Insights on the Federal Budget Process and What it Means for NIH Research

Since the release of President Biden’s Fiscal Year (FY) 2023 budget proposal last week, numerous NIH stakeholders have had questions about what it all means and where we stand in the budget process. Let me start by clarifying that the President’s Budget for FY2023 proposes an increase over the FY2022 Continuing Resolution for all of NIH’s 27 Institutes and Centers (ICs). The President’s Budget used the Continuing Resolution as the base for all discretionary budget decisions, including NIH’s ICs. 

Typically, it takes two months or more to develop the President’s Budget and supporting materials. The administration built its FY2023 budget proposal using the FY2022 Continuing Resolution as the current year baseline because appropriations were significantly delayed this year. Congress passed the Consolidated Appropriations Act, 2022, before the release of the President’s Budget for FY2023 but too late to adjust the numbers in the President’s Budget. After October 1, the beginning of the fiscal year, it typically takes the administration months to prepare and submit the President’s Budget, so pivoting to update the President’s Budget for 2022 enacted appropriations would have significantly delayed its release.

It is important to note that in instances in which spending levels in the President’s Budget for FY2023 are below the appropriations enacted for FY2022, the difference can be explained by the size of the later congressional increase, not the administration’s intent to reduce the funding of NIH ICs.

Here are some selected highlights of what’s in store for NIH in the President’s Budget for FY2023:

Reigniting the Cancer Moonshot. Provides $216 million for the Cancer Moonshot, a $22 million increase over the FY2022 enacted appropriation. The Moonshot is a bold effort to accelerate progress in cancer research and aims to make more therapies available to more patients. As part of this administration priority, NIH will work with other agencies to coordinate the collective efforts of the National Cancer Institute Cancer Centers and other networks to identify barriers to broader cancer screening and investigate the most effective means of delivering screening. In partnership with other federal agencies, NIH also will dedicate FY2023 funding to develop a focused program to expeditiously study and evaluate multicancer early detection tests, which could help detect cancers at an earlier stage when there may be more effective treatment options. 

Pandemic Preparedness. The President’s plan makes transformative investments in pandemic preparedness and biodefense across the Health and Human Services (HHS) public health agencies. Within the HHS-wide total of $81.7 billion, $12.1 billion is included for NIH research and development of vaccines, diagnostics, and therapeutics against high priority viral families, biosafety and biosecurity, and to expand laboratory capacity and clinical trial infrastructure.

Transforming Nutrition Science. Includes $97 million for the NIH Office of Nutrition Research — an increase of $96 million above the FY2022 enacted appropriations — to advance nutrition science to promote health and reduce the burden of diet-related diseases.

Combatting Overdose and Addiction. The budget proposal dedicates at least $2.2 billion within NIH for opioids, stimulant, and pain research. Within this total, $1.4 billion will support ongoing research across the NIH ICs, while $811 million is allocated to the NIH Helping to End Addiction Long-term Initiative. 

Health Disparities and Inequities Research. Provides an increase of $350 million above FY2022 enacted appropriations to enhance health disparities and inequities research, including $210 million for the National Institute on Minority Health and Health Disparities. The NIH also will continue to support the UNITE Initiative, which is an NIH-wide effort launched in early 2021 that is committed to ending racial inequities across the biomedical research enterprise.  This initiative builds upon and complements the advances in health disparities research at NIH. 

Lawrence A. Tabak, D.D.S., Ph.D.
Acting Director, NIH