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February 2001 Volume 4, Issue 3:
By Greg Brozeit
The NCI Bypass Budget- An Opportunity To Fill Research Gaps
The NCI Bypass Budget- An Opportunity To Fill Research Gaps

During the 106th Congress, the IMF Advocacy Program focused on raising awareness within Congress about multiple myeloma and building support for more research. Since Congress does not appropriate funding levels for specific disease research categories, the case was made for myeloma research as a justification for increases in overall funding for the National Cancer Institute (NCI). This was done through the inclusion of report language in NCI appropriations bills, questions posed by members of Congress to the agency, the IMF's participation in larger cancer coalitions, and the implementation of a myeloma Progress Review Group at NCI. 

The challenge will be to translate these various actions into real research projects benefiting today's patients. Policy makers must understand that unfulfilled science exists that can refine treatments and lead to cures. The best way for the incoming Bush Administration and the 107th Congress to demonstrate a commitment to these cancer patients is to fully fund the NCI bypass budget. 

What is the bypass budget?
NCI is the only federal research agency required by law to submit to the president a forward-looking budget, due prior to the submission of the annual budget package to Congress. Authorized in 1971 under the National Cancer Act, this so-called bypass budget provides specific goals and corresponding funding levels that NCI believes it needs to fulfill its statutory responsibility to find cures for all cancers.

Historically, approved funding levels for NCI have fallen well below the bypass budget recommendations. For example, in fiscal year 2001, the bypass budget called for a funding level of $4.1 billion for NCI. The final appropriation signed into law last December was $3.76 billion, approximately $340 million below the bypass budget recommendation. The recently released FY2002 NCI bypass budget recommended $5.03 billion for NCI, more than $1.2 billion above the 2001 funding level.

The first political test for the cancer community will come with the release of the first Bush budget, due after the state-of-the-union speech in February 2001. Will President Bush's budget request for NCI fulfill the $1.2 billion increase needed to achieve the NCI bypass budget request? The Clinton administration traditionally under-funded cancer research early in the budget process with the expectation that favorable congressional leadership would increase spending during the course of the legislative year. 

While funding increased, it never reached what most cancer advocates acknowledge as the real minimum needed to effectively fight all forms of cancer – the NCI bypass budget. Moreover, the recent 15% increases NCI has received over the past few years will not fill the gap between approved funding and the NCI bypass budget recommendations. And, as we all know, these increases are not keeping pace with knowledge needed to address real, unfulfilled research opportunities we all know about in our respective fields. In other words, funding is going up arithmetically while the number of potential promising research projects goes up exponentially.

Assuming, using the past three years as an indication, that NCI gets at least a 15% increase from Congress during the next appropriations cycle, that will still mean a difference of at least $660 million between actual funding and the bypass recommendation. Therefore it will be up to the cancer community to demand that the bypass budget recommendation become a floor for NCI funding. It can no longer be viewed as some “pie-in-the-sky” unrealistic spending ceiling that policy makers will debate but not take seriously. Perhaps the cancer community's rallying cry for the 107th Congress should be, “Bypass Budget or Bust.”

Bush, New Congressional Leadership Provide New Opportunities for Cancer Research
The Bush administration is expected to be a strong proponent for increased support for medical research as well as a wide range of cancer issues. During the campaign, President Bush repeatedly expressed support for investing more in medical research. According to a recent Los Angeles Times (Jan. 22, 2001) story, “Where he will spend money is on health care research. He has pledged to complete…doubling of the budget of the National Institutes of Health to $27.3 billion by 2003, with an additional $12 billion to renew the war on cancer.”

In a sign that the Bush administration values effective continuity, NCI Director Richard Klausner has been asked to remain as with the agency. Also, Senators Arlen Specter (R-PA), co-recipient of the 2000 IMF Public Service Award, and Tom Harkin (D-IA) will remain as chair and ranking member of the Senate Appropriations Sub-committee on Labor, HHS, and Education and Rep. David Obey (D-WI) will remain as ranking member of the House panel. 
Retired Rep. John Porter (R-IL), also co-recipient of the 2000 IMF Public Service Award, will be replaced as chair of the House subcommittee by Rep. Ralph Regula (R-OH). Although not new to Washington, DC, entering his 15th term in Congress, Rep. Ralph Regula (R-OH) is relatively new to the world of cancer policy. Previously chair of the appropriations Interior panel, Regula brings with him a wealth of experience and a strong reputation as leader and policy maker.
Another new face in cancer leadership will be Sen. Sam Brownback (R-KS), who is replacing retired Sen. Connie Mack (R-FL) as co-chair of Senate Cancer Caucus. Sen. Brownback, who will co-chair the caucus with Sen. Dianne Feinstein (D-CA), will be a vocal proponent of comprehensive cancer issues facing Congress. Reps. Sue Myrick (R-NC), Deborah Pryce (R-OH), Kent Bentsen (D-TX), and Lois Capps (D-CA) have agreed to serve as co-chairs of the House Cancer Caucus, replacing former Rep. Rick Lazio (R-NY). 

Wrapping Up the 106th Congress
Lost in the shuffle of the post-election drama was the unfinished business of the 106th Congress, which after a 2 month delay, completed its work in mid-December on the Labor, HHS, and Education legislation funding cancer research. Under the final agreement, signed into law by President Clinton, funding for the National Institutes of Health increased by 14.5% to $20.313 billion and the National Cancer Institute funding was projected to be approximately $3.76 billion, an increase of $476 million over last year.

While these figures are significant, they represent cuts from those reported in the last issue of Myeloma Today. Although members of the congressional appropriations leadership agreed to final funding levels (dubbed the Merlot Agreement because it was sealed with a toast of wine) in November, after members of the House Republican leadership objected to overall spending levels in the bill. Instead, the $2.7 billion of additional NIH funding secured in the Merlot Agreement was trimmed by $200 million to $2.5 billion. Under the terms of the compromise, NCI funding will lose approximately $40 million of its projected $500 million increase.

The NIH figures represent a slight retreat in the third year of five-year congressional pledge to double NIH funding. On an encouraging note, a number of congressional leaders pledged to restore the track to doubling NIH funding next year. One Voice Against Cancer was credited by a congressional leaders in it's effort to limit the cuts in cancer research as compared to other provisions in the bill. 

One Voice Against Cancer Lobby Days
The IMF will be advocating for increased funding for cancer research with 47 other organizations during the 2nd Annual One Voice Against Cancer Advocacy Days scheduled for April 1-3, 2001 in Washington, DC. Contact Greg Brozeit at (818) 728-4291 or greg.brozeit@worldnet.att.net if you are interested in attending. A limited number of stipends will be available.

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