[Congressional Record Volume 142, Number 130 (Thursday, September 19, 1996)]
[Senate]
[Pages S11044-S11046]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                     NIH REVITALIZATION ACT OF 1996

 Mrs. KASSEBAUM. Mr. President, due to time constraints, the 
report for the National Institutes of Health Revitalization Act of 
1996, S. 1897, was filed prior to the receipt of the cost estimate from 
the Congressional Budget Office. The following is a letter from the 
Congressional Budget Office scoring the National Institutes of Health 
Revitalization Act of 1996, S. 1897. I ask unanimous consent that this 
letter be printed in the Record.
  The letter follows:

                                                    U.S. Congress,


                                  Congressional Budget Office,

                               Washington, DC, September 19, 1996.
     Hon. Nancy Landon Kassebaum,
     Chairman, Committee on Labor and Human Resources, U.S. 
         Senate, Washington, DC.
       Dear Madam Chairman: The Congressional Budget Office has 
     prepared the enclosed cost estimate for S. 1897, the National 
     Institutes of Health Revitalization Act of 1996, as reported 
     by the Committee on Labor and Human Resources on September 9, 
     1996.
       Enactment of S. 1897 could affect direct spending. 
     Therefore, pay-as-you-go procedures would apply to the bill.
       If you wish further details on this estimate, we will be 
     pleased to provide them.
           Sincerely,
                                                     James L. Blum
                                  (For June E. O'Neill, Director).
       Enclosure.


               congressional budget office cost estimate

       1. Bill number: S. 1897.
       2. Bill title: National Institutes of Health Revitalization 
     Act of 1996.
       3. Bill status: As reported by the Committee on Labor and 
     Human Resources on September 9, 1996.
       4. Bill purpose: S. 1897 would extend expiring provisions, 
     eliminate duplicated or unnecessary advisory boards and 
     reports, codify certain existing programs, and create new 
     programs within the National Institutes of Health (NIH).
       5. Estimated cost to the Federal Government: Assuming 
     appropriation of the necessary funds, CBO estimates that the 
     federal government would spend $31.6 billion over the fiscal 
     years 1997-2002 period to implement the provisions of S. 
     1897.
       Table 1 summaries the estimated authorizations and outlays 
     that would result from S. 1897. The table provides the total 
     authorizations and outlays under two different sets of 
     assumptions. The first set of assumptions adjusts the 
     estimated amounts for projected inflation after 1996, while 
     the second set makes no allowance for projected inflation.
       The bill could not affect direct spending by establishing 
     the National Fund for Health Research. But S. 1897 does not 
     specify a revenue source for this new trust fund, and no 
     direct spending could occur until it receives funding.

[[Page S11045]]



                                                     TABLE 1.--ESTIMATED BUDGETARY IMPACT OF S. 1897                                                    
                                                        [By fiscal year, in millions of dollars]                                                        
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                               1996            1997            1998            1999            2000            2001            2002     
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                        SPENDING SUBJECT TO APPROPRIATIONS ACTION                                                       
                                                                                                                                                        
Spending under current law:                                                                                                                             
    Budget authority....................           8,042              36              37  ..............  ..............  ..............  ..............
    Estimated outlays...................           7,673           4,518             756              34              10  ..............  ..............
                                                                                                                                                        
                                                              WITH ADJUSTMENT FOR INFLATION                                                             
                                                                                                                                                        
Proposed changes:                                                                                                                                       
    Authorization level.................  ..............          10,222          10,518          10,858  ..............  ..............  ..............
    Estimated outlays...................  ..............           4,431           9,394          10,607           6,103           1,016              33
Spending under S. 1897                                                                                                                                  
    Authorization level.................           8,042          10,258          10,556          10,858  ..............  ..............  ..............
    Estimated outlays...................           7,673           8,950          10,150          10,641           6,113           1,016              33
                                                                                                                                                        
                                                            WITHOUT ADJUSTMENT FOR INFLATION                                                            
                                                                                                                                                        
Proposed changes:                                                                                                                                       
    Authorization level.................  ..............          10,132          10,132          10,169  ..............  ..............  ..............
    Estimated outlays...................  ..............           4,390           9,183          10,118           5,745             953              31
Spending under S. 1897:                                                                                                                                 
    Authorization level.................           8,042          10,168          10,169          10,169  ..............  ..............  ..............
    Estimated outlays...................           7,673           8,909           9,939          10,152           5,755             953              31
--------------------------------------------------------------------------------------------------------------------------------------------------------

       The cost of this bill fall within function 550.
       6. Basis of the estimate: Most of the authorizations in the 
     bill are for ``such sums as may be necessary.'' For these, 
     the estimated costs for 1997-1999 are based on 1996 
     appropriations (with and without adjustments for inflation). 
     The authorization for general activities of the National 
     Cancer Institute and the authorizations for the National 
     Institute on Aging, the National Institute on Alcohol Abuse 
     and Alcoholism, the National Institute on Drug Abuse, the 
     National Institute of Mental Health, the National Library of 
     Medicine, and Parkinson's reearch are for specified amounts 
     for 1997 and such sums as may be necessary for 1998 and 1999. 
     For these programs, the estimated costs in 1998 and 1999 are 
     based on the 1997 authorization, with and without adjustments 
     for inflation.
       1The authorized amount for the pediatric research 
     initiative is 450 million over the whole 1997-1999 period. 
     Finally, S. 1897 would authorize for diabetes research each 
     year from 1997 through 1999 the amount appropriated for this 
     purpose in 1996 increased by 25 percent.
       The estimate reflects these specific authorizations. Table 
     2 displays the authorizations estimated for each program with 
     adjustments for inflation.

 TABLE 2.--ESTIMATED AUTHORIZATION LEVELS WITH ADJUSTMENTS FOR INFLATION
                [By fiscal year, in millions of dollars]                
------------------------------------------------------------------------
                                                 1997     1998     1999 
------------------------------------------------------------------------
TITLE I AND II--PROVISIONS RELATING TO THE NATIONAL INSTITUTES OF HEALTH
                 AND TO THE NATIONAL RESEARCH INSTITUTES                
                                                                        
Director's Discretionary Fund................       12       12       13
Children's Vaccine Initiative................       19       19       20
Research on Osteoporosis, Paget's Disease,                              
 and Related Bone Disorders..................      120      124      128
National Human Genome Research Institute \1\.      175      180      185
                                                                        
               TITLE III--SPECIFIC INSTITUTES AND CENTERS               
                                                                        
National Cancer Institute:                                              
    Institute reauthorizations...............    3,456    3,560    3,664
    DES study \2\............................        8        9        9
National Heart Lung and Blood Institute......    1,600    1,647    1,695
National Institute of Allergy and Infectious                            
 Diseases:                                                              
    Research regarding tuberculosis..........        0        0       38
    Terry Beirn community-based AIDS research                           
     initiative..............................       26       27       27
National Institute of Child Health and Human                            
 Development:                                                           
    Research centers for contraception and                              
     infertility.............................        5        5        5
National Institute on Aging..................      550      567      583
National Institute on Alcohol Abuse and                                 
 Alcoholism..................................      330      340      350
National Institute on Drug Abuse.............      480      494      508
National Institute of Mental Health..........      750      772      794
National Center for Research Resources:                                 
    Authorizations--biomedical and behavioral                           
     research facilities.....................       21       21       22
    General clinical research centers........      150      155      159
    Enhancement awards.......................        1        1        1
National Library of Medicine.................      160      165      170
                                                                        
  TITLE IV, V, AND VI--AWARDS AND TRAINING, AIDS RESEARCH, AND GENERAL  
                               PROVISIONS                               
                                                                        
AIDS Loan Repayment Program and Increase in                             
 Maximum Repayment...........................        1        1        1
General Loan Repayment Program...............        2        2        2
Clincial Research Assistance \3\.............        1        1        1
Comprehensive Plan for Expenditure of AIDS                              
 Appropriations..............................    1,453    1,499    1,547
Emergency AIDS discretionary fund............       10       11       11
National Research Service Awards.............      408      421      435
National Foundation for Biomedical Research..    (\4\)    (\4\)    (\4\)
Establishment of a Pediatric Research                                   
 Initiative..................................       17       17       17
Diabetes Research............................      387      387      387
Parkinson's Research.........................       80       80       80
                                              --------------------------
      Total..................................   10,222   10,518   10,858
------------------------------------------------------------------------
\1\ S. 1897 would create the National Human Genome Research Institute   
  and transfer to it all obligations and balances of the National Center
  for Human Genome Research. In addition, the bill would provide the    
  authorization estimated above.                                        
\2\ The National Institute of Child Health and Human Development and the
  National Institute of Environmental Health Sciences also participate  
  in the DES program. However, approximately 80 percent of the program's
  spending is attributable to the National Cancer Institute.            
\3\ The amounts shown include both the costs that would result from the 
  expansion of the loan programs in Title IV as well as their           
  authorization under Title VI. In addition, the bill currently         
  authorizes the loan program regarding clinical researchers            
  indefinitely. However, it is CBO's understanding that the committee   
  intended to provide authorization only through 1999.                  
\4\ Costs of less than $500,000.                                        

                            Titles I and II

       Director's Discretionary Fund. S. 1897 would authorize 
     appropriations, of such sums as may be necessary over the 
     1997-1999 period for the Director's discretionary fund within 
     the Office of the Director of NIH. The fund enables the 
     Director to respond to emerging research opportunities and 
     health priorities. In addition, the Director uses the funds 
     to support several awards and seminars. Funding for these 
     activities in 1996 was $11 million.
       Children Vaccine Initiative. The bill would also 
     reauthorize the Children's Vaccine Initiative, extending 
     funding through 1999. The National Institute on Allergy and 
     Infectious Disease (NIAID), the National Institute on Child 
     Health and Human Development, and the National Institute on 
     Aging are also included in this initiative, but currently 
     NIAID is the only institute participating. If funding at the 
     1996 level adjusted for inflation, CBO estimates this program 
     would cost $57 million over the three-year period.
       Osteoporosis, Paget's Disease and Related Bone Disorders. 
     The bill would also reauthorize through 1999 the coordinated 
     research program on osteoporosis, Paget's disease, and 
     related bone disorders. This program is coordinated by the 
     Directors of the National Institute of Arthritis and 
     Musculoskeletal and Skin Diseases, the National Institute on 
     Aging, the National Institute of Dental Research, and the 
     National Institute of Diabetes and Digestive and Kidney 
     Diseases, and includes participation by several of the other 
     institutes and centers. If funded at the 1996 level adjusted 
     for inflation, this program would cost $372 million over the 
     three-year period.
       National Human Genome Research Institute. S. 1897 would 
     create the National Human Genome Research Institute and 
     transfer to it all functions, employees, assets, liabilities, 
     contracts, and records that the National Center for Human 
     Genome Research (NCHGR) performed and held before the 
     enactment of this legislation. Giving the NCHGR the status of 
     an institute would allow it to make awards of $100,000 or 
     less without Advisory Council approval, to establish less 
     extensive and time-consuming clearance requirements in the 
     publication process: to complete for funds solely designated 
     for research performed by institutes; and other freedoms. The 
     bill would authorize this institute from 1997 through 1999. 
     Based on the 1996 appropriation for the NCHGR adjusted for 
     inflation, CBO estimates this authorization would cost $450 
     million over the three-year period.

                               Title III

       Reauthorizations. This title would reauthorize all of the 
     institutes and centers of NIH through 1999. The estimated 
     authorizations with adjustments for inflation are shown in 
     Table 2. They total $23.3 billion over the 1997-1999 period.
       DES Program. S. 1897 would reauthorize from 1997 through 
     1999 the DES program, which conducts and supports research 
     and training, the dissemination of health information, and 
     other programs with respect to the diagnosis and treatment of 
     conditions associated with exposure to the drug 
     diethylstilbestrol (DES). Participating institutes include 
     the National Cancer Institute, the National Institute of 
     Child Health and Human Development, and the National 
     Institute of Environmental Health Sciences. In 1996, 80 
     percent of the spending occurred in the National Cancer 
     Institute. CBO estimates this provision would cost $26 
     million over the three-year period, assuming appropriations 
     at the 1996 level adjusted for inflation.
       General Clinical Research Centers. The bill would codify 
     the existing General Clinical Research Centers and authorize 
     them from 1997 through 1999. The Director of the National 
     Center for Research Resources (NCRR) awards grants for these 
     centers, which provide the infrastructure for clinical 
     research. The centers support clinical studies and career 
     development in all settings of the hospital or academic 
     medical center involved. Funding for this program in 1996 was 
     $146 million.
       Enhancement Awards. The bill would also require the 
     Director of NCRR to create two grant programs called the 
     Clinical Research Career Enhancement Award and the Innovative 
     Medical Science Award. The Clinical Research Enhancement 
     Awards would support

[[Page S11046]]

     individual careers in clinical research, with grants not to 
     exceed $130,000 per year per grant. The Innovative Medical 
     Science Awards would support individual clinical research 
     projects, with grants not to exceed $100,000 per year per 
     grant. The Director of NIH, together with the Director of the 
     NCRR, would establish a peer review mechanism to evaluate 
     applications for clinical research fellowships, Clinical 
     Research Enhancement Awards, and Innovative Medical Science 
     Awards. The bill would authorize these programs from 1997 
     through 1999. Based on information provided by the NCRR, CBO 
     estimates these grants would cost $3 million over the three-
     year period.

                          Titles IV, V, and VI

       Loan Repayment Programs. S. 1897 would raise the maximum 
     amount given to NIH to repay the educational loans of 
     qualified health professionals who agree to conduct AIDS 
     research, contraception and infertility research, and 
     research generally as employees of NIH. The maximum loan 
     repayment amount for clinical researchers would also be 
     raised. The maximum loan repayment for each year of service 
     would be increased from $20,000 to $35,000. Based on the 
     number of researchers that would be affected by the loan 
     repayment increase, CBO estimates increasing the maximum loan 
     amount would cost $1 million over the three-year period. In 
     addition, the bill would reauthorize from 1997-1999 the loan 
     repayment program fro research with respect to AIDS. 
     If funded at the 1996 level, CBO estimates the 
     authorization would cost $2 million over the three-year 
     period.
       The bill would also establish a general loan repayment 
     program. Like the other loan repayment programs, the 
     Secretary of HHS would act through the Director of NIH and 
     enter into agreements with qualified health professionals to 
     conduct research identified by the Director. The Federal 
     government would repay not more than $35,000 of the principal 
     and interest of the educational loans of such professionals 
     for each year of service. The loan repayment agreement would 
     be for a minimum of two years. The bill authorizes funding 
     for this program from 1997 through 1999. The Office of the 
     Director projects that it would spend approximately $1.5 
     million per year as a result of this program. Based on this 
     information, CBO estimates this new loan repayment program 
     would cost $5 million over the three-year period.
       S. 1897 would increase the cumulative number of contracts 
     permitted for scholarships and loan repayments for the 
     undergraduate scholarship program of the National Research 
     Institutes and the loan repayment program for clinical 
     researchers. Under current law, 50 such contracts are 
     authorized from 1994 through 1996; the bill would increase 
     the cumulative limit to 100 for the 1994 through 1999 period. 
     It would also reauthorize these programs from 1997 through 
     1999. Based on past spending by these programs, CBO estimates 
     that adding 50 contracts would cost $3 million over the 1997-
     1999 period.
       AIDS Research. S. 1897 would reauthorize comprehensive AIDS 
     research by the institutes and the AIDS emergency 
     discretionary fund from 1997 through 1999. The emergency 
     discretionary fund is used by the Director of the Office of 
     AIDS Research to fund additional AIDS research the Director 
     determines is needed. Assuming that appropriations are 
     provided at the 1996 level adjusted for inflation, CBO 
     estimates this provision would cost a total of $4,530 million 
     over the three-year period.
       National Research Service Awards. The bill would 
     reauthorize the National Research Service Awards from 1997 
     through 1999. These awards are given for biomedical and 
     behavioral research and training at NIH, at public and 
     nonprofit entities, and for pre-doctoral and post-doctoral 
     training of individuals to undertake biomedical and 
     behavioral research. The Office of the Director estimates 
     that NIH will spend $395 million on these awards in 1996. 
     Assuming this level of spending adjusted for inflation, CBO 
     estimates this provision would cost $1,265 million over the 
     three-year period.
       National Foundation for Biomedical Research. The bill would 
     reauthorize the National Foundation of Biomedical Research, a 
     nonprofit corporation, from 1997 through 1999. It was 
     established by the Secretary of HHS to support NIH and 
     advance collaboration with biomedical researchers from 
     universities, industry, and nonprofit organizations. The 
     foundation is currently in the initial stages of operation. 
     NIH is requesting $200,000 for 1997 for this foundation and 
     expects to need a similar level of funding for each of the 
     fiscal years 1998 and 1999. Based on this information, CBO 
     estimates the cost of this proposal would be less than $1 
     million over the three-year period.
       National Fund for Health Research. The bill would establish 
     the National Fund for Health Research. This fund would 
     consist of amounts transferred to it and interest earned on 
     it. The amount in the fund would be distributed each year to 
     all of the research institutes and centers of NIH, 
     provided that appropriations in that year are not less 
     than those of the prior year. This provision would set up 
     this account in the Treasury, but would not establish a 
     source of funding for it. When and if a source of income 
     is established for this trust fund, NIH would apparently 
     have the authority to spend amounts in the fund, including 
     interest earnings, without appropriations action. This 
     would be direct spending, but CBO has no basis for 
     estimating the amount of such spending until the source of 
     revenues for the fund is established.
       Pediatric Research Initiative. S. 1897 would require the 
     Secretary to establish, within the Office of the Director of 
     NIH, a Pediatric Research Initiative that would be headed by 
     the Director. The initiative would encourage increased 
     support for pediatric biomedical research within the NIH, 
     enhance collaborative multi-disciplinary research among the 
     institutes, increase pediatric research demonstrating how to 
     improve the quality of children's health care while reducing 
     cost, and develop clinical trials and information to promote 
     the safe and effective use of prescription drugs in the 
     pediatric population. The Director would have discretion in 
     the allocation of assistance among the institutes, among the 
     types of grants, and between basic and clinical research. The 
     bill would authorize $50 million for the 1997-1999 period.
       Diabetes Research. The bill would reauthorize and expand 
     funding for the conduct and support of research related to 
     diabetes by the NIH. The majority of this spending occurs 
     within the National Institute of Diabetes and Digestive 
     Kidney Diseases. S. 1897 would provide for each year from 
     1997 through 1999 the amount appropriated for this purpose in 
     1996 increased by 25 percent. In 1996, NIH spent $309 million 
     on research related to diabetes. if appropriations are made 
     for the full authorized amount, this research would cost 
     $1,160 million over the three-year period.
       Program for Parkinson's Disease. The bill would also 
     require the Director of NIH to establish a program for the 
     conduct and support of research and training concerning 
     Parkinson's disease. The Director would coordinate research 
     among all of the national research institutes conducting 
     Parkinson's research and would convene a research planning 
     conference at least every two years.
       The Director would also be required to establish two grant 
     programs pertaining to Parkinson's disease. The first would 
     award up to 10 Core Center Grants to encourage the 
     development of innovative multi-disciplinary research and 
     provide training concerning Parkinson's disease. Support for 
     a center would not be provided for a period longer than five 
     years, but support could be extended after a review. The 
     second grant program would support innovative proposals 
     leading to significant breakthroughs in Parkinson's research.
       S. 1897 would authorize $80 million for 1997 and such sums 
     as necessary for 1998 and 1999 for the Parkinson's disease 
     program. CBO estimates the cost of this provision to be $248 
     million over the three-year period, assuming adjustments for 
     inflation.
       7. Pay-as-you-go considerations: S. 1897 could affect 
     direct spending by establishing the National Fund for Health 
     Research. The bill does not establish a source of funding for 
     it, but when and if a source of income is established, NIH 
     would have the authority to spend amounts in the fund. Such 
     spending would include any interest earned by the fund and 
     would occur without appropriations action. This would be 
     direct spending, but CBO has no basis for estimating the 
     amount of such spending until the source of revenues for the 
     fund is established.
       8. Estimated cost to State and local governments: This bill 
     contains no intergovernmental mandates as defined in the 
     Unfunded Mandates Reform Act of 1995 (Public Law 104-4) and 
     would impose no cost on state, local, or tribal governments. 
     Some of the funds made available by this bill for research 
     activities would go to state and local governments, 
     particularly public universities.
       9. Estimated cost to the private sector: The bill would 
     impose no new private-sector mandates as defined in Public 
     Law 104-4.
       10. Estimate comparison: None.
       11. Previous estimate: None.
       12. Estimate prepared by: Federal Cost Estimate: Cyndi 
     Dudzinski (226-9010); Impact on State, Local, and Tribal 
     Governments: John Patterson (225-3220); Impact on the Private 
     Sector: Linda Bilheimer (225-2673).
       13. Estimate approved by: Robert A. Sunshine, for Paul N. 
     Van de Water, Assistant Director for Budget Analysis.

                          ____________________