Democrats just handed RFK Jr. billions more than he asked for. It was a big risk.

Democrats counted it as a win Tuesday when President Donald Trump signed a law providing $20 billion more for the agency that is the world's largest health research funder than Trump requested.

Democrats’ victory could prove pyrrhic. Trump’s health secretary, Robert F. Kennedy Jr., and his National Institutes of Health director, Jay Bhattacharya, have promised to spend the money, but not necessarily on projects Democrats will like.

They have already begun rerouting millions in discretionary funds to studies on autism, which Kennedy believes is caused by vaccines. They’ve cut support for studies of health disparities related to race or gender, and research on transgender people. They’ve withheld funds to pressure universities to change policies on campus protests, faculty hiring and admissions. And now they plan on shifting more money to red states that used to go to blue.

"I have no illusion that this bill alone will stop Secretary Kennedy’s nonstop, misinformed attacks on our health system," Sen. Patty Murray of Oregon, the top Democrat on the Appropriations Committee, told POLITICO.

For now, she’s happy with the result anyway.

"Protecting these key federal investments is a big deal that will save lives,” she said. “It means cancer research isn’t getting defunded — and neither are key programs to tackle the opioid crisis or help women get the contraception and basic preventive care they need.”

The law retains funding for all 27 institutes and centers at the National Institutes of Health — the Trump budget called for cutting them down to eight — and directs Kennedy to support more than 200 health programs. But beyond those high-level directives, Congress doesn’t control how Kennedy doles out the billions it allocated.

Democrats are likely to find their states get a smaller piece of the pie. Bhattacharya says he’s redirecting money away from elite coastal universities to the heartland.

Bhattacharya, a physician-scientist and health economist, says he wants to fundamentally change what he calls a system that disproportionately awards heavyweights like Harvard, MIT and Stanford, in favor of giving long underfunded institutions a bigger slice of the pie.

“They're excellent institutions. I'm not trying to diss them,” Bhattacharya said of the elites, in an interview with POLITICO. But the NIH is not a “full-time welfare act” for universities and scientific institutions, he added.

“I taught at Stanford for 25 years. But it is a missed opportunity to not invest in excellent scientific institutions that are present all across the country that have a very difficult time getting access to NIH funding.”

That’s music to the ears of Republicans on Capitol Hill who’ve always felt the flyover country they represent gets short shrift. But researchers at the nation’s elite coastal institutions say they've built up decades of infrastructure, knowledge and staffing that can't easily be replicated elsewhere. They say shifting funding away from the coasts could threaten medical breakthroughs and the nation’s standing as the global leader in biomedical research and development.

“Cancer, diabetes, Alzheimer's disease, does not have a red or blue component," Michael Collins, chancellor of UMass Chan Medical School in Worcester, Massachusetts, said. "The way that we are going to find cures, or change the course of history of those diseases, is by continuing to invest in the great American biomedical research enterprise where it exists.”

Bhattacharya’s grant makeover

Bhattacharya, who made a name for himself challenging the scientific establishment during the Covid-19 pandemic, isn't keen on maintaining the status quo. In his view, sending research dollars to red states could combat “scientific group think” that occurs when funding is concentrated in a small number of places.

But he disputed that his planned funding shift is politically motivated.

“My motivation is to make sure that the research dollars we spend actually lead to better health for Americans," Bhattacharya said. "To spend it much more efficiently — that's the motivation."

To achieve his goal, Bhattacharya is proposing an overhaul in how the NIH awards grants. He wants to break the link between research support, which covers the direct costs of conducting studies, and facility support, which covers infrastructure and overhead funding. Currently, the agency provides both types of support together.

In Bhattacharya’s vision, which would require congressional approval, institutions would compete separately for research and facility support.

“If an institution can offer a square foot of high-quality lab space more inexpensively than another institution, it would have a leg up in winning the facility support in the sort of institutional competition I'm envisioning,” he said.

His plan would allow scientists whose research proposals are approved for NIH funding to move to parts of the country with inexpensive labs to conduct their research, creating “a market for science, funded by the government in ways that would actually bring support naturally to other centers across the country,” Bhattacharya said.

The Trump administration sparked major controversy last year when it tried to cap universities’ indirect costs — which include facility funding — for research grants at 15 percent, a move that would’ve saved the federal government about $4 billion a year. The policy prompted states and universities to sue the agency, leading to an appeals court ruling that said the Trump administration could not reduce universities' overhead funding without congressional approval.

Bhattacharya floated his plan during a Tuesday Senate Health, Education, Labor and Pensions Committee hearing on modernizing the NIH.

“I like the sound of that,” said Republican Indiana Sen. Jim Banks, who had asked Bhattacharya to explain “why schools on the coast seem to get more NIH funding than states like my state that's doing a lot of research as well.”

It’s unlikely most lawmakers in Congress will support Bhattacharya’s plan to delink research funding from facility funding. But even without congressional support, the NIH is shifting the types of research it prioritizes through Bhattacharya’s “unified strategy,” which he first outlined in August.

The unified strategy shakes up how the agency reviews grant proposals, putting more emphasis on how innovative proposals are and their potential for improving Americans’ health outcomes — with a keen focus on advancing Kennedy's Make America Healthy Again agenda of tackling chronic disease.

“The real outcomes that people care about will now be the basis for evaluation of these portfolios, in addition to, of course, scientific advances that matter,” said Bhattacharya. “It'll allow the institute directors to essentially take scientific risks that have the chance of paying off big.”

The MAHA mission, in Bhattacharya's view, goes hand-in-hand with his goal of shifting research dollars from the coasts to red states like Alabama and Oklahoma.

“In rural areas, outside of the coast, especially in many states in the center of the country, you tend to have higher rates of chronic disease, higher rates of the kind of problems that the MAHA movement seeks to address,” he said. “We want to increase life expectancy everywhere. You can't do it without increasing life expectancy and addressing the chronic disease problems of the whole country.”

‘Winners and losers’

Bhattacharya said it’s “hard to predict” whether there will be winners and losers in his planned funding shift from elite coastal institutions to the heartland.

Ken Bayles, vice chancellor for research at the University of Nebraska Medical Center, is hoping to be a winner.

The biomedical research institution in Omaha has a grant proposal pending at NIH focused on cancer research in rural America and addressing health disparities. Bayles said he’s encouraged by Bhattacharya’s effort to level the playing field across research institutions and give rural universities a bigger piece of the pie. He hopes the shift means UNMC’s proposal will be funded and, eventually, the hospital will be able to establish a rural cancer research program in Nebraska, which has among the highest pediatric cancer rates nationwide.

“We are the ones who live here, who are best suited to address those problems important to us here in middle America,” he said. “There is a lot of untapped potential here.”

Institutions along the coasts, like UMass Chan, are concerned about losing out if Bhattacharya’s plan shrinks funding for the nation’s premiere biomedical research hubs.

Those institutions spent decades partnering with the NIH to build up their research infrastructure, facilities and equipment in service of advancing the country’s global standing in biomedical research. Collins, the UMass Chan chancellor, worries Bhattacharya’s plan would be a waste of the “enormous intellect” and “amazing investment in superstructure and infrastructure” in states like Massachusetts.

“To suggest that it's simple to take the money and distribute it on geographic balance doesn't recognize the importance of the investment that has been made over six or seven decades,” Collins said.

Former President George W. Bush’s NIH director, Elias Zerhouni, agrees. Shifting funding to underresourced institutions could put valuable biomedical research projects at risk, he said.

“When you pick and choose, the quality goes down,” Zerhouni told POLITICO. “The government is not good at picking and choosing. If the government gets into it, it becomes a political thing, and I hate that sort of politically motivated allocation of federal resources. It should be based on merit.”

Zerhouni agrees that there are potentially huge scientific, economic and cultural benefits to investing in biomedical research infrastructure in the heartland, including addressing chronic disease and access to health care in middle America. But it’s easier to have that conversation “when there's a growing environment of funding for the NIH,” said Sudip Parikh, the president of the American Association for the Advancement of Science, the world's largest professional society for scientists.

With Congress approving nearly flat funding for the NIH for next year, it will be difficult for Bhattacharya to implement his plan without singling out winners and losers, said Carrie Wolinetz, principal and chair of Lewis-Burke Associate's Health and Bioscience Innovation Policy Practice Group and former chief of staff to longtime NIH director Francis Collins.

“Just moving money around to underresourced institutions purely for the sake of moving money around doesn't make sense,” said Wolinetz. “If you're finding that we're not able to address particular scientific questions or particular public health needs, then that would be a good reason to do it. But that comes at a cost.”

In a June conversation with Bhattacharya on X Spaces, billionaire hedge fund manager Bill Ackman pushed back on the NIH director’s plan to geographically shift research funding, saying “scientific research should be allocated to the best scientists who are doing the most important work” and not based on geography.

But Bhattacharya told POLITICO the idea that concentrated groups of scientists in the traditional biomedical hubs are needed to “have high productivity” is outdated, given that modern technology enables researchers to virtually collaborate across the country. And he pushed back on criticism that his plan would lead to less funding for elite coastal institutions — saying it will simply give underresourced institutions a better chance at competing for funding.

“I suspect very strongly that the traditionally strong institutions that are good at getting NIH funding will find ways to continue to do that,” he said. “I don't think that those will wither and die.”