NIH Funding: FY1996-FY2025 Request

The National Institutes of Health (NIH) is the primary federal agency for medical, health, and behavioral research. It is the largest of the agencies that make up the Public Health Service (PHS) within the Department of Health and Human Services (HHS).¹ NIH consists of the Office of the Director (OD) and 27 Institutes and Centers (ICs) that focus on aspects of health, human development, and biomedical science. Of these, 24 ICs and OD support research programs. The OD sets overall policy for NIH and coordinates the programs and activities of all NIH components, particularly in areas of research that involve multiple institutes. In addition, the Advanced Research Projects Agency for Health (ARPA-H), first funded in FY2022, is established as an independent agency housed within NIH to advance "high-potential, high-impact" biomedical and health research.²

This report details the NIH budget with a focus on FY2024 and the FY2025 request. Almost all of NIH's funding is provided in the annual Departments of Labor, Health and Human Services, and Education, and Related Agencies (LHHS) Appropriations Act. NIH also receives smaller amounts of funding from the Department of Interior, Environment, and Related Agencies (INT) Appropriations Act and a mandatory budget authority for type 1 diabetes research.³ Through the annual appropriations process, Congress provides funding to the 24 research ICs, OD, ARPA-H, and a Buildings and Facilities account. Three support centers are funded through transfers from other accounts.

NIH activities cover a wide range of basic, clinical, and translational research, focused on particular diseases, areas of human health and development, or more fundamental aspects of biology and behavior. Its mission also includes research training and health information collection and dissemination.⁴ As of fall 2023, nearly 83% of the NIH budget funded extramural research (i.e., external) through grants, contracts, and other awards.⁵ In FY2025, NIH expects to support research performed by more than 300,000 individuals who work at over 2,800 hospitals, medical schools, universities, and other research institutions around the country.⁶ In addition, as of 2023, about 11% of the agency's budget supported intramural research (i.e., internal) conducted by nearly 6,000 NIH physicians and scientists, most of whom are located on the NIH campus in Bethesda, MD. The remaining 6% of the budget supported administration, construction, maintenance, and operations.⁷

Funding Sources

The vast majority of NIH funding comes from annual discretionary appropriations. NIH additionally receives some mandatory funding and other funding due to unique transfer or budgetary rules, as explained below. The total funding available for NIH activities, taking account of add-ons and transfers, is referred to as the NIH "program level."⁸

Discretionary budget authority. NIH's discretionary budget authority comes primarily from annual LHHS Appropriations Acts, with an additional smaller amount for the Superfund Research Program and related activities from the INT Appropriations Act.⁹

PHS Evaluation Set-Aside. The PHS Evaluation Set-Aside, also known as the PHS Evaluation Tap, has the effect of redistributing a certain percentage of eligible appropriations among HHS accounts funded by the LHHS Act (up to 2.5% of eligible appropriations in FY2024).¹⁰ Eligible appropriations potentially subject to the transfer include any provided for programs authorized in the Public Health Service Act, with some exemptions.¹¹ In recent years, appropriations laws have directed specific amounts of PHS tap funds to specific agencies. NIH has received a large share of PHS Evaluation Tap transfers in recent years, specifically to the National Institute of General Medical Sciences (NIGMS). By convention, appropriations acts direct where specified PHS Evaluation Tap transfers are to be allocated but do not specify the accounts that are to be the sources of those transfers. Thus, tables in this report show only the amount of PHS Evaluation Tap funds received in any NIH account.

Mandatory Type I Diabetes Funding. In addition, NIH has received mandatory funding of $150 million annually that is provided in Public Health Service Act (PHSA) Section 330B for a special program on type 1 diabetes research, most recently extended to December 31, 2024, by the Consolidated Appropriations Act, 2024 (P.L. 118-42).

21^st Century Cures Act Innovation Account. NIH also receives funding through LHHS appropriations subject to different budget enforcement rules than the rest of the NIH funding in the act: appropriations to the NIH Innovation Account created by the 21^st Century Cures Act ("the Cures Act," P.L. 114-255) to fund programs authorized by the act for FY2017 through FY2026, as shown in Table 1.¹² For appropriated amounts to the account—up the limit authorized for each fiscal year—the amounts are subtracted from any cost estimate for enforcing discretionary spending limits (i.e., the budget caps). In effect, appropriations to the NIH Innovation Account as authorized by the Cures Act are not subject to discretionary spending limits.¹³ The NIH Director may transfer these amounts from the NIH Innovation Account to other NIH accounts, but only for the purposes specified in the Cures Act. All amounts authorized by the Cures Act have been fully appropriated to the Innovation Account from FY2017 to FY2024, including $407 million for FY2024. For FY2025, $127 million is authorized to be appropriated.

NIH Funding: FY2023-FY2025 Request

Table 2 provides an overview of recent-year NIH funding from FY2023 final appropriations to proposed amounts in the FY2025 budget request. The first section of the table summarizes discretionary funding to each of NIH's accounts in annual LHHS appropriations, ending with the total discretionary amount enacted or proposed in LHHS each year. Next, the table summarizes funding by other sources (see previous section) and then summarizes the total NIH program level for each year accounting for all sources of funds. In this table, ARPA-H funding is presented separately from the rest of NIH, and thus a separate "NIH and ARPA-H" program level is shown. The table ends with proposed mandatory funding in the President's budget requests.

The following discussion provides a summary of enacted and proposed NIH funding in FY2024 and FY2025, respectively, with a discussion of highlighted changes in each year.

FY2024 Enacted

As shown in Table 2, in FY2024-enacted appropriations, NIH received a total program level of $47.311 billion, a decrease in its overall program level from the prior year (-$368 million, or -0.8%) for the first time since FY2013 (see Table 3). Accounting for ARPA-H, which saw level funding for FY2024 and FY2023, the overall NIH and ARPA-H program level decreased by 0.7%. The overall program level decrease owes primarily to a reduction in funding authorized for the 21^st Century Cures Act NIH Innovation Account, which is effectively exempt from discretionary spending limits: $407 million in FY2024 compared with $1,085 million in FY2023 (see previous section and Table 1). In terms of LHHS discretionary budget authority effectively subject to the spending limits, NIH actually received an increase in FY2024 funding relative to FY2023 enacted (+305 million; +0.7%). However, this increase in discretionary funding did not fully compensate for the effect of the decreased Cures Act Innovation Account authorization level in FY2024.

The NIH account that saw the largest increase relative to FY2023 was the National Institute on Aging (NIA), an increase of $96 million (+2.2%), which included an increase of $90 million for Alzheimer's disease and related dementias research (see below and Table A-1). Several NIH accounts, all of which have received Cures Act transfers, saw notable decreases in FY2024 funding when accounting for such transfers: (1) the National Cancer Institute (-$93 million, or -1.3%); (2) the National Institute of Neurological Disorders and Stroke (NINDS; -$119 million, or -4.3%); and (3) the National Institute of Mental Health (NIMH; -$68 million, or -3.2%). These decreases reflect reductions in authorized funding for the Cancer Moonshot and BRAIN initiative programs under the Cures Act, as shown in Table 1. When not accounting for Cures Act transfers, all three accounts saw increases in LHHS discretionary budget authority, as shown in Table 2.

In addition, through accompanying report language, Congress directed increases for program funding within NIH accounts, even when those accounts did not see increases in their overall FY2024 funding level relative to FY2023. For the most part, Congress has not specified NIH funding for particular diseases or research topics through appropriations and instead allows the ICs to award funding within their mission areas based on their own strategic planning and priority-setting processes. However, there are some exceptions, as summarized in Table A-1. Some selected directed increases include the following:

• Alzheimer's disease and related dementias: An increase of $100 million across NIH, including $10 million for NINDS and $90 million for NIA.
• Mental health research: An increase of $75 million for the NIMH to fund mental health diagnosis, treatment, and prevention research, including the impact of social media on mental health.
• Lyme and tick-borne disease: $100 million for the National Institute of Allergy and Infectious Diseases (NIAID). In FY2023, NIH spent a total of $99 million on tickborne disease research across all ICs, including $93 million funded by NIAID.¹⁴

FY2025 Request

Under the Biden Administration's FY2025 request, NIH would receive a program level of $48.674 billion, an increase of $1.363 billion relative to FY2024 enacted (+2.9%,) as shown in Table 2. (Note that the FY2025 request was formulated before FY2024-enacted appropriations were finalized.)¹⁵

As proposed, most IC accounts would receive an increase in funding compared with FY2024-enacted levels, though in many cases a small increase (less than 1%). The accounts that would see decreases are (1) the National Institute on Aging ($82 million decrease, or -1.8%), (2) the National Institute on Minority Health and Health Disparities ($7.7 million decrease, or -1.4%), and (3) the National Center for Advancing Translational Sciences ($2.2 million decrease, or -0.2%).¹⁶ ARPA-H would see level funding with FY2024-enacted appropriations: $1.500 billion. The Innovation Account would receive the full amount authorized to be appropriated: $127 million.¹⁷

The budget request also proposes two new sources of mandatory funding for NIH: $1.448 billion in new mandatory funding for the Cancer Moonshot for FY2025 and $2.69 billion in new mandatory funding for pandemic preparedness, to be made available for five years. Accounting for this proposed mandatory funding, NIH and ARPA-H would receive a total FY2025 program level of $54.312 billion, a $5.5 billion (11.3%) increase from FY2024 enacted.

The mandatory Cancer Moonshot proposed funding would go to the National Cancer Institute, which, in addition to $742 million in proposed discretionary funding, would provide for an overall FY2025 Cancer Moonshot funding level of $2.164 billion. The Cancer Moonshot is President Biden's initiative to cut the U.S. death rate from cancer by 50% over the next 25 years and to improve the experience of patients and their families living with cancer.¹⁸ The new mandatory Cancer Moonshot funding would extend the expired Cures Act authorization for the Cancer Moonshot initiative (see Table 1 ). The total program funding would support related research, training, and health education activities.¹⁹ The $2.960 billion pandemic preparedness funding is NIH's portion of $20 billion in total mandatory funding proposed across HHS, to be appropriated to the Public Health and Social Services Emergency Fund, according to the request.²⁰ The proposal generally does not designate specific amounts for NIH ICs but describes a number of activities the new funding would support, including vaccine and therapeutic development, expanding laboratory capacity, and developing next-generation diagnostics.²¹ This is the third year in which the Administration has proposed mandatory pandemic preparedness funding; Congress has not adopted the proposal to date.

The Administration estimates that the proposed FY2025 funding level would support 43,636 research project grants, an increase of 460 from FY2023 enacted, with a total of 10,273 new and competing grants.²² With respect to specific research areas and initiatives, some highlights and increases from the request include the following:²³

Women's health research: The FY2025 request includes $154 million for the Office of Women's Health research within the Office of the Director, an increase of $76 million from both FY2023 and FY2024 enacted, each of which provided $76.5 million.²⁴ The new funds are intended to support research on topics such as research in menopause and diabetes, opioid use disorder in pregnant women, and alcohol use during pregnancy. NIH also intends to create a new nationwide network of centers of excellence and innovation in women's health.

Mental and behavioral health: The FY2025 request includes an increase of $200 million relative to FY2023 for the National Institute of Mental Health to support better diagnostics, improved treatments, and enhanced precision of care for mental health. Compared with FY2024 enacted, NIMH would see a $274.8 million (12.1%) increase under the FY2025 request (accounting for Cures Act transfers), per the table below.

See Table A-2 for a summary of specific program funding requested in the FY2025 budget request.

Trends

Table 3 outlines NIH program level funding from FY1996 to the FY2025 request. Figure 1 illustrates funding trends in both current (also called nominal dollars) and projected constant (i.e., inflation-adjusted) FY2023 dollars (funding shown is total budget authority).

NIH has seen periods of high and low funding growth. Between FY1996 and FY1998, funding for NIH grew from $11.928 billion to $13.675 billion (nominal dollars). Over the next five years, Congress and the President doubled the NIH budget to $27.167 billion in FY2003 (often referred to as the NIH budget doubling period). In each of FY1999 through FY2003, NIH received annual funding increases of 14% to 16%. From FY2003 to FY2015, NIH funding increased more gradually in nominal dollars.²⁵ In some years, (FY2006, FY2011, and FY2013) funding for the agency decreased in nominal dollars.²⁶ From FY2016 through FY2023, NIH received funding increases each year. The largest percentage increase was from FY2017 to FY2018, where the program level increased by $3.010 billion (+8.8%), making this the largest percentage increase since FY2003. As noted earlier, the FY2024 program level marks the first decrease since FY2013, representing a 0.7% decrease from the FY2023 level (including ARPA-H funding). The FY2025 budget request would provide a 2.8% increase to the FY2024-enacted level.

The lower half of Figure 1 shows NIH funding adjusted for inflation (in projected constant FY2023 dollars) using the Biomedical Research and Development Price Index (BRDPI).²⁷ It shows that the purchasing power of NIH funding initially peaked in FY2003 (the last year of the five-year doubling period) and then declined fairly steadily for more than a decade until consecutive funding increases were provided in each of FY2016 through FY2023. The FY2023 program level was 1.2% greater than the peak FY2003 program level, although the FY2023 program level included funding for a new agency, ARPA-H, and therefore was not exactly comparable to the FY2003 level. Once again in FY2024, the NIH program level (including ARPA-H) is less than the FY2003 peak level (-2.7%). When excluding funding for ARPA-H, the FY2024 level is 5.2% less than the FY2003 level. The FY2025 proposed inflation-adjusted NIH and ARPA-H program level is 2.6% less than the FY2003 program level and 3.3% less than the FY2003 level when excluding ARPA-H funding.

Figure 1. NIH Funding, FY1998-FY2025 Request Program Level Funding in Current and Projected Constant (FY2023) Dollars.

Source: Sources used for the FY2025 request and for FY2024 and FY2023 program levels are in Table 2. The FY2022 (and earlier) program levels are from NIH Budget Office, Appropriations History by Institute/Center (1938 to Present), at http://officeofbudget.od.nih.gov/approp_hist.html. Inflation adjustment reflects the Biomedical Research and Development Price Index (BRDPI), updated January 2024, at https://officeofbudget.od.nih.gov/gbiPriceIndexes.html. Notes: By convention, program level totals include amounts "transferred in" pursuant to PHS tap but do not include any amounts "transferred out" under this same authority. Program level includes all budget authority, including appropriations for the Global Fund to Fight AIDS, TB, and Malaria (FY2002-FY2011) that were subject to transfer-out. As of FY2012, NIH no longer receives appropriations for the National Institute of Allergy and Infectious Diseases (NIAID) identifying resources for the Global Fund; this responsibility was transferred to another federal agency. In general, amounts provided to NIH designated for emergency requirements are excluded from these totals (e.g., the FY2020 and FY2021 amounts do not include the amounts provided in the coronavirus supplemental appropriations acts). PB = President's budget.

Appendix A. NIH Funding Details

Program-Specific Funding

For the most part, Congress does not specify NIH funding for particular diseases or research topics through appropriations and instead allows the ICs to award funding within their mission areas based on their own strategic planning and priority-setting processes. Research funding is generally awarded on a flexible and competitive basis through various funding allocation mechanisms intended to balance scientific and health priorities.²⁸

However, in some cases, Congress and the President specify funding levels for programs or research areas within NIH accounts throughout the budget and appropriations process. Congress uses appropriations report language to designate funding for specified purposes, whereas the President proposes amounts in the annual budget request.²⁹ This practice has expanded since FY2015.³⁰

In FY2024, Congress used appropriations report language to specify a certain amount of IC funding for designated purposes, as summarized in Table A-1. Most of these amounts are specified in the explanatory statement accompanying enacted appropriations.³¹ In a few cases, amounts specified in the Senate appropriations report (S.Rept. 118-84) are incorporated by reference.³² Sometimes the language specifies a certain amount for a certain purpose; in other cases, the language provides increased or additional funding. The appropriations reports also include many general statements recommending the agency to fund certain programs or areas of research, as well as statements expressing the opinion or concerns of Congress regarding NIH. These broad statements are not summarized here.

Appendix B. Acronyms and Abbreviations