Over the course of the last three years, a bipartisan group of lawmakers made painstaking attempts to pass a major restructuring of biomedical research in America. Known as the 21st Century Cures Act, the bill streamlined regulatory policy at the Food and Drug Administration. It also called for billions more to be spent on key functions at the National Institutes of Health, such as combating the opioid epidemic and undertaking then-Vice President Joe Biden’s cancer moonshot. When the bill ultimately passed in December, it was hailed as a triumph ? not just because it was the biggest piece of legislation to make it through Congress, but because it had been done the right way, with hearings, negotiations, no rancor and plenty of bipartisanship. And yet, advocates were worried. To get the bill over the finish line, House Speaker Paul Ryan (R-Wis.) had made critical changes. The $4.8 billion devoted to the NIH over 10 years would no longer be mandatory spending. While the fees and cuts to pay for the NIH funding would remain automatic ? and set aside with express written language that that fund be used for 21st Century Cures priorities ? lawmakers would have to vote each year to spend it. One top biomedical research advocate told The Huffington Post in that moment that he feared Congress would fund the NIH at a lower level in the coming year precisely because they knew that the 21st Century Funds were there, waiting to be used. And on Thursday, those fears were realized as President Donald Trump unveiled a budget that included a $5.8 billion reduction in NIH funding.