President Signs Economic Stimulus Bill Containing NIH Funding and Numerous Health Provisions

2009-02-18

Yesterday, President Obama signed into law the American Recovery and Reinvestment Act (HR 1). This economic stimulus bill contains a number of important provisions for hematologists and for health-care providers and researchers. Following is an outline of some of the most significant sections:

  • National Institutes of Health (NIH): The bill includes $10 billion for NIH over the next two years, providing $8.2 billion for research funding, $7.4 billion of which is designated for the Institutes, Centers, and Common Fund for research projects, and $800 million of which will be retained by the Office of the Director for research activities. The legislation also provides $1.3 billion for the National Center for Research Resources, with $1 billion designated for construction and renovation at extramural research facilities and $300 million for "shared instrumentation and other capital equipment." An additional $500 million is included for construction and renovation of NIH intramural buildings.

NIH has indicated that it intends to use the funding in the bill to support already reviewed, highly meritorious investigator-initiated applications (R01s, R23s, and R03s) that can be completed within two years; supplement current grants; and award “Challenge Grants” through an RFA that will be initiated from the Office of the Director.

NIH Acting Director Raynard Kington, MD, PhD, indicated in a recent announcement that “many types of funding mechanisms will be supported, but, in general, NIH will focus scientific activities in several areas:

  1. We will choose among recently peer reviewed, highly meritorious R01 and similar mechanisms capable of making significant advances in two years. R01s are projects proposed directly from scientists across the country.
  2. We will also fund new R01 applications that have a reasonable expectation of making progress in two years. The adherence to this time frame is in direct response to the spirit of the law.
  3. We will accelerate the tempo of ongoing science through targeted supplements to current grants. For example, we may competitively expand the scope of current research awards or supplement an existing award with additional support for infrastructure (e.g., equipment) that will be used in the two-year availability of these funds.
  4. NIH anticipates supporting new types of activities that fit into the structure of the ARRA. For example, it will support a reasonable number of awards to jump start the new NIH Challenge Grant program. This program is designed to focus on health and science problems where progress can be expected in two years. The number of awards and amount of funds will be determined, based on the scientific merit and the quality of applications. I anticipate—out of the OD funds in the ARRA--NIH will support at least $100 to $200 million—but the science will drive the actual level.
  5. We will also use other funding mechanisms as appropriate.

The impact of this stimulus to scientists cannot be overstated. The impact extends far beyond the current economic challenges and immediate scientists who will receive funds, to allied health workers, technicians, students, trade workers, and others who will receive the leveraged benefits.”

Grassroots advocacy by the research community was crucial to securing this important funding for NIH, and ASH thanks everyone who has participated in the Society's advocacy efforts. The Society encourages members to visit the ASH Advocacy Center to take a moment to contact your Senators and Representatives to thank them for their support of biomedical research and including funding for NIH in the economic recovery package.

  • Health Information Technology: The bill requires the federal government take a leadership role to develop interoperable standards by 2010 that provide for the nationwide electronic exchange and use of health information. The Act provides $19 billion for health IT infrastructure and Medicare and Medicaid incentives to encourage doctors, hospitals, and other providers to use health IT. Practitioners and hospitals that engage in the "meaningful use" of health IT may be eligible to receive Medicare or Medicaid incentives beginning in 2011, with penalties for failing to "meaningfully use" health IT beginning in 2014. The bill also creates the Office of the National Coordinator of Health IT to oversee the transition to health IT. A number of privacy and security provisions are included in an effort to protect patients' private records. The Congressional Budget Office estimates the bill will result in approximately 90 percent of doctors and 70 percent of hospitals adopting certified electronic health records within the next decade.
  • Comparative Effectiveness: The conference report establishes a Federal Coordinating Council for Comparative Effectiveness Research. The Council will assist the Department of Health and Human Services, Veterans' Affairs, Department of Defense, and other federal agencies to coordinate or support comparative effectiveness research. The Council will also advise the President and Congress on:
    1. the infrastructure needs of comparative effectiveness research within the federal government;
    2. appropriate expenditures for comparative effectiveness research by federal agencies; and
    3. opportunities to coordinate comparative effectiveness research.

The Council will be composed of a maximum of 15 members, who are all senior federal officers or employees with responsibility for health-related programs, appointed by the President. At least half the members must be physicians with clinical expertise. The Council must submit a report to the President and Congress no later than June 30, 2009, which will detail federal activities on comparative effectiveness research and make recommendations for further steps. Additionally, the conference report includes language specifically not permitting the Council to mandate coverage, reimbursement or other policies for any public or private payer.

  • COBRA Coverage:The stimulus bill provides for the continuation of COBRA benefits for workers and families of workers involuntarily terminated between September 1, 2008, and December 31, 2009, who remain unemployed. This provision provides a 65 percent federal subsidy for COBRA continuation premiums for up to nine months for qualifying workers. This subsidy also applies to health-care continuation coverage if required by states for small employers. This provision also provides an additional 60 days time for workers terminated between September 1, 2008, and the bill’s enactment to elect COBRA benefits and receive the subsidy.
  • Temporary Medicaid Federal Medical Assistance Percentage (FMAP): The bill provides a temporary increase to FMAP funding to states for the period between October 1, 2008, and December 31, 2010. This provision provides an across-the-board FMAP increase of 6.2 percent to all states and a similar increase for territories. Additional FMAP increases are available to states based on increases in unemployment.  This provision contains a maintenance-of-eligibility provision that requires states to maintain eligibility equivalent to that which was available July 1, 2008. The provision also contains a prompt payment requirement on the states to ensure that payments are being made to practitioners, nursing homes, and hospitals by specified deadlines. 

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