How Congressional Appropriations Impact Academic Medicine

April 12, 2023

On March 9, President Joe Biden announced his proposed federal budget for fiscal year (FY) 2024. This signals the beginning of the appropriations season for Congress, but what does that entail and how does it impact academic medicine? Keep reading for the details and take action.

The Constitution states that “No Money shall be drawn from the Treasury, but in Consequence of Appropriations made by Law.” This means that Congress must pass spending bills, known as appropriations bills, each fiscal year that are then signed by the President into law to fund federal agencies and programs.

Approximately one-third of the federal budget, and what AAMC Action focuses on when discussing appropriations, is called “discretionary spending.” This spending is set on an annual basis by Congress and the President, so it’s vital for AAMC Action to advocate for our priorities to be included and at robust funding levels.

The U.S. House of Representatives and the U.S. Senate have many committees and subcommittees on various public policy issues. Both chambers have an Appropriations Committee, which is broken down into subcommittees for 12 specific appropriations bills. In essence, each subcommittee considers a spending bill related to various departments and parts of the government’s operations.

The Labor, Health and Human Services appropriations bill contains many key funding priorities for academic medicine. The subcommittee will allocate federal funds toward agencies and programs including the National Institutes for Health (NIH) and Health Resources and Services and Administration (HRSA) Title VII health professions and Title VIII nursing workforce development programs, in addition to agencies like the Centers for Disease Control and Prevention (CDC) and programs like the National Health Service Corps and Children’s Hospitals Graduate Medical Education..

After the subcommittee in each chamber hosts hearings and markups on their version of the appropriations bill, it goes to the full chamber (either the House or the Senate) for votes. The chamber will typically aim to vote on the appropriations bills in May or June and discuss any amendments, or changes needed before the next fiscal year begins on October 1, though lawmakers often miss these deadlines.

If bills have not been approved by the House and the Senate and signed into law by the President by October 1, Congress will need to pass a continuing resolution (CR) that temporarily maintains funding levels from the previous fiscal year while Congress continues working on outstanding legislation.

The AAMC advocates for a number of public policy issues that fall under the academic medicine umbrella, including a number of programs that are funded through the appropriations process. For example, Congress can maintain or increase funding for two key policies in FY 2024 appropriations:

  • Increased funding for the NIH. The NIH is the nation’s primary funder of medical research, and just about every test, treatment, preventive strategy, or cure used today can be traced back to NIH-funded research. NIH-funded research also generates high-quality jobs and business development in every state across the country and enhances U.S. global competitiveness. The AAMC is asking for federal lawmakers to increase NIH’s base funding to at least $51 billion, a 7.3% increase over the comparable FY 2023 program level. Strong, steady funding growth for the NIH is necessary to enhance economic development, medical innovation, and life-saving treatments, diagnostics, and prevention strategies for patients and their loved ones.
  • Increased funding for HRSA Title VII health professions programs and Title VIII nursing workforce development programs. These workforce programs support the recruitment and retention of providers in rural areas and communities that have been historically marginalized and medically underserved. The programs play a key role in training and growing a diverse and culturally competent health workforce and closing health equity gaps to improve the health of people everywhere. There is bipartisan support for these health workforce programs, and AAMC Action encourages Congress to appropriate a total of $1.51 billion – $980 million for Title VII and $530 million for Title VIII – to provide a significant investment in the health care workforce.

AAMC Action will continue to raise awareness of the need for robust, sustained funding for these vital programs to improve the health of people everywhere. Take action now and stay tuned for an update on final FY 2024 appropriations legislation later this year.