Scientific Research Advocacy Council

Extended SRAC Statement on NIH Cuts

Research focused on cardiovascular disease meets a major public health need because it saves lives. In fact, cardiovascular disease accounted for over 900,000 deaths in the United States in 2022, and heart disease and stroke led to more deaths in 2022 in the United States than all forms of cancer and chronic lower respiratory diseases. Heart rhythm disorders such as sudden cardiac arrest, atrial fibrillation, and ventricular tachycardia contribute prominently to morbidity and mortality from cardiovascular disease. Many in the United States die from these heart rhythm disorders, and many others are left with incapacitating disability from strokes and heart failure that occur as a consequence. The Heart Rhythm Society (HRS) and Heart Rhythm Advocates (HRA) lead the efforts to advocate for treatment and prevention of sudden cardiac arrest, atrial fibrillation, ventricular tachycardia, and other heart rhythm conditions in the United States and internationally, in part through promotion of rigorous scientific research supported by the National Institutes of Health (NIH).

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On February 7, 2025, the new administration in Washington directed the NIH to announce major cuts in extramural research (research performed at centers that are not part of the NIH) budget, which was $35 billion in Fiscal Year 2023. This NIH budget represents just a small fraction of the overall federal budget of $6.75 trillion and is much smaller than the portions of the 2024 federal budget allocated for Medicare ($874 billion), Social Security ($1.46 trillion), and defense ($874 billion). The announcement on February 7 further cut the already modest NIH budget from $35 billion to $31 billion by reducing the maximum indirect cost (IDC) rate (also called the Facilities and Administrative, or F&A rate) to 15%. As this F&A rate is typically over 50% for many urban medical centers and universities, this represents a major funding cut. In addition, news reports indicate that the new administration plans to cut $3 billion from the $9.1 billion National Science Foundation budget.

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In response to this order, a complaint was filed by 22 states on February 10, 2025. The suit noted that research institutions negotiate IDC rates with the federal government through a carefully regulated process governed by regulations promulgated by the Office of Management and Budget (OMB) and the Department of Health and Human Services (HHS). In 2018 Congress enacted an appropriations rider prohibiting HHS or NIH from spending appropriated funds “to develop or implement a modified approach to” the reimbursement of “indirect costs” and “deviations from negotiated rates.” In response to the lawsuit from the 22 states and a motion from the Association of American Medical Colleges (AAMC), on February 10, 2025, the United States District Court of Massachusetts issued an emergency motion for a temporary restraining order, preventing the February 7 notice from NIH from going into effect nationwide.

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Universities and hospitals carry millions of dollars in research infrastructure costs, which cannot be absorbed in typical NIH direct cost budgets providing $250,000-$500,000 per year. F&A expenses, which cover infrastructure, compliance, and operational support, ensure that research institutions can conduct high-impact scientific research safely, efficiently, and in compliance with federal regulations. F&A costs support critical functions such as high-tech lab operations and maintenance, utility costs, state-of-the art equipment, secure data storage, health and radiation safety, biohazard safety, regulatory compliance including patient safety in clinical trials, ethical use of animals, and educational resources, including libraries and access to electronic journals and articles. While universities contribute significant institutional funds to cover these expenses, they cannot sustain research programs without federal reimbursement for a portion of these necessary costs.  F&A reimbursements are not a source of profit for universities but rather a mechanism to ensure research sustainability. Furthermore, F&A reimbursement rates are subject to audits every 2 to 4 years, ensuring that only allowable expenses are included, preventing misuse, and maintaining cost efficiency.

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The justification provided for the reduction in the maximum NIH F&A rate to 15% is that private foundations have an F&A rate of about 15%. This justification represents a fundamental misunderstanding of fiscal operations at U. S. academic medical centers. In fact, the 0-15% F&A funds from private foundations are not sufficient to cover research infrastructure costs, and university hospitals continue to rely on the NIH F&A funds to make up the difference. The 0.06% savings in the overall federal budget from reducing the NIH F&A rate by $4 billion ($4 billion/$6.75 trillion = 0.0006) jeopardizes America's global leadership in health-related research and biomedical innovation, making us significantly weaker in this critical domain. Any reductions in federal research support would hinder scientific progress, slow technological innovation, and weaken our nation's global competitiveness.

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The fallout from these cuts could lead to university hospitals suspending research, hiring more physicians with 100% clinical responsibilities and fewer physician-scientists/PhD-scientists who are key to making life-saving break-throughs, fewer opportunities to train the next generation of clinical and basic science investigators America needs to lead medical innovation, and ultimately, increased morbidity and mortality of Americans and those around the world because necessary advances to detect and treat disease are not forthcoming. This is expected to result in harm across the lifespan with a negative impact on our aging population, which has increased rates of atrial fibrillation; pediatric patients with congenital heart disease or arrhythmias; and even those in their prime who may develop undetected structural heart disease or die from sudden cardiac arrest, leaving behind loved ones, including spouses and children.

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There are actions we can take as we consider this bleak future. While recent court orders have stayed the F&A cuts, the funding for NIH that will be appropriated by Congress for the current fiscal year when the continuing resolution expires will be critical. As there is substantial uncertainty about future funding, we propose a proactive approach with three components: 1) development of short-term fiscal strategies to preserve ongoing health-related research; 2) initiation of a campaign to educate the public; and 3) legislative advocacy in Washington and appropriate engagement of the judicial system to discourage further actions with adverse effects on health-related research in the United States.

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Regarding immediate fiscal strategies, we would like to offer institutions alternative strategies to damaging actions they might consider in response to these funding cuts. Given that direct costs associated with many NIH grants are already capped at specific limits that have not increased over the past two decades despite inflation, covering indirect costs with funding provided for direct costs is not feasible. Hence, we would like to discourage institutional responses that would allocate a portion of the direct costs from NIH awards to cover infrastructure costs, encroach on physician-scientist research effort by having them absorb more clinical time, and reduce the number of physician-scientist/PhD-scientist faculty positions in favor of 100% clinical faculty positions. We can instead encourage alternative institutional strategies such as philanthropy, industry, private foundation, or endowment fund support for research infrastructure to maintain health-related research infrastructure in this time of crisis. Second, by initiating a public education campaign through advertisements and social media, we can increase public awareness of the importance of research related to sudden cardiac arrest, atrial fibrillation, cardiac physiologic pacing for heart failure, and other prevalent and important conditions. Third, we can work through HRA to educate lawmakers about these public health concerns and engage the judicial system as needed based on the questionable legality of recent executive orders. In all these initiatives, HRS and HRA will work together with other professional organizations to present a unified message to the public, lawmakers, and the new administration in Washington.

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We encourage our members to utilize this link to write to their Congressional representatives, Senators, and State Governors to continue to support federal research funding and act to increase our global competitiveness in research and the health of our country.  Template letters can be personalized with actual dollar amounts of NIH funding for each state and congressional district available here: Federal Research Funding Data