Facing Budget Crisis, Should Texas Be in the Cancer Business?

To solve the state’s budget crisis, lawmakers are considering sweeping cuts to almost everything, from school funding to child welfare services. But a $300-million-a-year cancer institute championed by Gov. Rick Perry and now-retired cyclist Lance Armstrong and approved by voters in 2007 has so far escaped the budget knife.

Advocates for the Cancer Prevention and Research Institute of Texas say they believe it will be spared for two key reasons: First, it’s funded by voter-sanctioned bonds — $3 billion over 10 years — and the state’s only financial responsibility in the next budget is roughly $14.5 million in debt service. Second, they say, it’s been an early success, using its funding to draw prominent cancer researchers to Texas, launch prevention programs statewide and lay the foundation for drug development locally, a potential economic driver. 

“We’re gaining ground and building a bank of the best talent, the best research,” said Jimmy Mansour, the founding chairman of the cancer institute. “It’s because Texas made a commitment to cancer, and people are seeing this and wanting to be a part of it.”

But some budget watchdogs say that now is not the time for Texas to be racking up more debt and question whether it even makes economic sense for the state to be in the cancer business. At a minimum, they argue, the institute, which comes before the Senate Finance Committee today, should be subject to the same kind of belt-tightening every other agency is and not be treated as a sacred cow.

“It’s one of those items you could easily put on hold and delay until the revenue comes back,” said Talmadge Heflin, director of the Texas Public Policy Foundation’s Center for Fiscal Policy, and the former Appropriations chairman who led the Texas House through its last big budget shortfall in 2003. “Why should we be going into debt to do research the health care industries, the private sector, should be doing?”

When the cancer institute was first proposed in 2007, it generated big headlines: Perry laid out the proposal in his State of the State speech, and Armstrong joined forces with lawmakers to promote it. Voters approved a constitutional amendment to fund the institute by selling $3 billion in bonds over a decade, an investment intended not just to save lives but to make Texas a bio-pharmaceutical capital.   

Mansour said this is precisely what is happening. In the institute’s first full year, it funded 155 grants totaling $216 million, according to its Legislative Appropriations Request — money used to bring cancer screenings to medically underserved communities, help biotech companies develop drugs and medical devices for patients and lure top cancer researchers from places like Harvard and Stanford to Texas labs. Armstrong, who formally retired from cycling on Wednesday, is now off to try his lobbying hand again, this time in California on a campaign to increase cigarette taxes to raise billions of dollars for cancer research there.

Despite the deep cuts being considered in health care, education and other social services in Texas, both the House and Senate drafts of the budget fully fund the cancer institute for the next biennium at $300 million per year, plus the funds remaining from the current budget cycle. Mansour said funding the program makes fiscal sense. For the $14.5 million in debt service, he said, the institute can have $600 million worth of impact — which he said has an economic return of about $1.8 billion. He said maintaining the institute's funding is even more important now that other states that have traditionally been research leaders are also facing budget shortfalls. Cuts like those other state agencies are facing would set the institute back three or four years, he said — detrimental when major research breakthroughs could take a decade or two to develop.

But Rep. Jim Keffer, the Eastland Republican who filed the cancer institute bill in the House in 2007, said that just because the institute’s funding has remained in place in the initial budgets doesn’t mean it won't ultimately face cuts. The fact that the governor is behind it, and voters approved it, certainly gives it some protection, he said — that along with the good work the institute has done in a short time frame.

“Still, it’s a tough budget cycle and everything is on the table,” he said. “It’s going to be questioned, and we can’t get our feelings hurt.”

Mansour said the cancer institute's leaders are good at keeping their feelings in check, at least in public. Asked about some industry insiders’ suggestions that there have been high-level disagreements inside the institute — namely about how much to spend on different aspects of cancer research — Mansour was frank.  

“To be perfectly honest, with any new institute or agency or company, the actual fine-tuning of the vision, the mission, takes time,” he said. “When you get very dedicated public servants in the room, you’re going to have some disagreement, clearly.”

But no one at the institute questions whether Texas ought to be in the cancer business, said Dr. Joseph Bailes, an oncologist and vice chairman of the institute's Oversight Committee. Indeed, he said, the state’s major medical institutions — from M.D. Anderson in Houston to the University of Texas Southwestern Medical Center in Dallas — have been in it successfully for years. The cancer institute “is a step above, because it allows the rapid commercialization of drugs that work,” he said. “If you don’t get the drugs to the people, they’re not going to help.”

Doug Ulman, president and CEO of the Austin-based Lance Armstrong Foundation, acknowledged that keeping cancer research funded — and keeping institutions like CPRIT going — is no easy task, because breakthroughs aren’t instantaneous. They often take years of patience. “Many of these developments are not going to happen overnight,” he said. “The key is sustained support over time.”