1. FY 2015 Federal Budget & Appropriations Update Kathryn G. Schubert CRD Associates Coalition for Health Funding April 23, 2014

2. CRD Associates Founded in 1980 Government Relations Strategic consulting

3. Background Founded in 1970 Largest nonprofit alliance to preserve and strenghten public health investments 80+ member organizations Advocate for the public health continuum – NIH, CDC, HRSA, SAMHSA, AHRQ, FDA, etc.

4. Mandatory vs. Discretionary Discretionary spending is at Congress’ “discretion” – “Defense” discretionary is military spending – “Nondefense” discretionary or “NDD” is everything else Research, education, food/drug/airline/public safety Mandatory spending enacted by law – Entitlement Programs (e.g., Medicare) To change spending, must change eligibility rules

5. Appropriations Timetable President submits budget request (Feb.) Congress adopts a Budget Resolution (April) Appropriations Committees make 302(b) allocations to 12 subcommittees (May) Subcommittees hold hearings, mark up appropriations bills (May – June) Full Committee ratifies bills (June) YOU ARE HERE

6. Appropriations Timetable (cont) House floor debate, vote (June) Senate develops and adopts its own appropriations bills (July – Sept.) Differences ironed out in Conference Committee (Sept.) To president for signature or veto (Sept. 30) New fiscal year begins (Oct. 1)

7. In Reality… Budget process rarely works as it should Continuing resolution is “parachute” for annual appropriations process – Funds federal government in absence of appropriations bills for finite period – Programs funded at current level (generally) Outstanding bills are frequently bundled in “omnibus” or “minibus” measures – FY 2013: Year of the “CRomnibus”

8. CR Funding, Number of Days

9. BCA (2011) set caps for next decade Sequestration (effective March 2013) – Cuts to all programs, projects, activities – FY2014-FY2012 cuts to spending caps Government Shutdown! (October 2013) Ryan-Murray Budget Agreement BBA 2013 – FY2014 $1.012 trillion v. FY2015 $1.013 trillion FY2016 Sequestration STILL LAW Last Year: The Worst of Times

11. Congress passes, President signs Consolidated Appropriations Act of 2014 – Omnibus measure includes all 12 spending bills – First Labor-HHS bill since FY 2012 – Good news: increases for discretionary health programs – Bad news: levels remain below FY 2010

12. FY 2015: Better or Worse? For better… – Early agreement on topline provides stability – Shutdown left yearning for regular order – Appropriators reasserting their authority For worse… – Late start: President’s budget March 4 – “Stability:” So we thought in FY 2014 – Continued sequestration makes cutting harder – Devolution of appropriations – Election year

13. NIH Budget Authority (in billions, not adjusted for inflation)

14. Previous Cuts to NIH Funding Base funding Reduction 1942 ($700,000)-1.5% or $11,000 1952 ($56.9 million)-12% or $7.8 million 1967 ($1.01 billion)-7.8% or $86 million 1970 ($1.06 billion)-4.3% or $48 million 2006 ($28.4 billion) 2011 ($30.6 billion) -0.1% or $33.7 million -0.8% or $320 million 2013 ($29.504 billion)-5.1% or $1.55 billion

15. Changing Face of Advocacy: FY2015 and Beyond Changing world – we now lobby on the budget resolution Seek highest top-level number for our division – Caps already set Work together with other groups – A rising tide lifts all boats Appropriations = policy and programs

16. The Time is NOW!

17. Questions? kschubert@dc-crd.com Publichealthfunding.org @healthfunding