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  • Writer's pictureAssociation of Academic Physiatrists

Cloudy Appropriations Process Slowly Moving Forward

Congress has begun the FY 2024 federal appropriations process following passage of an agreement in June, the Fiscal Responsibility Act of 2023, that linked spending cuts to an extension of the nation’s debt ceiling. This new agreement, which passed both the House and Senate by wide margins, establishes caps on discretionary spending from Fiscal Years (FY) 2024 through 2025 and suspends the debt limit through January 1, 2025. The measure sets a FY 24 defense spending limit of $868.349 billion and nondefense limit of $703.651 billion and holds spending limits to 1% growth in FY 25. After 2025, the legislation sets nonbinding limits that would be subject to the regular appropriations process, but not hard budget caps.

Congress now must move forward with the FY 2024 appropriations process under this new agreement. The House Labor-HHS-Education Appropriations Subcommittee has released its FY 2024 spending bill which provides $43 billion to the National Institutes of Health (NIH), $3.8 billion below the FY23 enacted level, and reduces funding for the Office of the Director, the National Institute of Allergy and Infectious Diseases, and the new ARPA-H program, which already has $1.5 billion available in unspent funding. NIH specific details include $2.7 billion for the National Institute of Neurological Disorders and Stroke (NINDS), a cut of $139 million below the enacted level. The Administration for Community Living Aging and Disability Services Program would be funded at $2.4 billion which would be slight decrease in discretionary spending from FY 23.

In late June, the Senate Appropriations Committee held its markup of the Fiscal Year (FY) 2024 Military Construction, Veterans Affairs, and Related Agencies (MilCon-VA) Appropriations Bill; the Agriculture, Rural Development, Food and Drug Administration, and Related Agencies (Ag-FDA), Appropriations Bill. Some key elements of this spending package include $121.01 billion for the Veterans Health Administration, a proposed increase of $1.35 billion over FY 23 and $938 million for VA Medical and Prosthetic Research, a proposed increase of $22 million over FY 23. The House version of the FY 24 VA appropriations bill includes $138.127 billion for the Veterans Health Administration, matching the President’s budget request. In addition, the Committee provides $938 million for Medical and Prosthetic Research for fiscal year 2024, equal to the President’s requested level and the recommended level in the Senate version.

House Republicans have unveiled all 12 of their proposed FY 2024 spending bills and the Senate is hoping to finish all 12 of their bills by July 27. At that point the real work begins as there is widespread disagreement between the GOP House and the Democratic controlled Senate on spending priorities. The deadline to pass spending bills for FY 2024 is September 30, 2023.

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