House and Senate Republicans have floated separate plans to reorganize the National Institutes of Health, but the efforts are unlikely to go anywhere this Congress, say multiple Capitol Hill staffers and other stakeholders.

Prior to the COVID-19 pandemic, the NIH enjoyed bipartisan support from Congress, with year-over-year funding increases and praise for the agency whenever its officials appeared before Congress. 

But the pandemic put a harsh spotlight on the agency, and in the last couple years, congressional Republicans have held hearings investigating the agency’s use of gain-of-function research and allegations of sexual harassment among research grantees. Both the House and Senate have proposed major changes to how the agency conducts its day-to-day research.

The NIH pays for more biomedical research than any other public institution in the world, allocating more than 90 percent of its roughly $49 billion budget to research. 

The last time Congress proposed major reorganizations of the agency was in 2007. That law, which also reauthorized the agency, established new divisions within NIH, reorganizing several existing divisions.

But Congress also reviewed the agency as part of a 2016 medical research law that authorized $6.3 billion in funding, with most going toward the NIH. 

But between the COVID-19 pandemic, artificial intelligence, telehealth and the digitization of public health data, the medical research field looks very different than it did when those bills passed.

The larger scientific community is encouraging Congress to take a more collaborative approach to any future NIH overhauls in the coming years. 

“There are some changes that could make sense, but it really needs to be led by the science and research opportunities,” said Lizbet Boroughs, associate vice president for government relations and public policy at the Association of American Universities.

House and Senate proposals

Retiring House Energy and Commerce Chair Cathy McMorris Rodgers, R-Wash., has made oversight of the biomedical research agency a top priority.

In June her committee introduced a detailed plan to restructure and reorganize the agency. GOP appropriators included the proposal in the fiscal 2025 Labor-HHS-Education spending bill. But Senate appropriators only included minor changes to the agency in their 2025 funding bill.

McMorris Rodgers’ proposal would consolidate the agency’s current 27 institutes and centers into 15, initiate a congressionally-mandated review of the agency’s performance and enforce financial disclosures, among other proposals. 

House Republicans have said that the framework should be seen as the start of a conversation, and not a finished product. 

But House Republican appropriators put the proposal in the 2025 Labor-HHS-Education funding bill, and some in the scientific community said the House committee’s draft doesn’t rely on science, just cost-cutting.

“I think that there’s distrust among a segment of influential Republicans on the House side, especially in the Freedom Caucus, and that’s where a lot of this is coming from,” Ellie Dehoney, vice president of Policy & Advocacy at Research!America said.

By contrast, a Senate proposal is getting a more serious look from stakeholders.

Senate Health, Education, Labor and Pensions Committee ranking member Bill Cassidy, R-La., has been looking into NIH overhaul since last year. In 2023, Cassidy requested information from stakeholders on how the NIH could improve its processes for approving federal research grants, support the biomedical research workforce and improve collaboration between academia and industry.

Cassidy’s white paper, which looks to funnel more resources towards early-stage research and address biomedical workforce challenges, has not yet become legislation, but the Louisiana senator is not planning on dropping the issue any time soon.

If the Senate were to flip to Republican control in November, Cassidy would be well-positioned to usher in major overhauls of the agency.

Cassidy is the main driver of the issue in the Senate. But the other key players in the Senate — Sens. Susan Collins, R-Maine, and Patty Murray, D-Wash., the ranking member and chair of the Senate Appropriations Committee and Bernie Sanders, chairman of the Senate HELP Committee — are less interested in a complete overhaul of the agency.

And despite the controversies surrounding the agency, proposed overall NIH funding levels are on par or slightly better than they were last year — neither the House or Senate has proposed funding cuts. 

The House spending bill would hold NIH spending steady at $48 billion.

The Senate bill would provide a modest bump to $50.2 billion in base discretionary funding for the National Institutes of Health, or $2.05 billion more than fiscal 2024 levels. The measure includes $127 million in additional funding for cancer research to bring the total funding to $50.35 billion.

It would grant the NIH new authorities related to addressing sexual harassment and bypassing the transfer of research awards to other institutions. 

Experts anticipate that some of these smaller NIH overhauls, included in the Senate funding proposal, are more likely to move this Congress compared to a large agency overhaul. 

“I think despite these lingering concerns about whether there’s any falling out with Congress, appropriations are still seeing an increase,” said Erik Fatemi, a former Senate appropriations staffer and current principal at Cornerstone.