Budget Options
December 8, 2016

Discretionary Spending Health Option 14

Function 050 - National Defense

End Congressional Direction of Medical Research in the Department of Defense

CBO periodically issues a compendium of policy options (called Options for Reducing the Deficit) covering a broad range of issues, as well as separate reports that include options for changing federal tax and spending policies in particular areas. This option appears in one of those publications. The options are derived from many sources and reflect a range of possibilities. For each option, CBO presents an estimate of its effects on the budget but makes no recommendations. Inclusion or exclusion of any particular option does not imply an endorsement or rejection by CBO.

Billions of Dollars 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2017-2021 2017-2026
Change in Discretionary Spending                        
  Budget authority 0 -1.2 -1.2 -1.3 -1.3 -1.3 -1.4 -1.4 -1.4 -1.4 -5.0 -11.9
  Outlays 0 -0.1 -0.5 -0.9 -1.1 -1.2 -1.3 -1.3 -1.3 -1.4 -2.6 -9.2

This option would take effect in October 2017.

Savings for this option are measured against CBO’s baseline, which takes the most recent appropriation and increases it for future years by the agency’s projection of inflation in the economy. For most other budget options for national defense, savings are measured in relation to the Department of Defense’s 2017 Future Years Defense Program and CBO’s extension of that plan.

The Department of Defense (DoD) typically plans to conduct modest amounts of medical research and development (R&D), focusing on areas of inquiry that are relevant mainly to the armed services. Past projects have included the testing of hard body armor and studies of traumatic brain injury and other conditions that are more prevalent among service members than in the general population. The Congress often makes additional, unrequested appropriations and directs DoD to undertake other research. Over the past three fiscal years, for example, DoD has requested a total of $2.4 billion and the Congress has appropriated $5.5 billion for medical R&D. During those years, the Congress funded projects to develop treatments for several diseases that are no more common among military personnel than they are in the general U.S. population—breast cancer, ovarian cancer, and prostate cancer, for example. The Congress also has requested research on diseases that either would disqualify potential recruits or would provide grounds for medical discharge—amyotrophic lateral sclerosis, muscular dystrophy, and multiple sclerosis, for example.

This option, which would take effect in October 2017, would end Congressional direction of the department’s medical R&D, and it would end Congressional appropriations above DoD’s requests for that budget account. The Congressional Budget Office estimates that the option would reduce the need for discretionary budget authority by $12 billion from 2018 through 2026. Outlays would decrease by $9 billion. Those savings would be realized so long as the projects were not transferred directly to the National Institutes of Health (NIH) or some other part of the federal government.

An advantage of this option is that it would end the practice of having DoD conduct research on diseases and conditions that are unrelated to military service and for which the military health system may not have particular expertise. That research could be conducted by NIH, although a simple redirection of the research effort to NIH would not achieve savings in the federal budget. If the research was transferred to NIH, the Congress could direct that the research focus on those narrowly defined topics or it could require their funding out of NIH’s discretionary appropriation if that agency determined the projects to have more promise or greater value than other proposed research. This option also would help DoD to comply with the caps on discretionary spending for national defense under the Budget Control Act, although research redirected to NIH would be subject to the corresponding caps for nondefense discretionary spending.

A disadvantage of this option is that research projects would be forgone that might have led to improved treatments or even cures for various diseases. Although those diseases may have low prevalence among the military population, their prevalence would be higher not only in the general U.S. population but perhaps also among military family members or among military retirees and their families.