1. Research Funding in an Era of Austerity Emily Holubowich, MPP Senior Vice President, CRD Associates Executive Director, Coalition for Health Funding @healthfunding

2. Budget Control Act Changes Game Enacted August 2011 to avoid national default, reduce deficits over decade Cut $900 billion from discretionary spending starting FY 2012 Sequestration triggered March 2013 – Cut additional $1 trillion between FY 2013 - FY 2021 Social Security, Pell Grants, Medicaid exempt Bipartisan Budget Act enacts short-term changes

3. Federal Spending, FY 2014

4. Federal Spending, FY 2022 Source: Center on Budget and Policy Priorities based on CBO data

5. NDD Lowest Level Since Eisenhower Source: Center on Budget and Policy Priorities based on CBO data

6. Health in the Crosshairs Federal discretionary health cuts 11% to date – Wide variation across HHS Sequestration in FY 2013 alone… – Cut $2.5 billion from discretionary health Cut $1.5 billion from NIH Most cuts restored in FY 2014 – $1 billion restored at NIH FY 2015 level provides no room for growth

8. The Lost Decade (?) The levels are too low – Zero sum gain going forward – Levels don’t keep pace with inflation, growth – Conflicting priorities create additional strain Fierce competition for limited resources – Must do vs. nice to do – Cannibalization of health

9. NAEVR estimates that in 2013, United States spent $2.8 billion on vision research – Federal government: $717 million NEI: $637 million (intramural/extramural) Other NIH: $30 million DoD: $20 million VA: $20 million (intramural) Other (NSF, DoE): $10 million – Foundations: $50 million (est) – Industry: $2 billion (est) Funding Is Out There

10. Thinking Strategically to Survive Remain vigilant to break the cycle of austerity – Educate about impact of cuts, both real and opportunity costs Visit www.cutshurt.org for examples!www.cutshurt.org Adjust to the “new normal” Explore creative funding models amid declining federal funds – #IceBucketChallenge, walks, rallies aren’t enough Vision Research Funding Partnership: Imagining the Possibilities Sept. 17, 2014

11. Supplementing Federal Funding Many models for supplementing federal research investments in the private, philanthropic sector – Research (e.g., American Heart Association) – Career development (e.g., universities) – Young investigators (e.g., research societies)

12. ASH: “Bridging” the Gaps American Society of Hematology established “bridge” program to enhance competitiveness of its members in NIH applications Developed by Board in direct response to declining federal funding (pre-sequestration) Society is principal funder, with additional support from corporate, individual donors Meant to be temporary solution

13. ASH: “Bridging” the Gaps Goal: Sustain research and contribute to retention in hematology investigation Baseline commitment: $9 million over three years (2013-2015) Awards: 30, one-year awards of $150,000 each year Match: Institution must commit $50K – Ensures institution is vested in investigator success

14. ASH: “Bridging” the Gaps Eligibility: ASH members who applied for NIH R01 or equivalent but were denied funding – Investigators with $250K in resources ineligible Purpose: To address critiques from NIH application, strengthen for resubmission, and ultimately obtain NIH funding – NOT a new R01

15. ASH: “Bridging” the Gaps Research: basic, translational, patient- oriented clinical, outcomes-based Process: Synchronized with NIH cycle; study sections review bridge applications Demographics: Wide spectrum of researchers and disciplines (PhD, MD, MD/PhDs)

16. Success to Date Early wins show program’s promise – Positive feedback from awardees – 11 awardees have received R01s – NIH “loves it!” – ASAE 2013 Summit Award for “excellence in working to create a stronger America and world” Full evaluation planned Continuation to be considered

17. Lessons from ASH Governance: Who oversees the program? Administration: Who manages the program? Funding: Who funds, at what level? Where does money go? Match or no match? Eligibility: Who’s eligible, for what research? Promotion: How do you get the word out? Evaluation: How do you define “success?” What metrics?

18. Contact Emily J. Holubowich, MPP Senior Vice President Cavarocchi ∙ Ruscio ∙ Dennis Associates 202.484.1100 eholubowich@dc-crd.com Follow Me! @healthfunding