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Few federal agencies have enjoyed a more sterling reputation on Capitol Hill over the past several decades than the National Institutes of Health. But a bevy of challenges are spurring calls for reform on Capitol Hill that may be difficult for the agency to fend off without making some concessions.

The reputation of the NIH, coupled with excitement about the agency’s role in advancing discoveries to improve health, made possible a doubling of the agency’s budget that concluded 20 years ago. Many members of Congress remained sympathetic to the agency’s challenges during the ensuing period of flat or declining budgets, particularly Republicans, who are typically less supportive of non-defense or security domestic spending.

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Over the past decade, the agency’s standing — and its cadre of well-positioned congressional backers — resulted in multiple years of sizable growth, helping recoup ground lost following the doubling bust.

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