Storm Clouds Ahead for 21st-Century Cures Bill

The issue of mandatory versus discretionary funding could come back to haunt Chairman Fred Upton when the Senate takes up his bill.

By almost all standards, House Energy and Commerce Chairman Fred Upton knocked his medical-innovation bill out of the park, mustering an overwhelmingly favorable 344-77 vote for it in the House on Friday.

The only catch: 70 of the votes against the bill were from his own party, including from Budget Chairman Tom Price. Price's objection to the bill was $8.75 billion it would give to the National Institutes of Health, as this was categorized as mandatory spending and therefore not subject to budget caps.

When asked whether the funding issue that pitted some fiscal hawks against the majority of Republicans would come back when the Senate takes up the legislation, Price was confident: "It will," he said. An amendment put forth by Rep. Dave Brat that would have made the funding discretionary failed 281-141.

Republican Sen. Richard Burr, who coauthored a white paper on medical innovation with Senate Health, Education, Labor, and Pensions Committee Chairman Lamar Alexander, said he supports paying for additional NIH spending with discretionary funds.

"This is a discretionary program today; it should stay there," Burr said in an interview.

The House bill, called 21st-Century Cures, aims to bring new drugs to market faster by encouraging medical innovation. It gives additional funding to the NIH and the Food and Drug Administration, and includes reforms to the agencies as well.

Upton remains optimistic about the legislation's success in the upper chamber. "We're not expecting any hang-ups," he told reporters after the vote. "Leader [Mitch] McConnell, [Harry] Reid, others—there are some very significant, powerful players that truly want to get this done also.

"Our goal was always 300 votes," he added. "344 was icing on the cake. We'll continue to work with all of our colleagues."

While senators are maintaining an upbeat tone on the medical-innovation bill, the chamber is not looking at it's own version until the fall. And once the Senate is finished with its version of the bill, there could still be a long road ahead. Both chambers are hoping to take the legislation to conference.

"We're looking forward to that, actually. They're doing a good job, we're on a parallel track, and so we're looking forward to it," Alexander said in an interview, adding that he hopes to have a bill in the Senate by Thanksgiving.

"I'm not going to tell the Senate when to have their bill up, but we think it's important to get it passed in both houses and to the president's desk by the end of the year because of the election," Rep. Diana DeGette, Upton's Democratic cosponsor on the Cures bill, said in an interview.

"We've been talking to our colleagues in the Senate throughout the process, but I think once they see how thorough the language is and how we've really worked with the agencies and all of the outside groups, I think that gives a really good foundation to what they want to do," she said.

Democratic sponsors of the bill are hoping to wrangle more NIH funding out of the Senate process. The original amount was $10 billion, but it was lowered after budget hawks objected to the bill, claiming it would continue a trend of adding to the deficit in spite of the Republican promise to do the opposite.

"I would want as much as we can get if the Senate can plus it up. Because we spent two years, or a year and a half, talking about 10 billion in mandatory funding, and then just last week, because of the Republican conference issues, we had to drop it back," Democratic Rep. Gene Green, another key player on Cures, said in an interview.

But Brat said going to conference could severely complicate the issue of figuring out how to pay for the legislation.

"I think I've heard a few little tremors over in the Senate on this," he told reporters, referring to the funding question. "We put it at mandatory, and if they can't pay for it that way on the Senate side and then we got to conference—boy, that's going to be a tough issue to resolve."

Regardless of what happens next in the Senate, the Cures legislation did what very few things have been able to do so far this Congress: It brought Democrats and Republicans together on something big.

"I hope this will be a template for some of the really bold things that we can do going in the future," DeGette said. "This bill's not just about $8.75 billion for the NIH; it's also about 350 pages of structural changes in these agencies that's really going to help us expedite medical research. So I'm excited."