That prospect, in combination with other pressures on medical research budgets, is “chilling”, says Ann Bonham, chief scientific officer at the Association of American Medical Colleges in Washington DC. She notes that the Patient Protection and Affordable Care Act, the health-care-reform law that is the signature policy achievement of Obama’s first term and will ultimately extend health insurance to more than 30 million now-uninsured US citizens, also mandates a $155-billion cut in government payments to hospitals. That could hurt the large teaching hospitals that support much US medical research (see Nature 487, 13–14; 2012). Bonham worries that the confluence of stresses will consign the biomedical research enterprise to “death by 1,000 cuts”.
Supporters of Obama’s health-care reform argue that it will eventually curb soaring US government outlays for health care, thereby shrinking the deficit and producing more revenue for agencies, including the NIH. If the plan works, the reform is “likely to be a long-term gain for research”, says Ezekiel Emanuel, a medical ethicist and health-policy expert at the University of Pennsylvania in Philadelphia, who was the senior health-policy adviser to the White House budget office from 2009–11. Science could also benefit from another Obama goal: immigration reform. One result of such reform could be more ‘H-1B’ visas for foreign scientists and engineers, a need that both candidates emphasized during the campaign.
In the meantime, Obama’s science agenda will depend on cooperation with a Congress that includes some new faces. Last week’s general election not only returned him to office and decided state ballot measures; it also marked the end of some key lawmakers’ terms. The chairmanship of the Senate energy and water committee is being vacated by the retiring Jeff Bingaman, a Democrat from New Mexico. Some observers expect Ron Wyden, a Democrat from environmentally friendly Oregon, to fill the spot. Although generally liberal, Wyden is known for crossing the aisle to work with Republicans. “Wyden is a very thoughtful guy; he likes to think outside the box,” says Michael Lubell, director of public affairs for the American Physical Society in Washington DC.
In the House, it’s unclear who will chair the spending subcommittee that funds the NIH. The current chairman, Denny Rehberg of Montana, relinquished his House seat in a failed bid for the Senate. The science, space and technology committee is losing its chairman, Ralph Hall of Texas, who is stepping down in accordance with Republican term limits. Jim Sensenbrenner of Wisconsin, Dana Rohrabacher of California and Lamar Smith of Texas all want the job. Lubell says that his money is on Smith, a co-sponsor of patent-reform legislation who has also tried to make it easier for foreign graduates with science degrees to remain in the United States.
For now, Obama’s victory has created an opening for compromise after two years of Congressional gridlock. With the fiscal clock ticking, the coming weeks may well set the tone for the next four years.