process in a manner that addresses a wide range of Alaska priorities.”

“After Congress has repeatedly rejected funding his ‘big, beautiful’ border wall, the fact that President Trump would request $2 billion for a campaign promise that Mexico was supposed to pay for–while cutting funding from programs like Medicare, Medicaid, Social Security, and student loan forgiveness, and agencies like the National Institutes of Health and Centers for Disease Control and Prevention that are critical to the wellbeing of the American people–adds insult to injury.

In his State of the Union address last week, President Trump promised to help working-class families and protect Americans with pre-existing conditions. His budget request shows a different reality.”

“The Trump administration’s 2021 budget proposal includes increases to advance much-needed progress in pediatric cancer and pain research, among a few other targeted areas. However, overall, the budget would deal a devastating blow to patients and their families.

Medical, public health, and scientific progress requires us to treat R&D as a strategic national priority. Yet, the administration’s proposal embraces steep cuts to NIH which would undermine crucial, lifesaving research. It would also slash other critical investments; for example, the proposal would cut CDC by 10%, NSF by 7%, and zero out the budget for AHRQ.

The president’s FY2021 budget proposal is a nonstarter. A $2.6 billion cut to NIH and a $559 million cut to NCI would be disastrous to the cancer community and could reverse recent significant progress against cancer. 

Jennifer W. Pegher

In a national survey just commissioned by Research!America, 61% of respondents across party lines say current funding for research to prevent, cure, and treat disease is not enough. The budget released today is misaligned with the views and interests of the American people.

These cuts not only compromise the pace of such research, they also would further erode our competitive lead in science and technology. We urge Congress and the administration to work together to craft spending bills that bolster life-saving research to the benefit of us all.”