On December 26, 2007, nearly three months after the start of fiscal year 2008, President Bush signed a $555 billion domestic spending package for fiscal year 2008 that provided funding for the remaining 11 major spending bills before Congress. In the preceding weeks, the House and Senate were forced to cut millions of dollars from their own proposals in order to avoid the President's promised veto of any package with funds for domestic spending that exceeded his requests.

The Health and Human Services portion of the omnibus package included appropriations for the National Institutes of Health (NIH) and the Substance Abuse and Mental Health Services Administration (SAMHSA). For the fifth consecutive year the NIH budget failed to keep up with the rate of inflation in the cost of conducting biomedical research. Funding for NIH increased by 1.1% (Table 1), whereas the cost of conducting research is estimated to increase between 5% and 6% every year. This stagnant five-year period follows a period between 1999 and 2003 when funding for NIH doubled—from $15 billion to $26.4 billion.

SAMHSA programs were funded at levels near those of 2007, although community-based mental health services absorbed some cuts. As shown in Table 1, $7 million was cut from funding for the Center for Mental Health Services (CMHS) Mental Health Block Grant, which provides community-based mental health services to children and adults with severe mental disabilities. The systems of care program for children with serious emotional disturbance was cut by $2 million. CMHS's suicide prevention program was funded at $39.3 million, a $3.2 million increase over 2007 (data not shown).

The bill signed by the President also included language on a "public-access mandate" for research funded by NIH. The provision makes mandatory a voluntary policy that has been in effect since May 2005. The policy seeks to ensure that findings of taxpayer-funded research are available free of charge. Since 2005 NIH-funded investigators have been encouraged to submit electronic copies of manuscripts that have been accepted by peer-reviewed journals to NIH within 12 months after the article is published. NIH then posts the full text in its free PubMed Central archive. Most grantees have not complied with the voluntary policy. The National Library of Medicine estimates that of 65,000 eligible articles per year, only about 12% are being submitted by authors.

Early last month NIH officials described how the policy will be implemented. As of April 7, 2008, all articles arising from NIH funds must be submitted to PubMed Central upon acceptance for publication. Since 2005 the policy has raised concerns that two versions of a research study will be available to the public—the uncopyedited manuscript supplied by the author and the published version of the same manuscript. To allay these concerns, many biomedical journals will submit articles directly to PubMed Central on behalf of authors, and a list is provided on the NIH Web site (publicaccess.nih.gov/plans). The provision signed by the President requires that NIH implement the public-access policy "in a manner consistent with copyright law." The Association of American Publishers has warned that it will challenge the provision, stating that a mandatory policy "undermines" publishers' copyright and is "inconsistent with" U.S. laws.

During the first week of February, President Bush will release his proposed budget for fiscal year 2009, which begins on October 1. Health advocates are expecting that he will propose significant cuts in spending for domestic health programs.